Treatment of chronic and extreme ocular hypotension following glaucoma surgery with intraocular platelet-rich plasma: A case report

2018 ◽  
Vol 29 (4) ◽  
pp. NP9-NP12 ◽  
Author(s):  
Omneya Abdalrahman ◽  
Alejandra E Rodriguez ◽  
Jorge L Alio Del Barrio ◽  
Jorge L Alio
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Mitomycin C ◽  
Platelet Rich Plasma ◽  
Corneal Edema ◽  
Glaucoma Surgery ◽  
Applanation Tonometry ◽  
Safe Procedure ◽  
Rieger Syndrome ◽  
Ocular Hypotony

Purpose: To report a new approach for the treatment of severe ocular hypotony secondary to glaucoma filtering surgery with mitomycin C by injecting autologous eye platelet-rich plasma (E-PRP) in the anterior chamber to block excessive diffuse filtration through an abnormally thinned sclera. Methods: A 49-year-old patient with the Axenfeld–Rieger syndrome and severe chronic hypotony and corneal edema following filtering glaucoma surgery with mitomycin C received an isolated injection of 0.3 mL of autologous platelet-rich plasma in the anterior chamber. Results: Intraocular pressure measured by Goldman’s applanation tonometry 6 h after the procedure improved to 18 mmHg. Intraocular pressure remained stable along the full follow-up period of 6 month. No filtration or hypotony or any other complications were observed. Conclusion: Intracameral platelet-rich plasma (E-PRP) injection was an effective, rapidly effective, and safe procedure for treatment of severe chronic ocular hypotony following glaucoma filtrating surgery.

Short-term anterior chamber inflammation in phacoemulsification with and without Ex-Press glaucoma implant

2019 ◽  
Vol 30 (3) ◽  
pp. 533-537
Author(s):  
Shmuel Graffi ◽  
Beatrice Tiosano ◽  
Modi Naftali ◽  
Nakhoul Nakhoul ◽  
Michael Mimouni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Medical Center ◽  
Glaucoma Surgery ◽  
Consecutive Series ◽  
Device Implantation ◽  
Significant Difference ◽  
Clinically Significant ◽  
Retrospective Comparative Study

Purpose: The aim of this study was to investigate the incidence of clinically significant anterior chamber inflammation in a combined surgery, namely, phacoemulsification and Ex-Press miniature glaucoma device implantation, compared to phacoemulsification alone. Methods: A retrospective comparative study of a consecutive series of 210 participants above 18 years of age diagnosed with significant cataract and who required glaucoma surgery, namely, Ex-Press miniature glaucoma device implantation or cataract alone in one or both eyes. All were operated on by a single experienced glaucoma surgeon in a single medical center. A total of 231 eyes were included in this study. All cases underwent an uneventful surgery and were examined the day following the surgery for visual acuity, intraocular pressure, and signs of excessive anterior chamber inflammation (Standardization of Uveitis Nomenclature grading ⩾ 3). Results: The combined group included 55 eyes of 51 patients, of whom 15 (27.3%) demonstrated excessive anterior chamber inflammation. The phacoemulsification group included 176 eyes of 159 patients, of whom 12 (6.7%) demonstrated excessive anterior chamber inflammation. Visual acuity and intraocular pressure measurements showed no statistically significant difference between the two groups. Conclusion: The Ex-Press glaucoma device is efficient, safe, and known for its inert nature. However, combination of this procedure with phacoemulsification surgery might result in a condition encouraging excessive inflammation, which eventually could lead to excessive anterior chamber inflammations if not treated vigorously. Emphasizing and recognizing the risks, especially in glaucoma patients, is important.

Deep Sclerectomy with Mitomycin C for Glaucoma Secondary to Uveitis

2011 ◽  
Vol 21 (6) ◽  
pp. 708-714 ◽  
Author(s):  
Nitin Anand
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Cumulative Probability ◽  
Deep Sclerectomy ◽  
Retrospective Case ◽  
Uveitic Glaucoma ◽  
Needle Revision

Purpose. To report outcomes of deep sclerectomy augmented with mitomycin C (MMC) in eyes with raised intraocular pressure (IOP) secondary to uveitis. Methods. This was a retrospective case series of 26 eyes of 26 patients with uveitic glaucoma. Mitomycin C 0.2–0.4 mg/mL was applied subconjunctivally prior to scleral flap dissection for 2–3 minutes. Results. Mean follow-up was 46.5±22 months (range 12–83). Fifteen eyes (58%) had previous intraocular surgery. Preoperative IOP was 33±12 mmHg. Intraocular pressure at 1, 2, and 3 years after surgery was 13±4 mmHg, 13±4 mmHg, and 14±4 mmHg, respectively. The probability of IOP <21 and 18 mmHg with needle revision and laser goniopuncture but without medications or further glaucoma procedure was 89% and 84%, respectively, at 3 years. The cumulative probability for performing laser goniopuncture was 42% at 1 year, 50% at 2 years, and 64% at 3 years. Needle revision was performed in 6 eyes (23%). Three (12%) patients required further glaucoma surgery. The number of glaucoma medications decreased from 3.3±1.2 to 0.3±0.8 by last follow-up (p<0.001). Four eyes (15%) were on medications to control IOP Intraoperative perforation of trabeculo-Descemetic membrane occurred in 3 eyes (12%) and late iris entrapment in perforation or goniopuncture in 4 eyes (15%). Recurrence of uveitis was seen in 11 eyes (42%) with no loss in IOP control. Conclusions. Deep sclerectomy with MMC appears to be a safe and effective procedure to lower IOP in uveitic glaucoma with a low rate of complications.

The Impact of Corneal Edema on Intraocular Pressure Measurements Using Goldmann Applanation Tonometry, Tono-Pen XL, iCare, and ORA

2013 ◽  
Vol 22 (7) ◽  
pp. 584-590 ◽  
Author(s):  
Matthias Neuburger ◽  
Philip Maier ◽  
Daniel Böhringer ◽  
Thomas Reinhard ◽  
Jens F. Jordan
Keyword(s):  
Intraocular Pressure ◽  
Corneal Edema ◽  
Applanation Tonometry ◽  
Goldmann Applanation Tonometry ◽  
Pressure Measurements ◽  
The Impact

scholarly journals Letter to the Editor: Corneoscleral Melt 50 Years after Excision of Pterygium

2017 ◽  
Vol 11 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Aki Kondo ◽  
Tatsuya Mimura ◽  
Mari Goto ◽  
Yuko Kamei ◽  
Saito Yusuke ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Mitomycin C ◽  
Corneal Perforation ◽  
Corrected Visual Acuity ◽  
Pterygium Surgery ◽  
Postoperative Administration ◽  
Best Corrected Visual Acuity ◽  
Limbal Transplantation

Purpose: To report a case of corneoscleral melt that occurred 50 years after resection of pterygium with postoperative administration of mitomycin C (MMC). Results: A 93-year-old woman developed acute corneal perforation and scleral melt in her left eye at 50 years after pterygium surgery with postoperative topical MMC. She underwent limbal transplantation. The anterior chamber reformed postoperatively and her intraocular pressure was normal. At 12 months after transplantation, best-corrected visual acuity was 20/500 and the graft-host junction was well apposed. Conclusion: This case shows that corneoscleral melt can occur even 50 years after resection of pterygium combined with postoperative topical MMC.

Laminar drainage implant

2018 ◽  
Vol 29 (3) ◽  
pp. 278-286
Author(s):  
Sergio Jacobovitz ◽  
José Aloísio Massote ◽  
Sebastião Cronemberger
Keyword(s):  
Intraocular Pressure ◽  
Confidence Interval ◽  
Anterior Chamber ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Conjunctival Hyperemia ◽  
End Stage

Objective: To assess the feasibility of a novel surgical technique in painful blind eyes. Design: A prospective safety study conducted at the Federal University of Minas Gerais, Brazil. Participants/samples: A total of 15 end-stage glaucomatous eyes without light perception vision. Methods: After implantation, conjunctival hyperemia, discharge, erosion, aqueous humor leakage, corneal edema, hyphema, anterior chamber cells and depth, dislocation of the implant, and filtering bleb height were assessed by slit-lamp biomicroscopy. Intraocular pressure was measured preoperatively and 24 months following surgery. A numerical rating scale was used to evaluate pain. Anterior segment optical coherence tomography was also assessed. Results: Laminar drainage implant surgery was performed in all patients without major complications. Mean intraocular pressure was significantly reduced after surgery without hypotensive medication (preoperatively 54.5 ± 5.1 mmHg vs 24 months after surgery 37.0 ± 15.4 mmHg, p = 0.003). Subjective ocular pain intensity also reduced (preoperatively 10 vs at 24-month follow-up visits 0). Corneal edema incidence reduced from 85.7% (95% confidence interval: 57.2%–98.2%) to 16.7% (95% confidence interval: 2.1%–48.4%) at the 24-month follow-up. No patients experienced a prolonged flat anterior chamber or erosion of overlying tissues. Conclusion: The surgery was feasible and safe in painful blind eyes.

scholarly journals Malignant Glaucoma in a Pseudophakic Eye with Slack Lens Zonules

2021 ◽  
Vol 20 (3) ◽  
pp. 110-113
Author(s):  
Young Joo Choi ◽  
Chang Won Kee ◽  
Jong Chul Han
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Glaucoma Surgery ◽  
Aqueous Fluid ◽  
Vitreous Cavity ◽  
Anterior Chamber Angle ◽  
Initial Examination ◽  
Ahmed Valve ◽  
Malignant Glaucoma ◽  
Pars Plana

Purpose: To report a case of malignant glaucoma after glaucoma surgery in a pseudophakic eye with slack lens zonules.Case summary: An 83-year-old man presented with high intraocular pressure of the left eye. He underwent cataract surgery in the left eye ten years ago. He was diagnosed with glaucoma two years ago and had used anti-glaucoma medications. The initial examination of the left eye revealed intraocular pressure of 24 mmHg and zonular dehiscence. We performed Ahmed valve implant surgery because medical treatment failed to lower the intraocular pressure. The anterior chamber angle was nearly closed. After the surgery, over-filtration of aqueous fluid was observed. Injecting the balanced salt solution into the anterior chamber demonstrated misdirected flow of aqueous fluid into the vitreous cavity behind the unstable intraocular lens. The eye was diagnosed with malignant glaucoma; therefore, pars plana vitrectomy was performed. After the vitrectomy, the anterior chamber was not deep; therefore, we repositioned the tip of Ahmed valve implant from the anterior chamber to the vitreous cavity. Subsequently, the anterior chamber became deep and intraocular pressure normalized. The patient remained stable two months after the vitrectomy.Conclusions: Malignant glaucoma can occur in pseudophakic eyes with slack lens zonules after glaucoma surgery, due to misdirection of aqueous fluid. This case suggests that the tip of Ahmed valve implant should be located in the vitreous cavity after vitrectomy, to prevent misdirected flow of aqueous fluid.

scholarly journals The Effect of Selective Laser Trabeculoplasty on Intraocular Pressure in Patients with Dexamethasone Intravitreal Implant-Induced Elevated Intraocular Pressure

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Amin Bennedjai ◽  
Vincent Theillac ◽  
Jad Akesbi ◽  
Raphaël Adam ◽  
Thibaut Rodallec ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ocular Hypertension ◽  
Glaucoma Surgery ◽  
Safe Procedure ◽  
Selective Laser Trabeculoplasty ◽  
Dexamethasone Intravitreal Implant ◽  
Laser Trabeculoplasty ◽  
Intravitreal Implant ◽  
The Mean

Introduction. To assess the safety and efficacy of selective laser trabeculoplasty (SLT) for ocular hypertension (OHT) induced by a dexamethasone (DEX) intravitreal implant. Materials and Methods. We performed a retrospective study of patients who underwent an SLT procedure for ocular hypertension induced by injection of a DEX intravitreal implant. Patients had, at least, one injection of the DEX-implant for symptomatic macular edema. SLT was delivered to 360° of the trabecular meshwork in two sessions. The primary outcome was a decrease in IOP, evaluated at one, three, and six months after the SLT procedure. Results. Twenty-six eyes of 22 patients were included. The mean intraocular pressure (IOP) measured after DEX-implant injection was 25.4 ± 5.4 mmHg, and the mean increase in IOP was 35.8 ± 14.6%. The mean follow-up after SLT was 18.3 ± 7.7 months. After SLT, the mean IOP dropped by 30.9% at one month (16.9 ± 4.5 mmHg, p = 0.01 ), 33.6% at three months (16.0 ± 2.7 mmHg, p < 0.01 ), and 34.9% at six months (15.6 ± 2.1 mmHg, p < 0.01 ). Each patient had a minimum follow-up of 6 months after SLT. Eight eyes (31%) received a second DEX-implant injection after the SLT procedure without experiencing an increase in the IOP above 21 mmHg or >20%. No glaucoma surgery was required during the follow-up. The mean number of medications (1.65 ± 1.36) was significantly reduced at one (1.19 ± 1.20, p = 0.04 ), three (0.96 ± 1.03, p < 0.01 ), and six months (0.77 ± 0.95, p < 0.01 ) after SLT. Conclusion. SLT is an effective and safe procedure to control OHT following DEX-implant intravitreal injection.

Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors

2019 ◽  
Vol 30 (2) ◽  
pp. 350-359 ◽  
Author(s):  
Alessandro Rabiolo ◽  
Alessandro Marchese ◽  
Paolo Bettin ◽  
Davide Monteduro ◽  
Mario Galasso ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Glaucoma Surgery ◽  
Safe Procedure ◽  
Success Rates ◽  
Criterion A ◽  
Hypotony Maculopathy ◽  
Primary Surgery ◽  
Complete Failure ◽  
Needle Revision

Purpose: To evaluate the efficacy and safety of needle revision and examine factors predictive of failure. Methods: In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure. Results: The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively. Conclusion: Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

scholarly journals Superficial keratectomy and 360º conjunctival flap for bullous keratopathy in a dog: a case report

2011 ◽  
Vol 63 (3) ◽  
pp. 773-777 ◽  
Author(s):  
J.P.D. Ortiz ◽  
C.B.S. Lisbão ◽  
F.L.C. Brito ◽  
B. Martins ◽  
J.L. Laus
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Corneal Edema ◽  
Applanation Tonometry ◽  
Bullous Keratopathy ◽  
The Third ◽  
Conjunctival Flap ◽  
Schirmer Tear Test ◽  
History Of ◽  
The Right

A case of a two-year-old male Pinscher with a history of discomfort in the right eye was reported. The left eye had been enucleated by the referring veterinarian due to the same symptom with unsuccessful clinical treatment. The Schirmer tear test value was elevated and a decreased intraocular pressure was observed by applanation tonometry. Biomicroscopy revealed profuse corneal edema and keratoconus and fluorescein staining was negative. Gonioscopy and ophthalmoscopy did not provide any relevant data due to the corneal alterations. Bullous keratopathy was diagnosed. Surgery was performed in two steps: 1) superficial keratectomy and 360º conjunctival flap, and 2) superficial keratectomy to restore corneal transparency. Thirty days after the second superficial keratectomy, the third eyelid flap was removed. Conjunctivalization of the upper nasal quadrant of the cornea was observed. The axial portion of the cornea was transparent and vision was restored.

Elevated IOP and Intentional Tube Occlusion

2013 ◽  
Author(s):  
Ronald L. Gross
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Postoperative Period ◽  
Glaucoma Surgery ◽  
Suture Technique ◽  
Early Postoperative Period ◽  
Polypropylene Suture ◽  
The Impact ◽  
Tube Shunt

Intrinsic to glaucoma surgery using a tube shunt is the management of early postoperative hypotony. This consideration is unavoidable in all cases when using a tube shunt without an intrinsic valve and must still be considered in tube shunts that contain a valve, as the valve may not function as anticipated. Unfortunately, in the attempt to avoid hypotony and its associated complications, we are faced with elevated intraocular pressure (IOP) and its associated difficulties. However, the attempt to control IOP is not the only consideration when anticipating intentional tube occlusion. Additional factors such as technical complexity of the procedure, predictability of IOP in the early postoperative period, potential to reverse occlusion either partially or completely, and the impact on the long-term function of the tube shunt must be considered. The desired endpoint when occluding a tube intentionally is the complete prevention of flow to the tube shunt reservoir. The standard ways to occlude the tube are an external encircling ligature or an internal occluding suture, otherwise known as an “obturator” or a “ripcord,” or some combination thereof. With the external suture technique, prior to placing the reservoir, a 7–0 or 8–0 polyglactin 910 (Vicryl™ , Ethicon, Inc., Somerville, New Jersey) suture is tightly tied around the tube approximately 4–6 mm from the reservoir (Figure 35.1). It is anticipated that this suture will dissolve in about one month, opening the tube. However, the timing of opening may be highly variable between individuals, and that variability may be problematic. Alternatively, a 9–0 polypropylene suture can be placed around the tip of an anterior chamber tube with release performed by laser lysis. To prevent the polypropylene suture from floating freely in the anterior chamber after release, a pass should be made through the wall of the tube during placement. Alternatively, with the “ripcord” technique, the end of a 3–0 polypropylene suture without the needle is threaded into the distal opening of the tube at the reservoir for a distance of 4–6 mm.

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