Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year

PURPOSE: To evaluate the outcome after Ahmed valve implantation in patients with neovascular glaucoma when using intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU). METHODS: A total of 40 eyes of 40 patients with neovascular glaucoma who received antiglacomatous medication without previous glaucoma surgery were included in the present study. The patients received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of three consecutive visits where intraocular pressure (IOP) was >18 mmHg or 20% IOP reduction from baseline and the final number of topical medication did not reduce by at least two from baseline, 2) the need for additional surgery, or 3) the occurrence of a serious complication. RESULTS: The cumulative success rate was 77.5% at 12 months. The final number of topical medication after Ahmed valve implantation was 0.73+/-0.78, and the change in the number of medication from baseline was -2.18+/-0.84. Serious complications such as endophthalmitis, valve exposure or prolonged hypotony were not observed. CONCLUSIONS: The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation results in a high success rate and good IOP control and did not show serious complications within the postoperative period.

Effects of Medpor(R) Sheet as Substitute for Tarsus in Eyelid Reconstruction

PURPOSE: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.