Optimization of surgical treatment of secondary closed-angle glaucoma in patients with organic block of the anterior chamber angle

2021 ◽  
pp. 66-70
Author(s):  
I. M. Nasyrova ◽  
◽  
A.V. Ovchinnikova ◽  
Keyword(s):  
Surgical Treatment ◽  
Anterior Chamber ◽  
Saline Solution ◽  
Hypotensive Effect ◽  
Processing Technique ◽  
Anterior Chamber Angle ◽  
Closed Angle ◽  
Chamber Angle

Purpose. Optimization of surgical treatment of secondary closed-angle glaucoma in patients with organic block of the anterior chamber angle. Material and methods. The analysis of the results of 6 AGO using autologous scleral drains treated with MMC is presented in children with an organic block of the anterior chamber angle without the phenomena of neovascularization is privided. Five children had uveal glaucoma; one child had an essential mesodermal iris dystrophy with secondary glaucoma. In all cases before the formation of autologous scleral drains, intraoperative applications of MMC were performed, followed by a plentiful washing of the operating field with normal saline solution. The duration of follow-up was from 1.5 to 7 years. Results. The operations proceeded without complications. There was a long choroidal edema on one eye in the early postoperative, stopped with the help of conservative treatment for 10 days. In the long term, on one eye in the period of exacerbation of uveitis, dislocation of autodrainages arose, which was facilitated by the appearance of exudative effusion in the anterior chamber. Later on this eye the failure of the AGO developed. On the other eyes, the intraocular pressure remained compensated, and the functions were stable. Conclusion. Treatment of drainages from the autosclera with MMC before implanting them into the anterior chamber of the eye, in patients with organic block of the anterior chamber angle, is effective against the hypotensive effect of the operation and is safe for intraocular structures while observing the processing technique. Key words: secondary closed-angle glaucoma, anterior chamber, autologous

scholarly journals Ahmed valve implantation results in children with uveitic glaucoma

2021 ◽  
Vol 14 (1) ◽  
pp. 30-34
Author(s):  
L. A. Katargina ◽  
E. V. Denisova ◽  
I. N. A. Bahaaeddin ◽  
M. A. Khrabrova
Keyword(s):  
Intraocular Pressure ◽  
Surgical Treatment ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Anterior Chamber Angle ◽  
Safe Method ◽  
Ahmed Valve ◽  
Valve Implantation ◽  
Chamber Angle

The purpose is to evaluate the effectiveness and safety of Ahmed valve implantation in children with refractory postuveitic glaucoma (PUG).Material and methods. Ahmed valve was implanted to 10 children aged 7 to 17 years (10 eyes) with open-angle or mixed PUG uncompensated even by a maximum antihypertensive mode. Previously, all patients had undergone an average of 2.1 ± 0.9 surgeries aimed at normalizing the intraocular pressure (IOP) (predominantly, sinus trabeculectomy). 6 eyes were pseudophakic, 2 phakic, 2 aphakic. Ahmed valves were implanted according to the generally accepted technique. At the time of surgery IOP was 30.50 ± 4.35 mm Hg on average. The follow-up postsurgical period ranged from 3.9 to 23.6 months (averagely, 14.1 ± 6.5).Results. A stable hypotensive effect of the intervention was achieved in 90 % of cases, of which 3 patients had no hypotensives while 6 patients received hypotensive drugs even though their quantity was significantly smaller than before surgery (1.7 ± 1.49, p=0.028). At the end of the follow-up the average IOP was 18.1 ± 5.34 mm Hg, (significantly lower than before surgery, p = 0.008). During surgery, 1 patient experienced bleeding from the vessels of the anterior chamber angle after paracentesis, which was stopped by tamponade with sterile air. In other cases, the surgery as well as the immediate and distant postoperative period showed no complications.Conclusion. Ahmed valve implantation is an effective and safe method of the surgical treatment of refractory PUG in children and can be recommended in cases when previous antiglaucomatous operations proved ineffective, including patients with pseudophakia and aphakia.

scholarly journals Comparative assessment of different methods of congenital glaucoma surgical treatment considering patient’s age

2013 ◽  
Vol 94 (6) ◽  
pp. 847-850
Author(s):  
T K Toykuliev
Keyword(s):  
Surgical Treatment ◽  
Anterior Chamber ◽  
Antihypertensive Effect ◽  
Age Groups ◽  
Comparative Assessment ◽  
Congenital Glaucoma ◽  
Anterior Chamber Angle ◽  
Application Methods ◽  
Trabeculotomy Ab Externo ◽  
Chamber Angle

Aim. To study the effectiveness of antihypertensive operations of trabeculotomy ab externo and sinus trabeculoectomy in our modification in patients with congenital glaucoma and to justify its application. Methods. The following surgeries were performed: trabeculotomy ab externo - on 57 eyes of 51 patients, sinus trabeculoectomy - on 46 eyes of 42 children, classic trabeculoectomy - on 23 eyes of 19 patients, and trabeculoectomy with elements of intrascleral autodrainage in our modification - on 23 eyes of 23 patients. Among them, 22 patients were younger than 1 month, aged from 1 to 6 months - 30, from 6 months to 1 year - 18, from 1 to 3 years - 15 and from 3 to 5 years old - 8 patients. Results. Long-lasting hypotension was achieved in 86.95% of patients after sinus trabeculoectomy, in 80.39% of patients after trabeculotomy ab externo. The best results were obtained in patients younger than 6 months. In the older age groups, antihypertensive effect of trabeculotomy ab externo markedly decreased and was only 50% at the age of 3-5 years. The results after sinus trabeculoectomy were comparable in all age groups. Conclusions. Trabeculotomy ab externo can be recommended as an operation of choice during the first months of life in congenital glaucoma patients, based on the characteristics of the anterior chamber angle.

scholarly journals Usefulness of anterior chamber optical coherence tomography in glaucoma

2012 ◽  
Vol 2 (1) ◽  
pp. 3
Author(s):  
Marco Bogado ◽  
Jose Navero
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Chamber ◽  
Glaucoma Surgery ◽  
Contact Method ◽  
Deep Sclerectomy ◽  
Optical Coherence ◽  
Anterior Chamber Angle ◽  
High Quality ◽  
Chamber Angle

The aim of the study is to describe and assess whether anterior chamber optical coherence tomography (OCT) has the capacity to produce high quality images of patients with different angle configurations and to follow bleb’s morphology after glaucoma surgery. The eyes of two patients were evaluated with Visante OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA) in emergency pupillary block and in follow-up after nonpenetrating deep sclerectomy. Visante OCT provided high-resolution information regarding iris configuration and was useful to explore bleb’s morphology in patients after glaucoma surgery. Visante OCT offers a quick non-contact method of assessing the configuration of the anterior chamber angle. Despite its limitations, it may be of help during routine clinical evaluation of patients with glaucoma.

Glaucoma Problems Associated with Aniridia

2010 ◽  
Author(s):  
Peter A. Netland
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Trabecular Meshwork ◽  
Ciliary Body ◽  
Vision Loss ◽  
Visual Field Loss ◽  
Anterior Chamber Angle ◽  
Foveal Hypoplasia ◽  
Closed Angle ◽  
Chamber Angle

Glaucoma is a potentially vision-threatening problem that is commonly encountered in aniridia patients. This condition may develop at birth, or shortly thereafter. More commonly, however, glaucoma is acquired later in childhood or even young adulthood. If unrecognized and untreated, glaucoma can result in blindness. For this reason, it is important to be vigilant in watching for this condition in children affected with aniridia. Vision lost due to glaucomatous damage cannot be regained at a later time. In addition to glaucoma, children with aniridia may demonstrate other problems with their vision. They may have refractive errors, corneal or retinal problems, or abnormalities of eye movement. Foveal hypoplasia (lack of development of the retina) may limit vision in some children. In aniridia patients, cataract (opacification or cloudiness of the lens) is seen with approximately the same prevalence as glaucoma. Cataract, however, differs from glaucoma in that the vision loss due to cataract is reversible. Glaucoma is suspected in aniridia patients when there is an increased intraocular pressure. Glaucoma can be definitely diagnosed when changes of the optic nerve occur due to this elevated intraocular pressure. At the later stages of the disease, visual field loss occurs. In the normal eye, the fluid (aqueous humor) in the front of the eye (the anterior chamber) is produced by the ciliary body, which is located behind the iris (see Figure 5.1). The fluid produced from the ciliary body flows forward into the anterior chamber, where it drains from the anterior chamber angle through tissue called the trabecular meshwork. When there is an abnormal situation, the fluid exits the eye poorly or not at all, and the intraocular pressure may be increased. The fluid may be blocked from exiting the eye by a closed angle, or may flow poorly out of the eye even though the angle is open (see Figure 5.2). The angle may be closed in aniridic patients when the stump of residual iris covers the trabecular meshwork in the anterior chamber angle.

COMPARISON OF GONIOSCOPY AND ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN THE ASSESSMENT OF ANTERIOR CHAMBER ANGLE IN GLAUCOMATOUS PATIENTS OF A TERTIARY CARE HOSPITAL OF KUMAOUN REGION

2021 ◽  
pp. 20-23
Author(s):  
Snigdha Joshi ◽  
Vimlesh Sharma ◽  
Shanti Pandey ◽  
Govind Singh Titiyal
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Chamber ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Anterior Segment ◽  
Angle Closure ◽  
Care Hospital ◽  
Anterior Chamber Angle ◽  
Closed Angle ◽  
Chamber Angle

AIM:To nd the role of gonioscopy and anterior segment optical coherence tomography in detecting angle closure in different quadrants of anterior chamber angle in glaucomatous patients. Study design:Cross sectional study Material and Methods:65 patients with age >10 years of age with suspected angle closure were recruited from a tertiary care hospital in Kumaon Region. Subjects underwent gonioscopy and AS- OCT imaging in dark.Gonioscopy as gold standard , the ACA was graded using the Spaeth system by a two examiners masked to each other ndings then the results of both the techniques were compared. Results: 130 eyes of 65 patients studied. The angles in all quadrants compared between Gonioscopy and AS-OCT using chi-square test.Closedangle were found to be 5.4%(7%) with AS-OCT and 13.8%(18) with Gonioscopy in superior quardant. Closed-angle were more with Gonioscopy 10.8%(14) as compared to AS-OCT5.4%(7) in inferior quadrants. In temporal qudrant closed-angle with gonioscopy was 11.5%(15) as compared to AS-OCT 5.4% (7). Closed-angles with gonioscopy in nasal quadrant was 12.3%(16) as compared to 5.4%(7) in AS-OCT. Conclusion: AS-OCT is highly sensitive to detect closed angles, probably due to the dark ambient condition and its non-contact nature.With the 3600 analysis, the regional differences or quadrants can be evaluated which are either partially closed or open. Considering angle closure in terms of percentage or degrees could be more accurate than more limited cross-sectional assessment. Gonioscopy showed more number of closed angles as compared to AS-OCT.The angles which seemed closed on gonioscopy were found open in AS-OCT.

scholarly journals Evaluation of the Anterior Chamber Angle by Anterior Segment Optical Coherence Tomography After Implantable Phakic Contact Lens Implantation in Myopic Eyes.

2021 ◽  
Author(s):  
Mohamed Salah El-Din Mahmoud ◽  
Asmaa Anwar Mohamed ◽  
Hosny Ahmed Zein
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Chamber ◽  
Prospective Observational Study ◽  
Anterior Segment ◽  
Anterior Chamber Angle ◽  
Safe Method ◽  
Lens Implantation ◽  
Lens Vault ◽  
Chamber Angle

Abstract Purpose: To evaluate the changes in the angle of the AC and lens vault after IPCL implantation by AS-OCT in myopic patients.Methods: A prospective observational study involving 30 myopic eyes which were implanted with IPCL with AS-OCT was used for evaluation of the anterior chamber angle parameters as anterior chamber angle (ACA), angle opening distance (AOD) and, trabecular iris space area (TISA) and lens vault at 1,3 and 6 months postoperatively.Results: There were high significant changes between the preoperative values of ACA, AOD and, TISA and first follow-up after 1 month postoperatively with no significant changes between second and third follow-up after 3 and 6 months postoperatively. Regarding the vault, there were stable vault values with no significant changes after 6 months follow-up.Conclusion: IPCL is a safe method of correction of myopia with stable AC angle narrowing which was monitored by the safe noncontact tool, AS-OCT.

Temporary “liquid” Implant for Congenital Glaucoma (long-term results)

2020 ◽  
pp. 49-65
Author(s):  
N Bobrova ◽  
N Trofimova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Hypotensive Effect ◽  
Congenital Glaucoma ◽  
Long Term Results ◽  
General Will ◽  
Visual Functions ◽  
Advanced Stages ◽  
Intraocular Fluid

The aim of the work was to analyze the long-term results of using a temporary “liquid” implant in the surgery of congenital glaucoma in children. The basis of the developed method of filtrative antiglaucomatous surgery (Patent of Ukraine No. 45099 of 2009) – viscosinusotrabeculotomy – has been set the task of reducing the risk of developing intra- and postoperative complications, reducing the scarring rate and maintaining the newly created ways of the intraocular fluid outflow, which in general will increase the effectiveness of surgical treatment of congenital glaucoma in children. 54 children (91 eyes) with simple congenital glaucoma at the age of 1 to 36 months were operated on average (8.7 ± 8.2) months. The persistent and long-lasting hypotensive effect achieved due to viscosinusotrabeculotomy in children with developed and far-advanced stages of congenital glaucoma stops the processes of stretching of the membranes of the eye and stabilizes their size, which in general allows preserving and visual functions improving, in infancy – creating conditions for their formation.

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