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 Evaluation of the Effectiveness of Surgical Treatment of Malignant Glaucoma in Pseudophakic Eyes through Partial PPV with Establishment of Communication between the Anterior Chamber and the Vitreous Cavity

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Marek Rękas ◽  
Karolina Krix-Jachym ◽  
Tomasz Żarnowski
Keyword(s):  
Anterior Chamber ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Vitreous Cavity ◽  
Case Series Study ◽  
Malignant Glaucoma ◽  
Corrected Distance Visual Acuity ◽  
Efficacy Measures ◽  
Proposed Modification ◽  
One Year

Purpose. Determination of partial posterior vitrectomy (PPV) in the proposed modification for treatment of malignant glaucoma.Methods. The prospective, consecutive, single-center case series study involved patients in whom symptoms of malignant glaucoma occurred after combined cataract and glaucoma surgery or after glaucoma surgery in pseudophakic eye. When medical and laser treatment were not successful, partial PPV with establishment of communication between the anterior chamber and the vitreous cavity was performed. Efficacy measures were intraocular pressure (IOP) reduction, corrected distance visual acuity (CDVA), AND the number of antiglaucoma medications. Surgical success and occurring complications were also evaluated.Results. The study enrolled 20 eyes of 17 patients. Average IOP was reduced from 30.4 ± 14.2 (SD) mmHg to 14.6 ± 3.2 (SD) mmHg one year after surgery (P<0.00001). A statistically significant reduction of the number of antiglaucoma medications was obtained from 3.3 ± 1.1 (SD) preoperatively to 1.2 ± 1.1 (SD) at the end of follow-up. Statistically significant improvement of CDVA was observed 3, 6, and 12 months after surgery.Conclusions. Partial PPV with establishment of communication between the anterior chamber and the vitreous cavity enables effective IOP control over a 12-month observation; however, in most cases, it is necessary to use antiglaucoma medications for IOP control.

Unusual presentation of a choroidal melanoma

2021 ◽  
Vol 14 (5) ◽  
pp. e240983
Author(s):  
Sunila Jain ◽  
Kar Yen Phoong
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Pars Plana Vitrectomy ◽  
Visual Loss ◽  
Spindle Cell ◽  
Choroidal Melanoma ◽  
Artificial Eye ◽  
History Of ◽  
Pars Plana ◽  
Eye Clinic

A 49-year-old gentleman presented with a 1-day history of painful deterioration of vision in his right eye. He was lifting heavy weights just before this visual loss. On examination, his vision was perception of light in that eye, with a medically uncontrollable high intraocular pressure and hyphaema almost completely filling his anterior chamber. An ultrasound performed suggested a working diagnosis of a Valsalva related ‘eight ball’ bleed. After an anterior chamber washout, he had another episode of bleeding three days later. A pars plana vitrectomy was performed and the sample obtained was sent off to the laboratory, revealing a choroidal melanoma. Following enucleation, the histology confirmed a large necrotic spindle cell melanoma, with a haemorrhagic background. Fortunately, no liver metastasis was found. Since his diagnosis 3 years ago, he continues to be followed up in an artificial eye clinic and has regular liver scans under the care of his oncologist.

scholarly journals Safety and Efficacy of 25G vitrectomy surgery for malignant glaucoma in pseudophakia

2019 ◽  
Author(s):  
fei you
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Safety And Efficacy ◽  
Corrected Visual Acuity ◽  
Malignant Glaucoma ◽  
Intraocular Hemorrhage ◽  
Significant Difference ◽  
Best Corrected Visual Acuity

Abstract Background: malignant glaucoma after cataract surgery is still one of the serious complications, if not handled properly，it may lead to serious consequences. It is notoriously difficult to treat. 25G vitrectomy was performed to evaluate the safety and efficacy for the treatment of malignant glaucoma in pseudophakia. Methods: This is a retrospective, comparative case series study. A total of 20 eyes of 20 patients with malignant glaucoma after phacoemulsification were analyzed retrospectively in The First Affiliated Hospital Of Anhui Medical University from May 2015 to January 2018. All Medical Data including the best corrected visual acuity (BCVA), Change of intraocular pressure (IOP), the length of eye axis, and the depth of anterior chamber were recorded. SPSS 17.0 statistical software was used for analysis .Before surgery, the best corrected visual acuity (BCVA) was 1.8±0.6. The intraocular pressure was between 18-57mmHg, with an average of 35.2±10.4mmHg.The depth of anterior chamber was between 0.9-1.9mm, with an average of 1.3±0.2mm.The length of eye axis was 19.7-22.5mm,with an average of 20.6±0.5mm.All the patients were accomplished with 25G vitrectomy. Besides, anterior chamber inflammatory reaction and other complications were also observed postoperation. Results: The patients were followed up for 6-12 months with an average of 9 months. BCVA at the last follow up improved to 0.8±0.1, and there was significant difference compared to that before operation (P<0.01).IOP was from 12-19mmHg, an average of 16.1±2.5mmHg, there was significant difference compared to that before operation (t=7.6, p<0.01).Only one patient occurred low IOP (6mmHg) after surgery, IOP returned to normal level (14mmHg) after conservative treatment. No serious complications including corneal endothelium decompensation, intraocular lens (IOL) capture, intraocular hemorrhage, endophthalmitis and uncontrolled IOP were observed. Conclusions: 25G minimally invasive vitrectomy can treat malignant glaucoma after cataract surgery safely and effectively

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.

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.

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.

Changes in intraocular pressure and anterior chamber angle after congenital cataract extraction

2019 ◽  
Vol 23 (4) ◽  
pp. e30-e31 ◽  
Author(s):  
Jylan Gouda ◽  
Abdelrahman Elhusseiny ◽  
Reham H. Tomairek ◽  
Dina Elfayoumi ◽  
Ahmed Awadein ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Congenital Cataract ◽  
Cataract Extraction ◽  
Anterior Chamber Angle ◽  
Chamber Angle

scholarly journals The changes of anatomic and topographic characteristics of eye anterior segment after uncomplicated cataract phacoemulsification

2013 ◽  
Vol 94 (6) ◽  
pp. 853-858
Author(s):  
A A Ryabtseva ◽  
M P Yugaj ◽  
N S Nikitina
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Ultrasound Biomicroscopy ◽  
Anterior Chamber Angle ◽  
Ciliary Processes ◽  
Lens Implantation ◽  
Topographic Characteristics ◽  
Chamber Angle

Aim. To study the changes of anatomic and topographic characteristics of the eye anterior segment after uncomplicated cataract phacoemulsification using corneal incision with intraocular soft lens implantation. Methods. The data of ultrasound biomicroscopy and noncontact tonometry of 58 eyes (56 patients, 32 females, 24 males aged 54 to 78 years) before and after cataract phacoemulsification were analyzed. Paitents with survived ocular trauma, refractive keratoplasty, glaucoma, uveitis, and surgical complications (incomplete capsulorrhexis, posterior capsule rupture, ciliary zonule disinsertion, corneal burn). Apart from the common examinations (visual acuity testing, tonometry, tonography, eye A- and B-ultrasonography, biomicroscopy), all patients underwent eye ultrasound biomicroscopy. Results. Anterior chamber depth increased from 2.73±0.10 to 4.17±0.06 mm (p ≤0.001). Trabecula-iris distance measured at 500 μm from the scleral spur, increased from 0.38±0.02 to 0.47±0.02 mm (p ≤0.001). Anterior chamber angle increased from 28.69±1.87 to 42.73±1.56 degrees (p ≤0.001), the angle between the iris and the sclera increased from 32.78±1.39 to 41.36±0.84 degrees (p ≤0.001), the angle between the sclera and ciliary processes increased from 39.48±1.29 to 45.30±1.16 degrees (p ≤0.001). Intraocular pressure according to the non-contact tonometry data decreased from 18.16±1.29 to 13.55±0.95 mm Hg (p ≤0.001). Conclusion. Anterior chamber depth, trabecula-iris distance, anterior chamber angle, the angle between sclera and iris and the angle between sclera and ciliary processes increased significantly after phacoemulsification with intraocular lens implantation. Intraocular pressure decreased significantly according to the non-contact tonometry data.

scholarly journals Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

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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