refractory glaucoma
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2021 ◽  
pp. 112067212110700
Author(s):  
Rakhi. P. D’cruz ◽  
Aparna Rao

Purpose Iridocorneal endothelial (ICE) syndrome is well known to cause refractory glaucoma in young adults. Commonly acclaimed mechanism for trabeculectomy failure in these cases include accelerated subconjunctival fibrosis, abnormal endothelial proliferation, and closure of ostium. In the following article, we present a case of Iridocorneal endothelial syndrome that presented with refractory glaucoma after trabeculectomy due to rapidly progressive peripheral anterior synechiae causing angle closure and corneal decompensation that mandated a tailored surgical approach of management. Methods: This is a descriptive case report based on electronic medical records, patient observation, surgical intervention, and follow-ups. Case description: A thirty-eight-year-old-male presented to us with signs suggestive of iridocorneal endothelial syndrome with gonioscopy revealing peripheral anterior synechiae (PAS) over four clock-hours temporally. Uncontrolled intraocular pressure (IOP) despite maximal medical therapy mandated augmented trabeculectomy with anti-fibrotics. The bleb failed within 3 weeks of trabeculectomy, with evidence of progressive crawling PAS causing endothelial decompensation and raised IOP. He underwent Ahmed glaucoma valve (AGV) implant surgery with viscosynechiolysis and sectoral iridectomy under antiviral cover. This helped control IOP and retain corneal clarity, with no recurrence of PAS in the affected area. Conclusion: Progressive peripheral synechiae in ICE syndrome can cause early bleb failure and refractory glaucoma. Careful viscosynechiolysis and sectoral iridectomy alongside a second implant surgery can help salvage visual functions and preserve corneal clarity while preventing further progression of PAS in these eyes.


Author(s):  
A.P. Shakhalova ◽  
◽  
R.V. Sevciuc ◽  
O.N. Onufriichuk ◽  
A.V. Kuroyedov ◽  
...  

Refractory glaucoma laser treatment: together or instead?


2021 ◽  
Vol 14 (10) ◽  
pp. 1560-1564
Author(s):  
Dina Abd Elfattah ◽  
◽  
Tharwat Mokbel ◽  
Hisham Elsorogy ◽  
Abd-Elmonem A. Elhesy ◽  
...  

AIM: To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. METHODS: This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP?≤?21 mm Hg without medications indicated complete success while IOP?≤?21 mm Hg with medications indicated qualified success; and IOP<6 mm Hg was defined as hypotony. RESULTS: After a year of follow-up, IOP was significantly reduced in the intraluminal stenting group than in the external ligation group (11.67±0.89 vs 14.2±4.0 mm Hg, respectively, P=0.024). Postoperative hypotony was more common in the external ligation group (2 cases, 13.33%) than in the intraluminal stenting group (1 case, 6.67%). CONCLUSION: Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony (transient and persistent) that occurs in conventional AGV surgery.


2021 ◽  
Vol 18 (3) ◽  
pp. 422-426
Author(s):  
O. A. Kolpakova ◽  
O. L. Fabrikantov

Purpose. To analyze the outcomes of the national polymer microshunt implantation in refractory glaucoma surgery and to show its efficacy and safety. Patients and methods. We analyzed the results of treatment of 90 patients (90 eyes) with refractory glaucoma. All patients were divided into two groups: main group and comparison group. The patients in the main group (44 eyes) were implanted with the national polymer microshunt (Reper-NN). The patients in the comparison group (46 eyes) were implanted with Ex-PRESS. Control criteria in the postoperative period included visometry, tonometry by Maklakov, computed perimetry. The examinations were performed preoperatively, at discharge, in a month, in six months and later postoperatively.Results. When implanting the national polymer microshunt we reached the significant decrease in the intraocular pressure in the postoperative period in comparison with the preoperative level. The implantation outcomes of the national polymer microshunt and Ex-PRESS were comparable in efficacy and safety. The easy implantation and special construction of the national polymer microshunt provided with the sufficient efficacy and safety in refractory glaucoma surgery and allowed recommending its further application in the clinical practice.Conclusion. The use of Reper-NN microshunt is effective and safe method of treating refractory glaucoma. The implantation of this shunt may be the method of choice both in primary and secondary refractory glaucoma surgery. The least price of Reper-NN microshunt in comparison with the foreign analogue allows this surgery to be more available for patients with refractory glaucoma.


2021 ◽  
Vol 20 (3) ◽  
pp. 30-39
Author(s):  
I. E. Ioshin ◽  
A. I. Tolchinskaya ◽  
I. V. Maksimov ◽  
A. V. Rakova ◽  
O. M. Potapova ◽  
...  

PURPOSE. To evaluate the efficacy and safety of repeated micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with previously operated refractory glaucoma.MATERIALS AND METHODS. We examined 89 patients aged 74.2±7.3 years with moderate (16), advanced (58) and terminal (15) stages of uncompensated primary openangle glaucoma (POAG) before and within 12 months after the first MP-TSCPC (SUPRA 810, “Quantel Medical”, France) using standard laser parameters — 100 J. Indications for repeated MP-TSCPC were determined for 23 patients in 3 (1 patient), 6 (14 patients), 9 (8 patients) months after the first procedure. Repeated MP-TSCPC was carried out with higher impact energy — 125 J.RESULTS. After the first procedure, the hypotensive effect was achieved in 66 (74.2%) patients with refractory glaucoma lasting up to 12 months of follow-up. Repeated MP-TSCPC in 23 patients reduced the IOP by 31.2% in moderate, 31.8% in advanced, and 22.9% in terminal stages (p<0.05) by 6 months of follow-up. As a result, during 12 months of observation, MP-TSCPC (single and double) led to stabilization of the IOP in 83.1% of cases.CONCLUSION. Single and repeated micropulse TSCPC with laser energies of 100 J and 125 J is an effective and safe method of treating patients with refractory glaucoma. A single MP-TSCPC with laser energy of 100 J was effective in 66 (74.2%) patients by 12 months of observation, and single followed by repeated (laser energy of 125 J) — in 74 (83.1%) patients. It is possible to revise the basic parameters of the MP-TSCPC procedure from 100 to 125 J to achieve a longer and at the same time safe hypotensive effect in patients with refractory glaucoma.


2021 ◽  
Author(s):  
Michele Figus ◽  
Pasquale Loiudice ◽  
Andrea Passani ◽  
Laura Perciballi ◽  
Luca Agnifili ◽  
...  

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Faisal Ahmed ◽  
Nada G. Mohamed

Purpose. Refractory glaucoma patients continue to require surgical intervention in the form of trabeculectomy surgery or glaucoma drainage device (GDD). Those patients that require a GDD but have thin sclera or scleromalacia present a challenge. Methods. In this article, we present a novel “TAG sandwich” single surgical procedure in which thinned sclera is reinforced with a pericardial patch graft (“bottom layer of the sandwich”) allowing safe implantation of the GDD (“the tube sandwich filling”) and then placing another patch graft on top of the tube part of the GDD (“top layer of the sandwich”). The surgery was performed on an open-angle glaucoma patient with a generalized thin sclera and uncontrolled intraocular pressure despite maximal topical medication and oral acetazolamide. Results. Reinforcing a compromised sclera with a pericardium patch graft allowed the safe implantation of a glaucoma drainage device. The patient’s intraocular pressure was safely controlled at 7 mmHg almost 1-year postsurgery without intraocular pressure-lowering drops. Conclusions. This scleral strengthening procedure can be considered by readers in other ocular surgeries where there is a risk of scleral perforation, as well as part of a combined surgery where refractory glaucoma patients with thin sclera require scleral reinforcement to allow for safer implantation of a glaucoma drainage device.


2021 ◽  
Vol 20 (2) ◽  
pp. 51-56
Author(s):  
T. K. Botabekova ◽  
V. P. Erichev ◽  
N. A. Aldasheva ◽  
A. A. Bulgakova ◽  
G. K. Hachatryan

PURPOSE. To assess the hypotensive effectiveness, frequency and nature of intra- and postoperative complications in patients with various clinical manifestations of refractory glaucoma.MATERIALS AND METHODS. The study included 196 patients (196 eyes) with various forms, stages and clinical manifestations of glaucoma. There were 142 patients with primary glaucoma, among them 120 with open-angle glaucoma and 22 with angle-closure glaucoma. Among the patients with primary glaucoma, 85 had pseudophakia (77 with openangle and 8 with angle-closure forms); 57 had a native lens (43 with open-angle and 14 with angle-closure forms of the disease). Secondary glaucoma was presented mainly by patients with neovascular (21) and postuveal (16) glaucoma. The intraocular pressure (IOP) level in the group as a whole ranged from 16 to 50 mm Hg (on average 30.1±2.6 mm Hg). In all presented cases of surgical intervention, the Glautex drainage was used, which is a bioresorbable composite biomaterial based on polylactic acid (polylactide) and polyethylene glycol (manufactured by “HiBiTech”, Russia). Standard methods of patient examination were used. RESULTS.In patients with POAG, the IOP averaged 13.7± 4.7 mm Hg one week after surgery and 16.1±3 mm Hg 12 months after surgery. The absolute success of the operation was noted in 71 patients with POAG (59.2%); the relative hypotensive effect — in 85.8%. In primary angle-closure glaucoma, the same indicators were 47.6 and 61.1%, respectively. In the group of patients with neovascular and postuveal glaucoma, the hypotensive effect was as expected lower and amounted to 42.8 and 50.0%, respectively. The restart of therapy at different periods of observation was done in 78.3%. Complications, their frequency and nature, noted by us in the operated patients, could be attributed to those typical for fistulizing operations in refractory glaucoma. The most common complication was ciliochoroidal detachment, which was seen in all groups, but percentage-wise was more common in patients with PACG, neovascular and postuveal glaucoma.CONCLUSION. Composite drainage based on polylactic acid (polylactide) and polyethylene glycol (glautex) is an effective and safe solution to the issue of surgical treatment of glaucoma. The antihypertensive effectiveness of the Glautex drainage implant depends on the severity of the glaucomatous process and the timeliness of the surgical intervention. The frequency and nature of complications depends on the degree of refractoriness of glaucoma, initial clinical characteristics of the process, and patients' multimorbidity.


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