Ahmed Valve Implantation in an Eye with Choroidal Haemangioma

Sturge Weber syndrome is a rare phakomatoses characterised by vascular hamartomas affecting the leptomeninges, and cutaneous and ocular structures. Glaucoma results from angle anomalies, overproductionfrom ciliary body haemangioma, or reduction in aqueous outflow secondary to increased episcleral venous pressure. The presence of a choroidal haemangioma in an eye with advanced glaucoma adds to the complicated postoperative recovery. This report is of a 9-year-old girl with a right-sided facial naevus flammeus who was referred for advanced glaucoma in the right eye. The eye was buphthalmic, her intraocular pressure was 25 mm Hg while using 4 topical antiglaucoma medications, and the visual acuity was 6/36. The optic disc had advanced cupping with a pale neuroretinal rim. Her visual field was severely constricted with fixation splitting. She underwent Ahmed valve implantation with controlled filtration via nylon stenting of the tube. Her postoperative recovery was complicated, and she needed further ligation of the tube to reduce drainage. Six weeks later, her intraocular pressure was controlled at 14 mm Hg without any antiglaucoma medication after removal of the nylon stent. Managing an eye with advanced glaucoma in the presence of a choroidal haemangioma needs meticulous controlled drainage to prevent detrimental postoperative complications.

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Ahmed valve implantation results in children with uveitic glaucoma

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2021-14-1-30-34 ◽

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.

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Visually Evoked Potentials in a Patient with a Fyodorov-Zuev Keratoprosthesis

Case Reports in Ophthalmology ◽

10.1159/000369579 ◽

2015 ◽

Vol 6 (1) ◽

pp. 12-17

Author(s):

Roy Schwartz ◽

Adiel Barak ◽

Hadas Newman

Keyword(s):

Evoked Potential ◽

Corneal Dystrophy ◽

Visually Evoked Potentials ◽

Past Medical History ◽

Visual Status ◽

Ahmed Valve ◽

Pars Plana ◽

The Right ◽

Valve Implantation ◽

Normal Latency

Purpose: To describe a visually evoked potential (VEP) examination performed on a patient with a keratoprosthesis. Methods: We report the case of a 60-year-old patient with a Fyodorov-Zuev keratoprosthesis in the right eye complained of gradual visual deterioration in that eye. His past medical history consisted of failed corneal graft procedures due to corneal dystrophy and an Ahmed valve implantation due to secondary glaucoma. A clinical examination and an ultrasound demonstrated vitreal opacities. In order to assess the visual status, a flash VEP test was conducted. Results: VEP recorded from the right eye consisted of a broadened and poorly formed positive P1 wave, with a subnormal amplitude, but a normal latency. Consequently, the patient underwent a pars plana vitrectomy. Conclusion: This case demonstrates the viability of VEP exams in patients with keratoprostheses.

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PERBANDINGAN TEKANAN INTRAOKULAR LATIHAN BENCHPRESS DAN BICEPS MASS ROUTINE POLA PROGRESSIVE OVERLOAD

Human Care Journal ◽

10.32883/hcj.v5i2.787 ◽

2020 ◽

Vol 5 (2) ◽

pp. 486

Author(s):

Dian Eka Saputra ◽

Ardizal Rahman ◽

Andrini Ariesti

Keyword(s):

Intraocular Pressure ◽

Weight Training ◽

Valsalva Maneuver ◽

Venous Pressure ◽

Isometric Exercise ◽

Abdominal Pressure ◽

Sitting Position ◽

Iop Elevation ◽

The Right ◽

Lying Down

Weight training as an isometric exercise can increase intraocular pressure (IOP) during exercise. Several mechanism theories are proposed in analyzing IOP elevation in weight training. Increased intra-abdominal pressure increases intracranial pressure thereby increasing IOP. Another theory is the Valsalva maneuver which results in an increase in intrathoracic venous pressure that is transmitted to the veins leading to the ocular so that IOP increases. IOP elevations over a period of time are at risk of causing glaucoma and blindness.Method: This study’s sample consisted of 62 students who were given biceps mass routine and benchpress training with 5 sets of progressive overload patterns. IOP values were measured before training, between sets and 30 minutes after rest using a non-contact tonometry.Result: There was a statistically significant correlation between the increase in IOP values between before exercise with the fifth set in the right eye lying position exercise (10.323mmHg) and the left eye (11.419mmHg) to the increase in the IOP value before exercise with the fifth set in the sitting position of the right eye ( 6,581mmHg) and left eye (7,435mmHg).Conclusion: IOP values increase during weight training at both positions of the progressive overload pattern. The greater the training load the greater the IOP value. The lying down position gives the effect of increasing the greater IOP value.

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Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

Journal of Clinical Medicine ◽

10.3390/jcm9072039 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2039

Author(s):

Chiara Posarelli ◽

Mario Damiano Toro ◽

Robert Rejdak ◽

Tomasz Żarnowski ◽

Dorota Pożarowska ◽

...

Keyword(s):

Intraocular Pressure ◽

Demographic Data ◽

Case Series ◽

Glaucoma Surgery ◽

Refractory Glaucoma ◽

Safety And Efficacy ◽

Surgical Success ◽

Ahmed Valve ◽

Valve Implantation ◽

Type 3

Background: Refractory glaucoma still represents a challenge for ophthalmologists to manage intraocular pressure. The present study aimed to evaluate long term efficacy and safety of a second Ahmed valve implantation after the failure of a first implant in patients with refractory glaucoma and elevated intraocular pressure (IOP). Methods: Retrospective, multicenter non-comparative case series. Twenty-eight patients were retrospectively recruited between January 2011 and December 2017. Demographic data, glaucoma type, visual acuity, intraocular pressure, medical therapy, and complications were registered. Three criteria of success were established: Type 1 surgical success: IOP ≤ 15 mmHg and a reduction of IOP ≥ 40% from baseline; Type 2 surgical success: IOP ≤ 18 mmHg and a reduction of IOP ≥ 30% from baseline; and Type 3 surgical success: IOP ≤ 21 mmHg and a reduction of IOP ≥ 20% from baseline. Surgical failure has been established as IOP less than 5 mmHg or over 21 mmHg and less than a 20% reduction of IOP from baseline despite medications in two consecutive visits, light perception loss referable to glaucoma, and the necessity for further glaucoma surgery. Failure was observed in six (21%) patients. (3) Results: Mean IOP and mean glaucoma medication number significantly reduced from baseline after the second implantation, and the surgical success rate at 72 months ranged from 10% to 78% based on the different criteria of success. Failure was observed in six (21%) patients. Conclusions: This study confirmed the safety and efficacy of a second Ahmed valve implantation in patients with refractory glaucoma and elevated IOP at baseline.

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Long-term intraocular pressure after combined trabeculotomy-trabeculectomy in glaucoma associated with Sturge-Weber syndrome

European Journal of Ophthalmology ◽

10.5301/ejo.5001024 ◽

2017 ◽

Vol 28 (2) ◽

pp. 210-215 ◽

Cited By ~ 3

Author(s):

Devindra Sood ◽

Aanchal Rathore ◽

Ishaana Sood ◽

Dinesh Kumar ◽

Narender N. Sood

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Vision Loss ◽

Intraoperative Complications ◽

Repeat Surgery ◽

Antiglaucoma Medication ◽

Weber Syndrome ◽

Sturge Weber Syndrome

Purpose: Vision loss in Sturge-Weber syndrome (SWS), a rare congenital disorder, is primarily due to glaucoma. Methods: We reviewed the data of all consecutive SWS-associated glaucoma cases in patients who had undergone combined trabeculotomy-trabeculectomy (CTT) at a tertiary glaucoma facility between January 1993 and December 2015. We analyzed the preoperative and postoperative intraocular pressure (IOP), corneal clarity, visual acuity, success rate, need for repeat surgery, and number of topical antiglaucoma medications needed at last follow-up. Results: Twenty-six eyes of 20 patients with SWS (surgical age 0.7-96 months; mean 18.64 ± 29.74 months) had undergone primary CTT. The mean preoperative IOP was 32.76 ± 7.86 mm Hg (range 22-54 mm Hg) with medication (mean 3.11 ± 1.17; range 1-5). At the last follow-up (61-288 months); mean SD 134.73 ± 67.77 months), two eyes had IOP <6 mm Hg. Twenty-four eyes analyzed had an IOP of 13.63 ± 6.11 (mean ± SD; range 9-41) mm Hg. All these had an IOP <15 mm Hg at last follow-up except one, which had an IOP of 41 mm Hg. There was a mean reduction of 54.62% ± 31.33% in IOP from baseline. The antiglaucoma medication score at last follow-up visit was 0-3. No eye achieved predefined complete success or modified complete success. A total of 41.7% (10/24) of eyes attained both qualified and modified qualified success. Eleven eyes needed repeat surgeries. No intraoperative complications were noted. Visual acuity was below 6/60 in four eyes. Conclusions: Combined trabeculotomy-trabeculectomy showed promising results as a treatment for SWS-associated glaucoma in children. Long-term visual and surgical outcomes are encouraging.

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Ahmed valve implantation in childhood glaucoma associated with Sturge–Weber syndrome: our experience

Eye ◽

10.1038/s41433-018-0233-x ◽

2018 ◽

Vol 33 (3) ◽

pp. 464-468 ◽

Cited By ~ 2

Author(s):

Jaya Kaushik ◽

Jitendra Kumar Singh Parihar ◽

Vaibhav Kumar Jain ◽

Vijay Mathur

Keyword(s):

Ahmed Valve ◽

Weber Syndrome ◽

Sturge Weber Syndrome ◽

Valve Implantation

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

European Journal of Ophthalmology ◽

10.1177/112067210801800205 ◽

2008 ◽

Vol 18 (2) ◽

pp. 191-198 ◽

Cited By ~ 10

Author(s):

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.

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Ahmed valve implantation results in neovascular glaucoma patients: Evaluation of short-term and remote

Ophthalmology journal ◽

10.17816/ov2015320-23 ◽

2015 ◽

Vol 8 (3) ◽

pp. 20-23

Author(s):

Olga Gennadievna Pavlova ◽

Vadim Petrovich Nikolaenko

Keyword(s):

Intraocular Pressure ◽

Pain Syndrome ◽

Neovascular Glaucoma ◽

Anterior Chamber Angle ◽

Short Term ◽

Lowering Therapy ◽

Ahmed Valve ◽

Valve Implantation ◽

Implantation Method ◽

Main Complication

Objective: to evaluate Ahmed valve implantation results in neovascular glaucoma patients. Methods: standard implantation method was used in 87 patients aged 57-86 years. Check-up examinations were performed in 1 week, 1, 3, 6, 9, 12 and 36 months after surgery. Results: during short-term post-op period (one month after surgery), intraocular pressure normalized in 48 patients. During remote post-op period (6-36 months after surgery), intraocular pressure normalization was achieved in 69 patients (79.2 %), among them in 62 patients (71.2 %) - against the background of IOP-lowering treatment. The main complication was a hemorrhage from anterior chamber angle and iris new vessels that was found in 37 patients (42.5 %), in a quarter of cases it required hyphema washout. In three patients, sustained hypotony developed, in one case it brought to globe sub-atrophy. In two of observed patients, enucleation was performed because of pain syndrome rebound. Conclusions: In 79.2 % neovascular glaucoma patients, the valve implantation led to IOP normalization, while in 71.2 % of cases it required a return to IOP-lowering therapy.

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Late-onset malignant glaucoma

Latin American Journal of Ophthalmology ◽

10.25259/lajo_19_2019 ◽

2020 ◽

Vol 3 ◽

pp. 1

Author(s):

Ramiro José Daud ◽

Horacio Freile ◽

Mauricio Freile ◽

Soledad Mariano

Keyword(s):

Intraocular Pressure ◽

Case Report ◽

Acute Pain ◽

Late Onset ◽

Slit Lamp ◽

Normal Range ◽

Slit Lamp Examination ◽

Complete Occlusion ◽

Malignant Glaucoma ◽

The Right

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.

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Effect of postural changes on intraocular pressure in patients with acute angle-closure glaucoma in Indian population

Latin American Journal of Ophthalmology ◽

10.25259/lajo_18_2019 ◽

2020 ◽

Vol 3 ◽

pp. 2

Author(s):

Sanjay Mishra ◽

Ashok Kumar

Keyword(s):

Intraocular Pressure ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Sitting Position ◽

Rebound Tonometer ◽

Antiglaucoma Medication ◽

Primary Angle Closure Glaucoma ◽

Postural Changes ◽

Healthy Control

Objective: The objective of the study was to compare the posture-induced intraocular pressure (IOP) changes in primary angle-closure glaucoma (PACG) with or without glaucoma medications, and healthy control eyes with normal IOPs in Indian subjects. Materials and Methods: The IOP was measured in the sitting position and the supine position after 10, 20, and 30 min with a rebound tonometer. Results: Twenty-five patients with PACG and 30 controls with normal IOPs were studied. The IOP in the sitting position measured with the rebound tonometer was 13.8 + 3.2 mm Hg in eyes with PAC, and 12.9 + 2.9 mm Hg in eyes with normal IOPs. The IOP increased to 14.4 mm Hg, 16.8 mm Hg, and 18.9 mm Hg at 10 min, 20 min, and 30 min in PACG subjects. In normal age-matched controls, the IOP increased to 13.4 mm Hg, 14.9 mm Hg, and 17.8 mm Hg at 10 min, 20 min, and 30 min, respectively, but none of these differences were significant (P = 0.09; P = 0.08, P = 0.08). The mean postural IOP change from baseline was also not significant between the two groups. Only three patients were on single antiglaucoma medication with well-controlled IOP in the PACG group. Conclusions: Postural IOP changes are comparable among eyes with PACG with and without glaucoma medications, and control eyes.

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