Usage of E-Polytetrafluoroethylene (e-PTFE) Membrane for Managing Trabeculectomy Flap- Related Over-Filtration Due to Unavailability of Scleral Patch Graft during Nation-Wide Lockdown

Scleral flap tears during trabeculectomy are difficult to repair in a predictable fashion. Donor scleral flap reinforcements are commonly preferred for managing trabeculectomy flap-related over-filtration, leading to shallow anterior chamber (AC). Due to the advent of COVID-19 lockdown, especially in the initial phases, eye banking activities almost came to a standstill, with almost no corneal and/or scleral tissue retrievals. Hence, in this manuscript we have presented a mini case series with follow-up of two of our cases; where Gore-Tex (e-polytetrafluoroethylene) implant was used as an alternative to scleral patch graft, for managing trabeculectomy flap-related over-filtration, with their pros and cons. Though Gore-Tex implant stability in both cases were contentious, it still served the purpose of managing the flap-related over- filtration and subsequent shallow AC.

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Results and Complications after Implantation of a Black Iris-Lens Diaphragm in Patients with Traumatically Induced Aphakia and Aniridia

European Journal of Ophthalmology ◽

10.5301/ejo.2011.6484 ◽

2011 ◽

Vol 21 (6) ◽

pp. 754-759 ◽

Cited By ~ 5

Author(s):

Vasileios Petousis ◽

Lothar Krause ◽

Gregor Willerding ◽

Michael H. Foerster ◽

Nikolaos E. Bechrakis

Keyword(s):

Anterior Chamber ◽

Surgical Repair ◽

Silicone Oil ◽

Case Series ◽

Corrected Visual Acuity ◽

Time Out ◽

Anatomic Results ◽

The Mean ◽

Positive Effect

Purpose. The black iris-lens diaphragm (ILD) can be used in the treatment of traumatic aniridia and aphakia. The aim of our study was to show postoperative functional and anatomic results and complications in a small case series. Methods. We retrospectively analyzed the files of 16 patients managed with a black ILD or a sole iris diaphragm in the period 1994–2007. Four of them were female and 12 were male. The mean age of the group was 50±17 years. At the time of the implantation, all of the eyes had already undergone primary surgical repair. Results. The preoperative best-corrected visual acuity in half of the patients was ≥0.1 and remained stable after the first postoperative year. During the follow-up years, one eye developed a subluxation of the implant and one eye an anterior chamber hemorrhage. At the same time, out of 8 eyes carrying a silicone tamponade in the vitreous cavity, silicone oil entered the anterior chamber in 3 cases. In one case, enucleation was undertaken due to phthisis. Conclusions. In the case of severely traumatized eyes with aniridia and aphakia, the implantation of a black ILD can have a positive effect on functional and anatomic stabilization.

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Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

Ophthalmology and Eye Diseases ◽

10.4137/oed.s12672 ◽

2013 ◽

Vol 5 ◽

pp. OED.S12672

Author(s):

Kagmeni Giles ◽

Moukouri Ernest ◽

Domngang Christelle ◽

Nguefack-Tsague Georges ◽

Cheuteu Raoul ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Teaching Hospital ◽

Case Series ◽

University Teaching ◽

Case Series Study ◽

The Mean ◽

The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

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Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/2124581 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Jea H. Yu ◽

Chuck Nguyen ◽

Esmeralda Gallemore ◽

Ron P. Gallemore

Keyword(s):

Open Angle Glaucoma ◽

Effective Means ◽

Case Series ◽

Neovascular Glaucoma ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Scleral Flap ◽

Retrospective Case ◽

Glaucoma Drainage Devices ◽

Patch Graft

Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions.Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement.Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from39±14 mmHg to15±2 mmHg and the number of glaucoma medications was reduced from4±1to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively.Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

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Visual outcomes of Visian ICL implantation for high myopia in patients with shallow anterior chamber depth

10.21203/rs.2.497/v3 ◽

2019 ◽

Author(s):

Lingling Niu ◽

Huamao Miao ◽

Tian Han ◽

Lan Ding ◽

Xiaoying Wang ◽

...

Keyword(s):

Visual Acuity ◽

Observational Study ◽

Anterior Chamber ◽

High Myopia ◽

Anterior Chamber Depth ◽

Distance Visual Acuity ◽

Visual Outcomes ◽

Icl V4c ◽

Shallow Anterior Chamber

Abstract Background: High myopia with shallow anterior chamber depth (ACD less than 2.8 mm) is not rare. This observational study aims to evaluate visual outcomes after implantation of the Visian Implantable Collamer Lens with a central hole (ICL V4c) in these patients. Methods: A prospective cohort of consecutive 51 eyes of 31 patients (20 to 42 years old) was followed for at least 12 months (average 15.35 ± 4.90 months, rangers from 12 to 25 months). The preoperative ACD was 2.74 ± 0.04 mm (2.65 to 2.79 mm). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), manifest refraction, vault, and endothelial cell density (ECD) were measured during the follow-ups after surgery. Results: All surgeries were performed safely and no complication was observed during the follow-up. At the last follow-up, the safety index (postoperative CDVA / preoperative CDVA) was 1.33 ± 0.60 and the efficacy index (postoperative UDVA / preoperative CDVA) was 1.14 ± 0.54. After the surgery, no eye had decreased CDVA and 59% (30 eyes) of the eyes gained at least one line. Forty-seven eyes (92%) were within ± 1.0 D and 35 eyes (69%) were within ± 0.5 D of the attempted refraction. The mean postoperative vault was 380.00 ± 152.84 µm (90 to 700µm). The ECD was reduced by 8.38 ± 0.06% as compared to the preoperative value (p < 0.001). No significant change was observed in IOP (p = 0.061) at the last follow-up. Ultrasound Biomicroscopy (UBM) showed none of the eyes had trabecular-iris angle closed. Conclusions: In this prospective observational study, ICL V4c implantation in patients with high myopia and shallow ACD achieved satisfying and stable visual outcomes. Its long-term safety and stability require further investigation. Trial Registration: This trial was retrospectively registered on 05/08/2018 under the number (ChiCTR1800017594)

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Case Series of Brittle Cornea Syndrome

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/4381273 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Taher Eleiwa ◽

Mariam Raheem ◽

Nimesh A. Patel ◽

Audina M. Berrocal ◽

Alana Grajewski ◽

...

Keyword(s):

Late Onset ◽

Treatment Options ◽

Case Series ◽

Autosomal Recessive Disorder ◽

Diagnostic Features ◽

Brittle Cornea Syndrome ◽

Patch Graft ◽

The Right ◽

Corneal Rupture

Purpose. This case series demonstrate diagnostic features, treatment options, and challenges for Brittle Cornea Syndrome. Observations. Three cases presented with bluish sclera and extremely thin cornea. Genetic workup was performed and confirmed the diagnosis of Brittle Cornea Syndrome, a rare autosomal recessive disorder characterized by corneal thinning and blue sclera. Case 1 was a 4-year-old boy who developed cataract and glaucoma after undergoing right tectonic penetrating keratoplasty (PK) secondary to a spontaneous corneal rupture. Glaucoma was controlled medically. Later, the kid underwent right transcorneal lensectomy and vitrectomy with synechiolysis. After 6 weeks, he sustained graft dehiscence that was repaired using onlay patch graft. Case 2 was a 7-year-old boy who underwent PK in the right eye, then a pericardial patch graft in the left eye following spontaneous corneal rupture. Glaucoma in both eyes was controlled medically. Case 3 was the 2-year-old sister of the 2nd case. She had a pachymetry of 238 μm OD and 254 μm OS. In the 3 cases, parents were instructed to take protective measures for both eyes and to continue with follow-up visits. Also, they were instructed to have regular screenings for late-onset hearing loss, dental abnormalities, and bone deformities. Conclusions. Long-term follow-up of children diagnosed with Brittle Cornea Syndrome is paramount to minimize the morbidity of corneal rupture and late-onset extraocular conditions.

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Allogenic dehydrated human pericardium patch graft (Tutoplast): A novel use for reconstruction in orbital implant exposure

European Journal of Ophthalmology ◽

10.1177/11206721211004398 ◽

2021 ◽

pp. 112067212110043

Author(s):

Hetvi Bhatt ◽

Linda Okafor ◽

Rina Bhatt

Keyword(s):

Case Series ◽

Glaucoma Drainage Device ◽

Fat Graft ◽

Silicone Implants ◽

Orbital Implant ◽

Presenting Symptoms ◽

Implant Exposure ◽

Patch Graft ◽

Human Pericardium

Purpose: Exposure of orbital implant post enucleation or evisceration remains one of the common complications irrespective of the type of implant used. Dermis fat graft and temporalis fascia have been used to repair the implant exposure in anophthalmic sockets. Tutoplast® pericardium, gamma sterilised dehydrated human pericardium, has been used as a scleral patch graft for glaucoma drainage device exposure and scleral thinning post squint surgery. We report the novel use of Tutoplast® patch graft to repair orbital implant exposure in this case series. Methods: The case notes of three patients who received Tutoplast® pericardium patch graft to repair implant exposure were reviewed. Data regarding presenting symptoms, implant type, time to exposure from primary surgery, post-operative complications and length of follow up post Tutoplast® pericardium patch graft were collected. Results: Three patients presented with implant exposure following evisceration. The presenting symptoms were recurrent infection, discharging socket and discomfort in all three patients. One patient had a Medpore implant, two had silicone implants. Total follow-up ranged from 9 to 22 months. In all three cases, there was relief from symptoms and the graft had incorporated fully into the surrounding orbital tissue with no recurrent exposure noted during the follow-up period. Conclusion: Tutoplast® pericardium has demonstrated a good safety profile and is a suitable material to use as a patch graft for orbital implant exposure.

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What to Choose for Trabeculectomy, 10/0 Nylon Monofilament or 8/0 Virgin Silk?

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i3.1230 ◽

2021 ◽

Vol 37 (3) ◽

Author(s):

Erum Shahid ◽

Uzma Fasih ◽

Arshad Shaikh

Keyword(s):

Anterior Chamber ◽

P Value ◽

Suture Materials ◽

Laser Trabeculoplasty ◽

Quasi Experimental ◽

Group A ◽

Ocular Pressure ◽

Shallow Anterior Chamber ◽

Group B

Purpose: To compare between 10/0 nylon monofilament and 8/0 virgin silk for conventional trabeculectomy in terms of rate of complications and bleb morphology. Study Design: Quasi experimental study. Place and Duration of Study: Abbasi Shaheed Hospital, Karachi, from January 2017 to December 2018. Methods: Thirty six patients who underwent conventional trabeculectomy with 6 months follow-up were included. Trabeculectomy for congenital, neovascular, traumatic glaucoma, revised surgery and laser trabeculoplasty were excluded. In group A, scleral flap and conjunctiva were closed with 8/0 virgin silk and in group B, 10/0 nylon monofilament was used. Main outcome measure was complications. Results: Group A had 13 (36%) and group B had 23 (63.9%) patients. Mean age was 55.5 ± 10.69. Pre-operative Intraocular pressure (IOP) was 33.4 ± 6.3 and 33.5 ± 12 mm Hg in group A & B respectively. Postoperatively at 3rd month IOP was 16.8 in group A and 15.0 in group B (p = 0.24).Shallow Anterior chamber was in 53% (n = 7) patients with 8/0 silk and 13% (n = 3) patients with 10/0 nylon with p value of < 0.05. Seidel test was positive in 38% (n = 5) patients in group A (p < 0.01). Re-suturing was done in 38% (n = 5) patients in group A with a p-value (p < 0.01). Conclusion: Shallow anterior chamber, wound leak with positive seidel test and additional intervention for re-suturing were more common in group A than group B. Diffuse blebs were frequently seen with both suture materials. Suture material does not affect final intra ocular pressure and success of trabeculectomy. Key Words: Bleb, Trabeculectomy, 10/0 Nylon, 8/0 silk.

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Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification

Journal of Ophthalmology ◽

10.1155/2017/2801025 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ashraf Ahmed Nossair ◽

Wael Ahmed Ewais ◽

Lamia Samy Ali

Keyword(s):

Retrospective Study ◽

Anterior Chamber ◽

Axial Length ◽

Anterior Chamber Depth ◽

Cost Effective ◽

Needle Aspiration ◽

Angle Closure ◽

Safe Technique ◽

Shallow Anterior Chamber

Purpose.To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification.Methods.A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD) failed to sufficiently deepen the anterior chamber.Results.Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92%) preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%). Postoperative follow-up period was 22.88 ± 10.24 (4–39) months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted.Conclusion.Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification.

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Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors

Current Journal of Glaucoma Practice with DVD ◽

10.5005/jp-journals-10028-1224 ◽

2017 ◽

Vol 11 (2) ◽

pp. 58-62 ◽

Cited By ~ 6

Author(s):

Ana Luiza B Scoralick ◽

Izabela Almeida ◽

Michele Ushida ◽

Diego T Dias ◽

Syril Dorairaj ◽

...

Keyword(s):

Surgical Outcomes ◽

Case Series ◽

Time Interval ◽

Success Rates ◽

Scleral Flap ◽

Safe Alternative ◽

Success Predictors ◽

Hypotony Maculopathy ◽

Fundus Imaging

ABSTRACT Aim To investigate surgical outcomes and success predictors of transconjunctival scleral flap resuturing for the management of hypotony due to overfiltration following trabeculectomy with mitomycin C. Materials and methods Noncomparative, retrospective, interventional case series in which all glaucoma patients from two glaucoma services undergoing transconjunctival scleral flap resuturing between May 2012 and July 2016 were enrolled. Included eyes had to have hypotony [intraocular pressure (IOP) ≤ 6 mm Hg] and/or hypotony maculopathy caused by excessive filtration following trabeculectomy. Key exclusion criteria were wound/bleb leaking and postoperative ocular trauma or infection. Preoperative and postoperative IOP, best-corrected visual acuity (BCVA), fundus imaging, surgical complications, and any subsequent related events or procedures were recorded. Rates of postsurgical hypotony and/or maculopathy resolution and possible success predictors were investigated. Results A total of 22 patients (22 eyes) with a mean age of 56.4 ± 15.2 years were included. Median follow-up was 245 days [interquartilerange (IR); 120–817 days] and mean IOP was increased from 2.9 ± 1.5 mm Hg (1–6 mm Hg) to 8.5 ± 3.1 mm Hg (2–16 mm Hg) at the last follow-up visit (p < 0.01). Approximately 75% of the cases (16 out of 22) had an IOP between 7 and 18 mm Hg at the end of the follow-up period. Median BCVA (log MAR) at last follow-up visit [0.1 (IR; 0.0- 0.3)] was significantly better than preoperative BCVA [0.4 (IR; 0.1-1.0); p < 0.01]. Hypotony resolved in 81% of the cases, while maculopathy resolution was found in 85% of the cases. Time interval between trabeculectomy and flap resuturing was the only factor significantly associated with patient's IOP at last follow-up visit (R2 = 0.23; p = 0.036). Success rates (IOP < 6 mm Hg at last follow-up visit) were halved in those left untreated for more than 6 months. No serious adverse event was recorded. Conclusion Our findings support the use of transconjunctival scleral flap resuturing as an effective and safe alternative for hypotony management due to overflitration following trabeculectomy. As time interval seems to influence the odds of hypotony resolution, early intervention is recommended. How to cite this article Scoralick ALB, Almeida I, Ushida M, Dias DT, Dorairaj S, Prata TS, Kanadani FN, Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017;11(2):58-62.

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