Safety and efficacy of Ahmed glaucoma valve implantation in refractory glaucomas in northern Indian eyes

To evaluate the safety and efficacy of Ahmed glaucoma valve [AGV] implantation in refractory glaucoma in Northern Indian eyes. The success rate of trabeculectomy remains low in cases of refractory glaucoma even with the use of antifibrotics. Glaucoma drainage devices have proven to be more efficacious in reducing intraocular pressure [IOP] in these glaucomas. Retrospective records of 55 consecutive patients who underwent AGV implantation at Dr. Shroff's Charity Eye Hospital, New Delhi, India from January 2003 to December 2012 were reviewed. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications, number of prior incisional surgeries, visual acuity and IOP on medical treatment. Postoperative data included visual acuity and IOP on day one, 1 week, 1 month, 3 months, 6 months, 1 year and yearly thereafter, number of anti-glaucoma medications, any complication or additional surgical intervention required. Success was defined as IOP >5 and <22 mmHg with or without treatment. Mean IOP decreased from 39.71 +/- 8.99 pre-operatively to 17.52 +/- 5.72 mmHg at last follow-up [p < 0.001] and number of medications reduced from 3.27 +/- 0.84 to 1.25 +/- 0.88 [p < 0.001]. Visual acuity remained within one Snellen line or improved at last follow-up in 47 cases [85.4%]. The cumulative probability of success was 85.45% at 1 year and 79.63% at 3 years. The incidence of post-operative complications was 25.45%.AGV implantation has proven to be safe and is effective in controlling IOP in refractory glaucoma in Northern Indian eyes

Vitreous occlusion of tube implant in a phakic patient with traumatic glaucoma

Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management