Combined Phacoemulsification and Ahmed Valve Glaucoma Drainage Implant: A Retrospective Case Series

2008 ◽  
Vol 18 (2) ◽  
pp. 191-198 ◽  
Author(s):  
N. Nassiri ◽  
N. Nassiri ◽  
S. Sadeghi Yarandi ◽  
B. Mohammadi ◽  
L. Rahmani
Keyword(s):  
Visual Acuity ◽  
Intraoperative Complications ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Success Rates ◽  
Retrospective Case ◽  
Antiglaucoma Medication ◽  
Ahmed Valve ◽  
The Mean ◽  
Valve Implantation

Purpose To report on the efficacy and safety of combined phacoemulsification and an Ahmed valve glaucoma drainage implant with respect to visual acuity improvement, intraocular pressure (IOP) control, and requirement for antiglaucoma medication. Methods A retrospective chart review was conducted of 41 eyes (31 patients) with coexisting visually significant cataracts and uncontrolled glaucoma who had combined phacoemulsification and Ahmed valve implantation. The outcome measures were: visual acuity, IOP, antiglaucoma medication requirements, and intra- and post-operative complications. Success was categorized as absolute (IOPp<21 mmHg without the need for antiglaucoma medication) and relative (IOPp<21 mmHg with one or more antiglaucoma medications). Failure was considered to be an IOPp<6 mmHg or IOP>21 mmHg on maximally tolerated medications or any devastating complication. Results The mean patient age was 67.3±5.9 years old. The mean visual acuity improved from 0.73±0.5 to 0.16±0.16 (p=0.000). The mean IOP decreased from 28.2±3.1 to 16.8±2.1 (p=0.000, 40.4%), while the number of antiglaucoma medication decreased from 2.6±0.66 to 1.2±1.4 (p=0.000). The absolute and relative success rates were 56.1% and 31.7%, respectively; 5 eyes (12.2%) were considered failures. There were no intraoperative complications; postoperative complications occurred in 8 eyes (19.5%). A hypertensive phase was detected in 12 (29.3%) eyes. Conclusions Combined phacoemulsification and Ahmed valve glaucoma drainage implantation is a safe and effective alternative to phacotrabeculectomy in patients with coexisting cataract and refractory glaucoma.

Single long scleral tunnel technique for prevention of Ahmed valve tube exposure

2018 ◽  
Vol 29 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Yadollah Eslami ◽  
Ebrahim Azaripour ◽  
Masoud Mohammadi ◽  
Mohammad Yaser Kiarudi ◽  
Ghasem Fakhraie ◽  
...  
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Additional Material ◽  
Long Period ◽  
Scleral Tunnel ◽  
Ahmed Valve ◽  
Tunnel Technique ◽  
The Mean ◽  
Valve Implantation

Purpose: To evaluate the outcome of single long scleral tunnel technique for the prevention of conjunctival erosions caused by the Ahmed glaucoma valve. Methods: This study was a retrospective case series that included 30 eyes of 30 patients who underwent glaucoma valve implantation surgery by the single long scleral tunnel technique. Results: The mean age of patients at the time of surgery was 52 ± 21.6 years (range: 10–90 years). The mean visual acuity was 1.5 ± 0.81 logMAR preoperatively. The intraocular pressure was 40.7 ± 9.18 mm Hg (range: 25–58) before surgery that decreased significantly to 19.7 ± 3.1 mm Hg (range: 14–25; p < 0.0001) after a mean follow-up of 37.2 ± 5.9 months. During follow-up, no case of tube exposure was detected in patients. Conclusion: Single long scleral technique was efficacious with no occurrence of tube exposure in relatively long period of follow-up. In this method, there is no need to harvest any additional material, and in situations with limited access to patch grafts, it is performable with the minimal facilities.

Outcomes of corneal neurotisation using processed nerve allografts: a multicentre case series

2020 ◽  
pp. bjophthalmol-2020-317361
Author(s):  
Adam R Sweeney ◽  
Margaret Wang ◽  
Christopher L Weller ◽  
Cat Burkat ◽  
Andrea L. Kossler ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Ocular Trauma ◽  
Surgical Techniques ◽  
Case Series ◽  
Retrospective Case ◽  
Corneal Sensation ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Maximal Gain ◽  
Prior Infection

BackgroundCorneal neurotisation is a rapidly evolving procedure treating neurotrophic keratopathy. The variety of surgical techniques used and corresponding outcomes after corneal neurotisation are not well understood. This study describes the techniques and outcomes in the largest case series of corneal neurotisation using processed nerve allografts to date.MethodsThis is a retrospective case series of patients who underwent corneal neurotisation with human cadaveric processed nerve allografts. All patients had preoperative and postoperative description of best corrected visual acuity and measurement of corneal sensation. Comparative studies after stratification of techniques were performed.ResultsA total of 17 patients were identified. The cause of corneal anaesthesia was prior infection in eight cases, trigeminal nerve palsy in eight cases and ocular trauma in one case. There were no intraoperative or postoperative complications. Following neurotisation surgery, the time to first gain of corneal sensation and maximal gain of sensation occurred at a mean of 3.7 months (range 1–8 months) and 6.6 months (range 3–15 months), respectively. The mean preoperative and postoperative corneal sensation as measured by Cochet-Bonnet aesthesiometry was 0.36 cm (range 0–3.2 cm) and 4.42 cm (range 0–6 cm), respectively (p<0.01). Visual acuity was unchanged after neurotisation. There were no statistical differences in outcomes based on end-to-end versus end-to-side coaptations, donor nerve selection or laterality of donor nerve.ConclusionCorneal neurotisation with processed nerve allografts is a safe and effective procedure. This study provides further evidence for the use of processed nerve allografts for corneal neurotisation.

scholarly journals Safety and effectiveness of intrastromal corneal ring segment implantation at Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia

2019 ◽  
Vol 6 (4) ◽  
pp. 1295
Author(s):  
Abdulaziz Alaqsam ◽  
Mohanna AL-Jindan ◽  
Ammar Almahmod ◽  
Ibrahim Gosadi
Keyword(s):  
Visual Acuity ◽  
Saudi Arabia ◽  
Case Series ◽  
Applanation Tonometry ◽  
Retrospective Case ◽  
Intrastromal Corneal Ring ◽  
Case Series Study ◽  
Ring Segment ◽  
The Mean ◽  
One Year

Background: Intrastromal corneal ring segment (ICRS) implantation is one of the treatment options of keratoconus. This study is aiming to evaluate safety and effectivness of ICRS implantation at Al-Dharan Eye Specialist Hospital.Methods: This study is a descriptive retrospective case series study. The target population of this study is patients diagnosed with corneal ectasia who underwent ICRS implantation in Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia. Preoperative and postoperative data about uncorrected visual acuity (UCVA), best spectacle–corrected visual acuity (BSCVA), manifest refraction, keratometry, applanation tonometry, corneal topography, and slit-lamp biomicroscopy and indirect ophthalmoscopy were retrieved from medical records of department of Medical Archive. Paired students t-test was used to compare preoperative and postoperative means of study variables.Results: The total number of recruited patients in this study was 57 patients where 62% of them were males. Sixty-six treated eyes were included in this study where no intra-operative complications were recorded. Upon comparing the mean preoperative data to the mean postoperative data at three months, six months and one year intervals, an overall improvement in the measured outcomes was witnessed. UCVA, BSCVA, and keratometric readings exhibited a statistically significant improvement when comparing preoperative with one-year postoperative findings (p<0.001).Conclusions: The findings of this study indicate that ICRS implantation is a safe and effective treatment for keratoconus.

scholarly journals Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis

2017 ◽  
Vol 38 (9) ◽  
pp. 1011-1019 ◽  
Author(s):  
Chakravarthy U. Dussa ◽  
Leonhard Döderlein ◽  
Raimund Forst ◽  
H. Böhm ◽  
Albert Fujak
Keyword(s):  
Cerebral Palsy ◽  
Case Series ◽  
Success Rates ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Revision Operation ◽  
3 Dimensional ◽  
Joint Deformity ◽  
The Mean

Background: Equinovalgus deformity is the second most common deformity in cerebral palsy and may be flexible or rigid. Several operative methods from joint sparing to arthrodesis have been described with varying success rates. The aim of this study was to investigate the effectiveness of naviculectomy in combination with midfoot arthrodesis (talo-cuneiform and calcaneocuboid arthrodesis) in the correction of a rigid equinovalgus foot deformity in cerebral palsy. Methods: Forty-eight rigid equinovalgus feet were operated upon in 30 patients from 2008 to 2013. Of these, 44 feet in 26 patients with cerebral palsy (Gross Motor Function Classification System III, IV, or V) with follow-up of more than 2 years were included in the study. The mean age at surgery was 18.1 years. The outcomes were measured objectively using radiographic angles and subjectively using 5 questions to be answered by the caregiver. The feet were then graded into excellent, good, fair, and poor. The mean follow-up was 5.0 ± 1.7 years. Results: Excellent to good results were obtained in 81% of the feet. Both objective and subjective outcomes improved significantly postoperatively ( P < .001). Three feet in 2 patients were graded as poor and underwent a revision operation for pain and recurrence. Conclusions: Naviculectomy in combination with midfoot arthrodesis enabled a good 3-dimensional correction of the forefoot. However, the procedure did not necessarily correct the fixed subtalar joint deformity. Several additional bony and soft-tissue procedures were necessary to achieve a complete correction in these difficult feet. Level of Evidence: Level IV, retrospective case series.

Implantation of XEN After Failed Trabeculectomy: an Efficient Therapy?

2021 ◽  
Author(s):  
Caroline Bormann ◽  
Manuela Schmidt ◽  
Catharina Busch ◽  
Matus Rehak ◽  
Christian Thomas Scharenberg ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Standard Procedure ◽  
Field Tests ◽  
Glaucoma Surgery ◽  
Corrected Visual Acuity ◽  
Ahmed Valve ◽  
Long Time ◽  
The Mean ◽  
Valve Implantation

Abstract Background Trabeculectomy (TE) has been the standard procedure in glaucoma surgery for a long time. This study examined the efficacy and safety profile of XEN45 Gel Stent (XEN) after failed and/or scarred trabeculectomy. Material and Methods We analysed all files of patients, who received a XEN after insufficient TE and examined changes in intraocular pressure (IOP), IOP-lowering medication, best corrected visual acuity, visual field tests as well as the intra- and postoperative complications recorded within a 12-month follow-up period. Results 31 eyes of 28 patients were analysed in our study (mean age: 66,2 ± 13,4 years; 39% female; 48% right eye; mean follow-up after TE: 70,3 ± 64,9 months). The mean IOP decreased from 23,5 ± 6,5 to 18,0 ± 5,3 mmHg (− 23,5% compared to baseline-IOP; p = 0,01) while the mean IOP-lowering medication could be reduced from 2,8 ± 1,1 to 1,1 ± 1,5 (p < 0,01) 12 months after XEN-implantation. The mean visual acuity did not change significantly (pre-op: 0,5 ± 0,6 logMAR; 12 months post-op: 0,5 ± 0,6 logMAR). The most common complications postoperatively were choroideal detachment due to postoperative hypotony in 4 eyes (13%), a needling procedure in 9 eyes (29%), a Re-XEN-Implantation in 4 eyes (13%), an open revision of the conjunctiva in 3 eyes (10%), and a Re-TE in 1 eye (3%) as well as an Ahmed-Valve implantation in 2 eyes (6%). Overall, neither needling procedure nor further glaucoma surgery was necessary in 19 eyes (61%). In 10 of 22 evaluable eyes (45%) an IOP reduction of > 20% was achieved 12 months after XEN implantation. Conclusion XEN could be an effective method to reduce IOP after failed TE. The rate of complications seems to be low and the rate of needling procedures and/or revisions is acceptable.

Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma

2019 ◽  
Vol 104 (2) ◽  
pp. 202-207
Author(s):  
Aldo Vagge ◽  
Carol L Shields ◽  
Jerry A Shields ◽  
Renelle Pointdujour-Lim ◽  
Bruce Schnall
Keyword(s):  
Visual Acuity ◽  
Uveal Melanoma ◽  
Visual Loss ◽  
Vision Loss ◽  
Case Series ◽  
Retrospective Case ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Dominant Eye ◽  
The Mean

ObjectiveTo determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma.Methods and analysisRetrospective case series of adult patients with amblyopia and dominant eye visual loss resulting from treatment of uveal melanoma. Review of best-corrected visual acuity (BCVA) in each eye (amblyopia eye vs melanoma eye) at date first seen and over time following treatment of uveal melanoma. BCVA in each eye was graded as improved (>2 logarithm of minimal angle of resolution (logMAR) lines) or unimproved (<2 logMAR lines).ResultsTwenty-one patients that met the inclusion criteria. Mean age at presentation was 56 years (range 39–73 years). Following treatment of the uveal melanoma and decline of BCVA in the dominant, the BCVA in the amblyopic eye improved in 11/21 (52%; 95% CI 30% to 74 %) patients. The degree of visual loss in the melanoma eye was to the level of the amblyopic eye or worse in 14 patients. In this group, BCVA improved in the amblyopic eye in 9/14 (64%; 95% CI 35% to 87 %) patients. Of these nine with improved eyes, the mean starting visual acuity was logMAR 0.6 (20/80) with mean improvement of logMAR 0.4 (4 lines±0.13 (range 0.2–0.6). Eight of nine eyes achieved a BCVA of 20/25 (n=3) or 20/20 (n=5).ConclusionVisual acuity in the amblyopic eye of adults can improve following visual loss in the contralateral dominant eye associated with treatment for uveal melanoma.

scholarly journals Warfarin Dose Requirements in Adults Hospitalized With COVID-19 Infection: A Retrospective Case Series

2021 ◽  
pp. 089719002110007
Author(s):  
Madison N. Irwin ◽  
Sarah Adie ◽  
Katherine Sandison ◽  
Sarah A. Alsomairy ◽  
Adamo Brancaccio
Keyword(s):  
Hospital Mortality ◽  
Case Series ◽  
Warfarin Dose ◽  
Retrospective Chart Review ◽  
Retrospective Case ◽  
Available N ◽  
Percentage Decrease ◽  
The Mean ◽  
Clinically Significant ◽  
The Impact

Purpose: To describe the impact of hospitalization with COVID-19 infection on warfarin dose requirements in adult inpatients. Summary: A retrospective chart review of 8 adults on warfarin admitted to Michigan Medicine with COVID-19 infection was conducted and reported as a case series. Outcomes of interest were difference in average daily dose of warfarin prior to admission (PTA) and while inpatient (IP), warfarin sensitivity, time in therapeutic range (TTR), confirmed or suspected thromboembolic event, any major or clinically significant bleeding episodes, and in-hospital mortality. IP average daily warfarin doses were lower when compared to PTA average daily doses [1.3 mg (1.3) vs. 6.2 mg (4.1)]. The mean percentage decrease in dose was 68.8% (23) and the mean absolute dose difference was 4.8 mg (4.3). Mean IP percentage tests in range was 30.8% (24.6) and mean IP warfarin sensitivity was 4.2 (3.8), both of which differed from PTA TTR and warfarin sensitivity for those with data available (n = 3, n = 6, respectively). One patient was treated for suspected acute pulmonary embolism while on warfarin and one patient experienced clinically relevant bleeding. In-hospital mortality was zero, mean length of stay (LOS) was 17 days (14.4), and mean intensive care unit (ICU) LOS for the 3 patients requiring ICU level care was 14.3 days (4.5). Conclusion: Decreased warfarin dose requirements were evident in this group of adults hospitalized with COVID-19 infection. These findings suggest lower doses of warfarin may be needed to achieve therapeutic anticoagulation while inpatient.

scholarly journals Traumatic displacement of laser in situ keratomileusis flaps: an integrated clinical case presentation and literature review

2021 ◽  
Author(s):  
Lu-Yang Shih ◽  
Kai-Ling Peng ◽  
Jiunn-Liang Chen
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Laser In Situ Keratomileusis ◽  
Ocular Surface Disease Index ◽  
Retrospective Case ◽  
Corneal Sensation ◽  
Replacement Surgery ◽  
Traumatic Dislocation ◽  
The Mean

Abstract Background Traumatic dislocation of laser-assisted in situ keratomileusis (LASIK) corneal flaps is an uncommon postoperative complication that could occur any time after LASIK, and could be visually devastating. We evaluated the visual outcomes, corneal sensation, tear function, and dry eye questionnaire results of patients with traumatic dislocation of LASIK flaps, including one LASIK flap amputation. Methods This is a retrospective case series. Twelve patients were diagnosed with traumatic displacement of the LASIK flap between August 2014 and January 2019. Of these, seven who underwent flap replacement surgery were included. Patient’s visual acuity, refraction, corneal sensitivity, non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface disease index (OSDI) results were evaluated. Results The patients’ mean age was 35.86 ± 5.84 years, and 42.9% (3/7) were male. The mean duration from LASIK to trauma was 8.86 ± 2.48 years.The mean preoperative and postoperative six-month best-corrected visual acuity were 0.55 ± 0.34 and 0.02 ± 0.03, respectively. Vision improvement was significant (P = 0.018). The mean spherical equivalent and astigmatism at six months postoperatively was − 1.0 ± 0.95 D and − 0.5 ± 0.25 D, respectively. The corneal flap was clear and well-positioned at the final follow-up (mean: 28.57 ± 6.9 months). 85.71% (6/7) of the patients showed worse corneal sensation in the injured eye. Interocular OSDI discrepancy was significantly less (P = 0.048) in those whose last visit was more than 30 months after the trauma. Conclusions Postoperative vision at six months was significantly improved, and the refractive data also showed some improvement. The corneal nerve and tear function recovery peaked before 30 months, while the OSDI continued to improve beyond 30 months.

scholarly journals Multifocal IOL Explantation in Patients with Opaque Lentis after Refractive Lens Exchange

2021 ◽  
Author(s):  
Maria Phylactou ◽  
Nizar Din ◽  
Francesco Matarazzo ◽  
Vincenzo Maurino
Keyword(s):  
Intraoperative Complications ◽  
Case Series ◽  
Retrospective Case ◽  
Yag Laser ◽  
Refractive Lens Exchange ◽  
Multifocal Iol ◽  
Refractive Lens ◽  
The Mean ◽  
Hydrophobic Acrylic ◽  
Iol Exchange

Abstract Purpose We describe the outcomes of intraocular lens (IOL) explantation in a cluster of opaque multifocal Lentis LS-313 following refractive lens exchange (RLE). Methods Single-centre, single-surgeon, retrospective case series. Results The study enrolled 10 eyes of 10 patients, 6 male and 4 female. All patients had uneventful RLE with multifocal IOL implantation. The mean patient age at the time of RLE was 53 years ± 2.52 (SD). Two eyes had YAG laser capsulotomy prior explantation. The mean interval between the initial RLE and IOL explantation was 5.4 years ± 1.4 (SD). IOL exchange was performed in all eyes in one procedure. Five eyes had in the bag hydrophobic acrylic IOL (3 multifocal and 2 monofocal) three eyes had 3-piece hydrophobic acrylic IOL in the ciliary sulcus and two had an anterior chamber IOL. Intraoperatively one patient had weak zonules and two patients had zonular dehiscence and required anterior vitrectomy. The mean preoperative CDVA was 0.25 ± 0.15 (SD) logMAR and at the final follow-up, improved to 0.00 ± 0.07 (SD) logMAR (p < 0.01). Light microscopy with von Kossa stain confirmed IOL calcification. No postoperative complications were recorded. Conclusions IOL exchange appears to be a feasible and safe surgical option for multifocal IOL opacification. However, patients must be warned of additional intraoperative risks including zonular dialysis, vitreous loss, retinal detachment and need for potential ACIOL with its associated sequel of complications. Moreover, YAG laser capsulotomy should be considered carefully as increases the chances of intraoperative complications and restricts the surgical options of secondary IOL insertion, including in-the-bag IOL exchange with MFIOL.

scholarly journals Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma

2021 ◽  
Vol 10 (8) ◽  
pp. 1606
Author(s):  
Hitomi Maki ◽  
Sotaro Mori ◽  
Hisanori Imai ◽  
Hiroko Yamada ◽  
Keiko Otsuka ◽  
...  
Keyword(s):  
Case Series ◽  
Neovascular Glaucoma ◽  
Ahmed Glaucoma Valve ◽  
Retrospective Case ◽  
Corneal Endothelial Cell Density ◽  
Drug Score ◽  
Pars Plana ◽  
The Mean ◽  
Valve Implantation ◽  
Ahmed Glaucoma Valve Implantation

Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively (p < 0.001). No significant change in the corneal endothelial cell density following surgery was observed (p = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.

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