Flexible Ahmed Valve for Selected Cases of Refractory Glaucoma

2011 ◽  
Vol 22 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Tharwat H. Mokbel ◽  
Mohamed A. Khalaf ◽  
Sherief E. El-Khouly ◽  
Nasser O. El-Metwally
Keyword(s):  
Flexible Plate ◽  
Ahmed Glaucoma Valve ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Ahmed Valve ◽  
History Of ◽  
Iop Measurement ◽  
Glaucoma Drainage Implants ◽  
Complete History

Purpose Glaucoma drainage implants are a useful alternative in treating glaucomas that are resistant to medical therapy and conventional glaucoma filtration surgery. The aim of this study is to evaluate flexible Ahmed glaucoma valve implant for selected cases of refractory glaucoma regarding its efficiency in controlling intraocular pressure (IOP) and possible postoperative complications of its implantation and their management. Method Patients included in this study were selected from patients with uncontrolled IOP by conventional filtration surgery as well as maximum tolerable topical medical treatment when surgery or laser is unlikely to control IOP. For every patient, complete history of age, sex, and history of previous ocular disease was done. Ocular examination for IOP measurement, best-corrected visual acuity measurement, and condition of conjunctiva was done. Ahmed glaucoma valve flexible plate implant (FP7 and FP8) was used. Results The present study included 40 eyes of 40 patients and preoperative IOP ranged from 32 mmHg to 58 mmHg with a mean of 40.36 ± 7.78 mmHg. The postoperative IOP ranged between 14.0 mmHg and 28.0 mmHg with a mean of 18.73 ± 4.8 mmHg. The criteria of success were applied in 37 eyes of 40 eyes (92.5%); they included 30 eyes (81.8%) with absolute success and 7 eyes (18.9%) with partial success. Conclusions Flexible Ahmed glaucoma valve plate implant is a satisfactory method for controlling elevated IOP in cases of refractory glaucoma with success rate of 92.5% and lower incidence of immediate postoperative and implant-related complications.

scholarly journals The DNA topoisomerase II inhibitor amsacrine as a novel candidate adjuvant in a model of glaucoma filtration surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kotaro Yamamoto ◽  
Taiki Kokubun ◽  
Kota Sato ◽  
Takahiro Akaishi ◽  
Atsushi Shimazaki ◽  
...  
Keyword(s):  
High Throughput Screening ◽  
Topoisomerase Ii ◽  
Dna Topoisomerase Ii ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Sharp Drop ◽  
Dna Topoisomerase ◽  
Topoisomerase Ii Inhibitor ◽  
Top2 Inhibitor

AbstractTreatments for refractory glaucoma include trabeculectomy, in which a filtering bleb is created to reduce aqueous pressure. Mitomycin C (MMC) is often used as an adjuvant to reduce post-trabeculectomy bleb scarring and consequent failure. However, scarring sometimes still occurs. Thus, we searched for more effective trabeculectomy adjuvants with high-throughput screening (HTS) of a library of 1,165 off-patent drug compounds. This revealed that amsacrine (AMSA), a DNA topoisomerase II (TOP2) inhibitor, was the top candidate. Compared to MMC, rabbits that underwent trabeculectomy with 10% AMSA had lower IOP at 42, 56, and 70 days (P < 0.01 at all measurement points) and a higher bleb score at 28, 42, 56, and 70 days (P =  < 0.01, 0.04, 0.04, and < 0.01, respectively). Compared to saline, rabbits that received 1% AMSA also had lower IOP and better bleb score at all time points, without a sharp drop in IOP just after surgery (all P < 0.01). Both effects were milder than MMC at 7 days (P = 0.02 and <0.01, respectively). Thus, this study showed that HTS may help identify new, promising uses for off-patent drugs. Furthermore, trabeculectomy with AMSA at a suitable concentration may improve the prognosis after trabeculectomy compared to MMC.

The role of Ahmed glaucoma valve in the management of refractory glaucoma: Long-term outcomes and complications

2020 ◽  
pp. 112067212096873
Author(s):  
Jade Luzu ◽  
Christophe Baudouin ◽  
Pascale Hamard
Keyword(s):  
Medical Treatment ◽  
Glaucoma Surgery ◽  
Ahmed Glaucoma Valve ◽  
Success Rates ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Corneal Decompensation

Purpose: To retrospectively evaluate the efficacy and long-term complications of the Ahmed glaucoma valve (AGV) in refractory glaucoma. Materials and methods: Seventy-eight eyes with glaucoma refractory to conventional surgical procedures (filtration surgery and diode laser cyclophotocoagulation) underwent AGV implantation between May 2006 and August 2018. The criteria for success were defined as an intraocular pressure (IOP) less than 18 mmHg and a decrease of at least 20% from the preoperative IOP. The criteria for failure were an IOP greater than 18 mmHg or less than 5 mmHg, an increase in medical treatment, a decrease of less than 20% of the initial IOP, the need for another glaucoma surgery, or a decrease in visual acuity attributable to the valve. Results: IOP decreased from 31.0 ± 9.0 mmHg to 17.2 ± 7.2 mmHg (mean follow-up 32.5 months), for a mean IOP lowering of 44.5% ( p < 0.001). Medical treatment was significantly reduced from 5.3 ± 1.5 to 2.8 ± 1.9 ( p < 0.0001). The cumulative success rates were 59.4% at 3 years and 45.1% at 5 years. Encapsulation of the filtration bleb was the most common short-term complication (32.1%). Relevant long-term complications were bleb fibrosis with elevated IOP (12.8%) and corneal decompensation (10.2%). Conclusion: The AGV is an effective procedure in the long-term for controlling IOP in refractory glaucoma, with limited incidence of complications. These results suggest that the AGV might be considered earlier in the surgical strategy for glaucoma not controlled after one well-performed conventional filtration surgery.

scholarly journals Glaucoma Surgery in Scleromalacia: Using Endoscopic Cyclophotocoagulation where Conventional Filtration Surgery or Angle Procedures are contraindicated

2017 ◽  
Vol 11 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Dan Lindfield ◽  
Miles R Stanford ◽  
Saurabh Goyal
Keyword(s):  
Minimally Invasive ◽  
Granulomatosis With Polyangiitis ◽  
Invasive Procedure ◽  
Glaucoma Surgery ◽  
Postoperative Management ◽  
Angle Closure ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
History Of ◽  
And Control

ABSTRACT Aim To describe the surgical management of glaucoma in a patient with severe scleromalacia, and secondary angle closure. Introduction The management of glaucoma with coexisting scleromalacia plus secondary angle closure is challenging as most commonly performed incisional glaucoma surgery as well as minimally invasive glaucoma surgery (MIGS), which targets the drainage angle are all contraindicated. Case report Medically refractory glaucoma in a 60-year-old male with a 30-year history of granulomatosis with polyangiitis resulting in extensive severe scleromalacia, cicatricial lower lid retraction with significant conjunctival exposure, and widespread synechial angle closure from chronic anterior uveitis was managed with combined phacoemulsification cataract surgery, and endoscopic cyclophotocoagulation (ECP). Careful postoperative management with intensive immunosuppression was used to successfully prevent complications related to the surgery, which resulted in improved visual acuity, and control of intraocular pressure (IOP). Conclusion The ECP is a minimally invasive procedure that targets inflow of aqueous, and can be safely and successfully used to control IOP in challenging patients with complex secondary glaucoma, where the use of traditional incisional surgery, and other MIGS procedures are all contraindicated. Clinical significance The choice of surgical treatment for medically refractory glaucoma needs to be selected based on the circumstances of individual patients, and take into consideration the condition of the sclera, conjunctiva and drainage angle, against the safety and efficacy of possible treatments. How to cite this article Rodrigues IAS, Lindfield D, Stanford MR, Goyal S. Glaucoma Surgery in Scleromalacia: Using Endoscopic Cyclophotocoagulation where Conventional Filtration Surgery or Angle Procedures are contraindicated. J Curr Glaucoma Pract 2017;11(2):73-75.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma

2021 ◽  
pp. 112067212110177
Author(s):  
Ayse Gul Kocak Altintas ◽  
Cagri Ilhan
Keyword(s):  
Clinical Characteristics ◽  
Pseudoexfoliation Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Mean Values ◽  
Time Parameters ◽  
The Mean ◽  
Group 2 ◽  
Surgical Manipulations ◽  
Phaco Time

Purpose: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. Methods: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. Results: The mean ages and male-to-female ratios of the groups were similar ( p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups ( p > 0.05, for all). Some surgical manipulations, including pupillary stretching ( p = 0.004), pupillary membrane peeling ( p = 0.021), iris hook using ( p = 0.041), and capsular tension ring implantation ( p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar ( p > 0.05, for both), the mean APP value was significantly lower in Group 2 ( p = 0.011). Conclusion: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

2021 ◽  
pp. 112067212110122
Author(s):  
Paolo Arpa ◽  
Cristina Arpa
Keyword(s):  
Surgical Technique ◽  
Anterior Chamber ◽  
Previous History ◽  
Implantation Technique ◽  
Fluid Loss ◽  
Ahmed Glaucoma Valve ◽  
Intraocular Hemorrhage ◽  
Hemorrhagic Complications ◽  
History Of ◽  
Choroidal Effusion

Purpose: To describe the application of a modified Ahmed glaucoma valve (AGV) surgical implantation technique in vitrectomized eyes, in order to minimize the risk of early postoperative hypotony, which leads to hemorrhagic complications. Materials and methods: Data of patients implanted with AGV using the surgical technique described were retrospectively reviewed. Inclusion criterion: glaucomatous eyes with previous history of pars plana vitrectomy. Intraocular pressure (IOP) measurement and ophthalmic examination were performed preoperatively and postoperatively weekly for 1 month for the detection of early hypotony, choroidal effusion/detachment, intraocular hemorrhage. The surgical technique consisted in creating a 5 mm long scleral tunnel with a 23 G needle reaching the anterior chamber at the iridocorneal angle, in which the Ahmed glaucoma valve tube was inserted. Results: Ten eyes of 10 patients were included. Median preoperative IOP was 30.5 mmHg [interquartile range (IQR) 28.3–33.0]; median postoperative IOP was 12.0 mmHg (IQR 9.3–13.0) at 1 week, and 12.5 mmHg (IQR 11.0–15.0) at 1 month. In no cases postoperative IOP was <8 mmHg. On the first postoperative day, five (50%) eyes showed few blood clots in the anterior chamber. On the second-week appointment, moderate choroidal effusion was observed in two eyes (20%). No hemorrhagic complications were observed. Conclusions: The creation of a long intrascleral tunnel with a 23 G needle for AGV implantation in vitrectomized eyes could be effective in decreasing leakage through the space between the valve tube and the sclerocorneal tissue. This technique is safe, easy to perform, feasible and fast. Due to its advantages and good postoperative results, it could also be adopted in non-vitrectomized eyes.

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