Sequential treatment of neovascular glaucoma with cataract by Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of conbercept injection combined with Ahmed valve implantation and phacoemulsification in the treatment of neovascular glaucoma(NVG).<p>METHODS: Retrospective analysis. Totally 18 patients(18 eyes)with NVG complicated combined with cataract in our hospital from June 2018 to January 2020. All patients received intraocular injection of conbercept at 3-7d before surgery, Ahmed valve implantation and phacoemulsification were performed after meeting the surgical indications. Best corrected visual acuity(BCVA), intraocular pressure(IOP), resolution of iris neovascularization and postoperative complications were followed up after the surgery, and all the cases were followed up 12mo. <p>RESULTS: Compared with preoperation(51.44±8.18 mmHg), IOP was significant decreased at 1, 7d, 1, 3, 6mo, 1a after surgery(25.94±11.82, 15.39±4.97, 15.94±2.69, 15.33±4.54, 18.89±7.95, 16.27±5.22 mmHg)(<i>P</i><0.05). Last follow up after surgery, BCVA was improved in 12 eyes(67%), unchanged in 5 eyes(28%)and decreased in one eye. At 1a after operation, the complete success rate was 83%(15 eyes), conditional success rate was 11%(2 eyes), one eye of losing control of IOP was failed. <p>CONCLUSION: Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification can not only effectively control postoperative IOP, but also improve the visual acuity of the patients as much as possible. It is an effective method for the treatment of NVG with cataract.

Análisis de resultados postoperatorios entre trabeculectomia y derivación con válvula ahmed en pacientes con glaucoma primario de ángulo abierto del Hospital Central Militar / Analysis of postoperative results between trabeculectomy and shunt with ahmed valve in patients with primary open-angle glaucoma at Hospital Central Militar

Resumen Introducción: El glaucoma es una enfermedad que afecta al ojo y se caracteriza por la lesión tanto del nervio óptico como de la retina, relacionados con el aumento de la presión intraocular. La detección el tratamiento adecuado ayuda a ofrecer una mejor calidad de vida al paciente. Objetivo: Comparar la presión intraocular posoperatoria entre la trabeculectomía y la derivación con válvula Ahmed en pacientes con glaucoma primario de ángulo abierto del Hospital Central Militar de Enero del 2017 a Enero de 2018. Material y método: Es un estudio observacional, descriptivo y retrospectivo, de pacientes diagnosticados con glaucoma primario de ángulo abierto atendidos en la consulta de oftalmología en el Hospital Central Militar de enero de 2017 a enero del 2018, en quienes se empleó como herramienta de trabajo sus expedientes clínicos electrónicos, utilizando el programa R versión 3.4.4 (R Foundation for Statistical Computing, Vienna, Austria). Resultados: Se identificaron un total de 100 pacientes en el periodo de estudio. Los pacientes presentaron una edad entre 32 y 93 años. El 35 % de los pacientes fueron sometidos a trabeculectomía y el 65 % restante fueron sometidos a derivación con válvula Ahmed donde se observó una mayor reducción con la válvula Ahmed en pacientes con mayor presión prequirúrgica. Conclusiones: Podemos concluir que la derivación con válvula Ahmed resulta en mejores resultados postoperatorios, los cuales se observan después de la segunda consulta de seguimiento, por lo cual esta técnica trae mejores resultados a manejos de la PIO de los pacientes que requieren tratamiento quirúrgico, a pesar de que la trabeculectomía sea el estándar de oro ya no representa mayores beneficios que utilizar una técnica menos invasiva como lo es la válvula Ahmed. Así mismo, la trabeculectomía regula mejor las presiones intraoculares en aquellos pacientes que no tienen tanto aumento de la PIO.

Abstract Introduction: Glaucoma is a disease that affects the eye and at the same time the injury as well as the optic nerve and the retina, related to the increase in intraocular pressure. The detection of adequate treatment helps to offer a better quality of life to the patient. Objective: To compare the postoperative intraocular pressure between the trabeculectomy and the Ahmed valve shunt in patients with primary open angle glaucoma of the Central Military Hospital from January 2017 to January 2018. Material and method: It is an observational, descriptive and retrospective study, patients diagnosed with glaucoma. his electronic clinical records, using the R program version 3.4.4 (R Foundation for Statistical Computing, Vienna, Austria). Results: A total of 100 patients were identified during the study period. The patients present an age between 32 and 93 years. 35% of the patients underwent a trabeculectomy and the remaining 65% underwent a bypass with the Ahmed valve where a greater reduction was observed with the Ahmed valve in patients with higher presurgical pressure. Conclusions: We can conclude that the derivation with the Ahmed valve results in better postoperative results, which are observed after the second follow-up visit, so this technique brings better results to the IOP management of patients who require treatment. surgical, a The work is not related to the use of a less invasive technique. Likewise, trabeculectomy better regulates intraocular pressures in those patients who do not have such an increase in IOP.

Resultados de la válvula de Ahmed en el glaucoma refractario pediátrico / Results of Ahmed valve implantation in pediatric refractory glaucoma

RESUMEN Objetivo: Determinar los resultados del implante dispositivo de glaucoma de Ahmed en pacientes con glaucoma pediátrico refractario. Métodos: Se realizó un estudio de serie de casos en 15 pacientes (17 ojos) con glaucoma pediátrico refractario atendidos en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" de enero del año 2011 a enero de 2016, a quienes se les implantó una válvula de Ahmed y fueron seguidos por un periodo de 3 años. Se evaluaron la agudeza visual, la presión intraocular pre y posoperatoria, el éxito completo, el éxito calificado, las complicaciones y las reintervenciones. Resultados: La mediana de edad de los pacientes fue de 4,0 años y predominó el sexo masculino (58,8 por ciento). La media de la presión intraocular preoperatoria fue de 37,3 mmHg y disminuyó a 19,4 mmHg de manera significativa (p= 0,000) en el posoperatorio. El análisis de supervivencia global mostró una probabilidad acumulada de éxito completo de 94,1 por ciento al 1,5 mes, 70,6 por ciento a los 12 meses, 58,8 por ciento a los 18 meses, y 47,1 por ciento a los 24 y a los 36 meses. La de éxito calificado fue de: 94,1 por ciento a los 12 meses, 82,4 por ciento a los 18 meses, y 76,5 por ciento a los 24 y a los 36 meses. La frecuencia de complicaciones fue de 29,4 por ciento y la de reintervenciones de 23,5 por ciento. Conclusiones: El implante de válvula de Ahmed en el glaucoma pediátrico refractario es una indicación para la reducción de la presión intraocular(AU)

ABSTRACT Objective: Determine the results of Ahmed glaucoma valve implantation in patients with pediatric refractory glaucoma. Methods: A case-series study was conducted of 15 patients (17 eyes) with pediatric refractory glaucoma attending the pediatric ophthalmology service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2011 to January 2016. These patients underwent Ahmed valve implantation and were followed up for a period of three years. Evaluation was performed of visual acuity, pre- and post-operative intraocular pressure, complete success, qualified success, complications and reinterventions. Results: Mean age of patients was 4.0 years, with a predominance of the male sex (58.8 percent). Mean preoperative intraocular pressure was 37.3 mmHg, significantly decreasing to 19.4 mmHg (p= 0.000) in the postoperative period. Overall survival analysis revealed a cumulative probability of complete success of 94.1 percent at 1.5 months, 70.6 percent at 12 months, 58.8 percent at 18 months and 47.1 percent at 24 and 36 months. Cumulative probability of qualified success was 94.1 percent at 12 months, 82.4 percent at 18 months and 76.5 percent at 24 and 36 months. The rate of complications and reinterventions was 29.4 percent and 23.5 percent, respectively. Conclusions: Indication of Ahmed valve implantation in pediatric refractory glaucoma is aimed at reducing intraocular pressure(AU)

Treatment for neovascular glaucoma with Ranibizumab and trabeculectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the curative effect of intravitreal injection of ranibizumab combined with trabeculectomy on neovascular glaucoma(NVG).<p>METHODS: The clinical data of 52 patients(52 affected eyes)with NVG who were admitted to the hospital between September 2015 and April 2017 were collected and retrospectively analyzed. The patients were divided into group A(intravitreal injection of ranibizumab combined with trabeculectomy, 31 affected eyes)and group B(intravitreal injection of ranibizumab combined with Ahmed glaucoma valve implantation, 21 affected eyes)according to the surgical method. They were followed up for 6mo after surgery. The intraocular pressure before surgery and after surgery, eyesight, visual field and complications after surgery were compared between two groups. The clinical curative effect was assessed. <p>RESULTS: The intraocular pressure of both groups decreased gradually after surgery. The intraocular pressure of group A was lower than that of group B at 7d, 1mo and 3mo after surgery(<i>P</i><0.05). There was no significant difference in the improvement of eyesight between the two groups at 6mo after surgery(<i>P</i>>0.05). The total effective rate of treatment in group A at 6mo after surgery was obviously higher than that in group B(97% <i>vs</i> 71%, <i>P</i>=0.013). The incidence rates of corneal edema and hyphema in group A were lower than those in group B(<i>P</i><0.05).<p>CONCLUSION: Intravitreal injection of ranibizumab combined with trabeculectomy for treating NVG can effectively decrease and maintain intraocular pressure and reduce the incidence of postoperative complications, with marked curative effect.

Clinical effects of anti-VEGF combined with Ahmed valve implantation and phacoemulsification or not for neovascular glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the efficacy of anti-VEGF combined with Ahmed valve implantation with phacoemulsification or not for neovascular glaucoma(NVG)with cataract. <p>METHODS: Totally 47 patients(47 eyes)of NVG with cataract were given intraocular injection of anti-VEGF before the surgery, and then treated with Ahmed valve implantation. 19 cases(19 eyes)combined with phacoemulsification, and single Ahmed valve implantation in 28 cases(28 eyes). The vision, IOP, anti-glaucoma medicines and complications of the two groups were recorded and compared with 6mo postoperatively. <p>RESULTS:The IOP of all cases at all time points after surgery was significantly decreased after surgery(<i>P</i> <0.05). 6mo after surgery, in the combined group, the vision was improved in 10 cases(10 eyes)(53%), unchanged in 8 cases(8 eyes)(42%)and decreased in 1 case(1 eye)(5%). The complete success rate was 84%(16/19), the conditional success rate was 11%(2/19), and the failure rate was 5%(1/19). In the single Ahmed valve group, the vision was improved in 11 cases(11 eyes)(39%), unchanged in 17 cases(17 eyes)(61%), decreased in 0 case(0 eye)(0%), complete success rate in operation was 61%(17/28), conditional success rate was 25%(7/28), and the failure rate was 14%(4/28).<p>CONCLUSION: Compare with anti-VEGF with Ahmed vlave implantation, combined with phacoemulsification can effectively control the postoperative IOP, improve the BCVA of the patient as much as possible, reduce the amount of the postoperative glaucoma medicament use, and facilitate the follow-up of the fundus of the patient. It is a efficacy treatment for NVG with cataract.

The Clinical Effect of Professional Nursing Intervention on Ahmed Glaucoma Valve Implantation / 昆明医科大学学报

Objective To discuss clinical effects and security of using Ahmed valve implantation surgery to cure neovascular glaucoma.Methods The clinical data of 78 patients with neovascular glaucoma in the Department of Ophthalmology from May 2015 to May 2017 were collected and retrospectively analyzed. The patients were randomly divided into the research group and the control group. Both groups were treated with Ahmed valve implantation surgery. Patients in the research group were treated with the professional nursing intervention of neovascular glaucoma. The intraocular pressure (IOP) and clinical effects of both groups before and after treatment were compared.Results The achievement ratio of operation in the research group and the control group was 87.5% and 84.2%, respectively. There was no statistical difference (P＞0.05) . The post－operation follow－up showed that average IOP in both groups was obviously lower than that in pre－operation (P＜0.01) . But average post－operative IOP in both groups had no statistical difference (P＞0.05) . There were three patients with complications in the research group, showing 10.0% of complication ratio. There were 10 patients with complications in the control group, showing 26.3% of complication ratio, which was the statistically different (P＜0.05) . Conclusions The curative effects of using Ahmed valve implantation surgery to cure neovascular glaucoma should be affirmed. The operation shows good short－term effects and reduction of complications but more long－term effects. By coordinating with nursing interference, long－term complications can be reduced. Therefore, it is an effective method to cure glaucoma.

Conjunctival Necrosis following Ahmed Valve Implantation and Subtenon Triamcinolone Injection

PURPOSE: We report a case of conjunctival necrosis in a glaucoma patient who underwent Ahmed valve implantation and subtenon triamcinolone injection. CASE SUMMARY: subconjunctival injections of mitomycin C in her right eye. Ahmed valve implantation and subtenon triamcinolone injection were performed in the right eye. Four weeks later, conjunctival necrosis was observed. After debridement of necrotic tissue, an additional conjunctival autograft was needed because of recurrence of the conjunctival necrosis. After amniotic membrane transplantation was performed for one more recurrent conjunctival necrosis, conjunctival epithelialization was completed. CONCLUSIONS: Although conjunctival necrosis after periocular injection of triamcinolone is a rare complication, previous multiple usage of antimetabolites such as mitomycin C might be associated with a higher risk of developing conjunctival necrosis. In such cases, aggressive surgical intervention may be helpful in the reconstruction of the conjunctival epithelium.

Effects of Early Postoperative Intraocular Pressure after Ahmed Glaucoma Valve Implantation on Long-term Surgical Outcomes

PURPOSE: To evaluate the long-term effects of early postoperative intraocular pressure (IOP) after Ahmed glaucoma valve (AGV) implantation on long-term surgical outcomes. METHODS: This retrospective, non-randomized study included 100 eyes of 100 patients who underwent AGV surgery. We divided the enrolled patients into four groups according to the presence of transient hypotony within the first postoperative week or the presence of a hypertensive phase during the first three postoperative months. Postoperative IOP, the number of glaucoma medications, and cumulative success rate were compared among the groups. RESULTS: There was significantly better IOP control and a better success rate in the non-hypertensive phase group 2 years postoperatively. However, no significant difference was found in the IOP or success rate at 2 years postoperatively between the transient hypotony and non-hypotony groups. Further subgroup analysis showed that the non-hypotony, non-hypertensive phase group had a significantly higher success rate (100%) at 2 years postoperatively. CONCLUSIONS: We can predict the long-term prognosis after AGV implantation by considering the early postoperative IOP state and the presence of a hypertensive phase.

Glaucoma refractario y catarata: un reto quirúrgico / Refractory glaucoma and cataract: a surgical challenge

Paciente masculino de 75 años de edad con antecedentes de hipertensión arterial y glaucoma por 30 años. Acudió a la Consulta de Baja Visión del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el año 2016 y refirió disminución progresiva de la visión en el ojo izquierdo. Al fondo de ojo se observó daño glaucomatoso avanzado y degeneración macular seca en evolución. Después de combinar 3 fármacos para ambos ojos a dosis máxima, los valores de la presión intraocular no eran protectores. Se implantó válvula de Ahmed en temporal inferior del ojo izquierdo. A la semana, la agudeza visual se limitaba a movimiento de manos; la presión intraocular era de 6 mmHg y la atalamia grado 4. Se drenó desprendimiento coroideo seroso y se reformó la cámara anterior. Se indicó tratamiento antinflamatorio tópico, sistémico y midriático ciclopléjico. A los 15 días la agudeza visual mejor corregida era de 0,2 y la presión intraocular de 12 mmHg, sin atalamia. Tres meses después se realizó facoemulsificación y se colocó lente intraocular plegable en saco capsular. La agudeza visual mejor corregida era de 0,6 y la presión intraocular de 11 mmHg. La presión intraocular nunca ha superado los 15 mmHg; no se ha detectado progresión del daño glaucomatoso y se ha conservado la agudeza visual(AU)

A male 75-year-old patient with a 30-year history of hypertension and glaucoma presented at the Low Vision Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the year 2016 and stated experiencing progressive vision reduction in his left eye. Funduscopy revealed advanced glaucomatous damage and dry macular degeneration in progress. After combining 3 drugs for both eyes at a top dosage, intraocular pressure values were not protective. An Ahmed valve was implanted in the inferior temporal quadrant of the left eye. One week later, visual acuity was limited to hand movement, intraocular pressure was 6 mmHg and athalamia was grade 4. The serous choroidal detachment was drained and the anterior chamber was reformed. Topical antiinflammatory, systemic and mydriatic cycloplegic treatment was indicated. Fifteen days later best corrected visual acuity was 0.2 and intraocular pressure was 12 mmHg, without athalamia. Phacoemulsification was performed three months later and a foldable intraocular lens was placed in the capsular sac. Best corrected visual acuity was 0.6 and intraocular pressure was 11 mmHg. Intraocular pressure has never exceeded 15 mmHg, glaucomatous damage has not been found to progress, and visual acuity has been preserved(AU)

Tube Erosion with Scleral Melting after Ahmed Valve Implantation Using a Synthetic Dural Substitute

PURPOSE: The objective of this case report was to present tube erosion of Ahmed valve implantation using a synthetic dura substitute (Neuro-Patch®, B. Braun, Boulogne, France). CASE SUMMARY: Tube erosion was caused by dissolution of the conjunctiva and partial-thickness scleral tunnel in 5 patients who received Ahmed valve implantation using a synthetic dura substitute for glaucoma treatment 2 to 4 months after the operation. Furthermore, the patients required re-operation for preventing secondary complications such as endophthalmitis. CONCLUSIONS: This case series using a synthetic dura substitute in Ahmed valve implantation demonstrated the risk of tube erosion with scleral tunnel melting and following secondary complications even with a partial-thickness scleral tunnel method.

Long-Term Outcome of Ahmed Valve Implantation Combined with 23-Gauge Vitrectomy in Eyes with Neovascular Glaucoma

PURPOSE: To investigate the surgical outcome of Ahmed glaucoma valve implantation (AVI) combined with 23-gauge vitrectomy in eyes with medically uncontrolled neovascular glaucoma (NVG). METHODS: Thirty six eyes of 35 NVG patients who underwent AVI combined with 23-gauge vitrectomy and have been followed-up at least 6 months after surgery and were retrospectively reviewed. Surgical success was defined as the control of intraocular pressure (IOP) between 6 and 21 mm Hg, irrespective of the use of topical IOP lowering medications. Surgical failure was defined as the failure of IOP control or visual acuity aggravated to no light perception after the surgery. Overall success rate, median survival time, and clinical factors associated with survival time were investigated. RESULTS: The overall success rate was 63.2% after a mean of 34.0 ± 31.7 months postoperative follow-up. The success rate was 83.3% at postoperative 6 months, 72.7% at postoperative 12 months and 63.2% at postoperative 3 years. The underlying retinal diseases were proliferative diabetic retinopathy (PDR; n = 20, 55.5%), central retinal vein occlusion (CRVO; n = 12, 33.3%), ocular ischemic syndrome (n = 2, 5.6%), and other retinal vascular diseases (n = 2, 5.6%). The survival times were significantly shorter in eyes with CRVO (20.2 ± 30.5 months) compared to PDR (33.1 ± 30.8 months), and in phakic eyes (33.1 ± 30.8 months) compared to pseudophakic eyes (37.7 ± 35.4 months) (p < 0.05). In the multivariate analysis, preoperative phakic eyes were significantly associated with a shorter survival time (hazard ratio = 5.626, p = 0.030). CONCLUSIONS: Combined surgery of Ahmed glaucoma valve implantation and 23-gauge vitrectomy showed favorable outcome in the treatment of medically uncontrolled NVG. Preoperative lens status may affect the long-term success rate in such patients.

Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

PURPOSE: To report serial cases of patients who received surgical treatment for tube erosion after Ahmed valve implantation. METHODS: In this retrospective and longitudinal study, surgical outcomes of reconstruction for tube erosion after Ahmed valve implantation were evaluated. Tube erosion occurred in 7 of 125 eyes (121 patients) at 60.5 ± 67.5 months (2 to 196 months). To prevent recurrence of tube erosion, the tube was repositioned backward in 4 eyes. Scleral allograft was used in all cases. Partial thickness scleral flap, collagen matrix implant, or bovine pericardium was used to cover the exposed tube in selected cases. In eyes with large conjunctival defects or severe adhesions between surrounding conjunctiva and episclera, rotational conjunctival flap, conjunctival autograft, or amniotic membrane graft was used to reconstruct the ocular surface. RESULTS: Three of 7 eyes (42.9%) with tube erosion were successfully repaired by the first surgical treatment. No recurrence of tube erosion was found after the second and the fourth surgical procedure in 3 and 1 eyes, respectively. There was no case of explantation of the Ahmed valve in our series. Tube erosion recurred in 1 of the 4 eyes in which tube-repositioning was required and in 3 of the 5 eyes in which a partial thickness scleral flap was made to cover a tube. One eye experienced recurrent tube erosion in a relatively short-term interval and was repaired successfully using both collagen matrix implantation and amniotic membrane transplantation. CONCLUSIONS: Tube erosion after Ahmed valve implantation was successfully treated by various methods including tube repositioning, partial thickness scleral flap combined with scleral allograft, biodegradable collagen implant, pericardial graft, and/or amniotic membrane transplantation.

Ahmed Valve Implant Surgery with Adjunctive Mitomycin C and Selective 5-Fluorouracil Injection

PURPOSE: To evaluate the surgical results of Ahmed valve implant surgery with adjunctive mitomycin C and selective postoperative 5-fluorouracil (5-FU) subconjunctival injection with a needling procedure. METHODS: In this retrospective study, 40 eyes of 40 patients who had undergone Ahmed valve implant surgery with adjunctive mitomycin C were observed for at least 1 year. The Ahmed valve was implanted after 5-minute application of 0.04% mitomycin C. Selective 5-FU injection with a needling procedure was performed during the follow- up period based on intraocular pressure (IOP). Hypertensive phase was defined as IOP higher than 21 mm Hg within 3 months after operation. IOP higher than 18 mm Hg regardless of IOP-lowering medications at 2 consecutive visits was considered to be a surgical failure. RESULTS: The mean follow-up period was 35.5 ± 12.4 months. Preoperative intraocular pressure was 32.8 ± 7.5 mm Hg, which decreased to 14.0 ± 4.2 mm Hg post-operatively. The number of glaucoma medications decreased significantly from 3.8 ± 0.5 to 2.0 ± 1.0. Eleven of 40 eyes (27.5%) experienced hypertensive phase at 6.0 ± 3.1 weeks after surgery. Kaplan-Meier survival analysis showed cumulative probability of surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years respectively. There were no risk factors that affecting surgical failure except age (hazard ratio = 0.17, p = 0.02). CONCLUSIONS: Ahmed valve implant surgery with adjunctive mitomycin C and selective 5-FU injection with a needling procedure showed good success in refractory glaucoma.

Revisión con aguja tras implante de válvula de Ahmed en la ciclitis heterocrómica de Fuchs / Needle revision after Ahmed valve implantation in the management of Fuch´s heterochromic cyclitis

La ciclitis heterocrómica de Fuchs es una uveítis crónica que puede ser asintomática por años o expresar solo la heterocromía antes que aparezca cualquier otro signo. El glaucoma se considera una de las complicaciones más difíciles de tratar, y requiere cirugía en múltiples ocasiones. Los dispositivos de drenaje están siendo cada vez más utilizados como alternativa de tratamiento quirúrgico en estos casos. Asiste a la consulta médica una paciente de 36 años de edad, con antecedentes de uveítis crónica unilateral del ojo izquierdo asociado a catarata y glaucoma descompensado, a pesar del tratamiento médico. Se presenta con 50 VAR de visión y presión intraocular de 32 mmHg. Se realizó cirugía combinada: facoemulsificación e implante de válvula Ahmed modelo S2 con mitomicina C (0,2 mg/mL) durante cinco minutos. Se diagnostica ampolla de filtración encapsulada en la octava semana. Se realiza revisión con aguja y subconjuntival de 1 mg de bevacizumab (avastin) subtenoniano en área de la filtrante. La inyección se repite días alternos hasta completar tres dosis según protocolo institucional. Se logran cifras de presión intraocular de 17 mmHg y agudeza visual mejor corregida de 95 VAR a los 18 meses posoperatorios(AU)

Fuch´s heterochromic cyclitis is chronic uveitis that may be asymptomatic for years or may express heretochromia just before the onset of any other sign. Glaucoma is considered one of the most difficult complications to be treated and requires multiple surgeries. Drainage devices are increasingly used as a surgical treatment option in these cases. Here is the case of a 36 years-old woman with a history of unilateral chronic uveitis in her left eye associated to cataract and decompensate glaucoma despite the medical therapy. She presented with 50 VAR visual acuity and 32 mmHg intraocular pressure. She underwent combined surgery based on phacoemulsification and S2 model Ahmed valve implantation with mitomycin C (0,2 mg/mL) for 5 minutes. The diagnosis was encapsulated filtering bleb at the 8th week of operation. Subconjuctival needle revision with one mg of subtenial bevacizumab (avastin) in the bleb area was performed. Injection was administered every other day till completion of three doses according to the institutional protocol. Eighteen months after the surgery, the intraocular pressure was 17nnHg and the best corrected visual acuity reached 95 VAR best corrected visual acuity(AU)

Surgical Results of Trabeculectomy and Ahmed Valve Implantation Following a Previous Failed Trabeculectomy in Primary Congenital Glaucoma Patients

PURPOSE: To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. METHODS: A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. RESULTS: The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38). CONCLUSIONS: There was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

Clinical Outcomes after Combined Ahmed Glaucoma Valve Implantation and Penetrating Keratoplasty or Pars Plana Vitrectomy

PURPOSE: To evaluate whether a combination of penetrating keratoplasty (PKP) or pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation affords a level of success similar to that of AGV implantation alone. METHODS: Eighteen eyes underwent simultaneous PPV and AGV, 14 eyes with PKP and AGV and 30 eyes with AGV implantation alone were evaluated. Success was defined as attainment of an intraocular pressure (IOP) >5 and <22 mmHg, with or without use of anti-glaucoma medication. Kaplan-Meier survival analysis was performed to compare cumulative survival between the combined surgery groups and the AGV implantation-alone group. Cox proportional hazard regression analysis was conducted to identify factors predictive of success in each of the three groups. RESULTS: Mean (+/-standard deviation) preoperative IOP was 30.2 +/- 10.2 mmHg in the PKP + AGV, 35.2 +/- 9.8 mmHg in the PPV + AGV, and 36.2 +/- 10.1 mmHg in the AGV implantation-alone group. The cumulative success rate at 18 months was 66.9%, 73.2%, and 70.8% in the three groups, respectively. Neither combined surgery group differed significantly in terms of cumulative success rate compared with the AGV implantation-alone group (p = 0.556, p = 0.487, respectively). The mean number of preoperative anti-glaucoma medications prescribed was significantly associated with success in the PKP + AGV implantation group (hazard ratio, 2.942; p = 0.024). CONCLUSIONS: Either PKP or PPV performed in conjunction with AGV implantation afforded similar success rates compared to patients treated with AGV implantation alone. Therefore, in patients with refractory glaucoma who have underlying corneal or retinal pathology requiring treatment with PKP or PPV, AGV implantation can be performed simultaneously.

Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage

PURPOSE: To compare the surgical outcomes between sequential -and simultaneous combined vitrectomy and Ahmed valve implantation (AVI) in neovascular glaucoma (NVG) patients with vitreous hemorrhage. METHODS: The medical records of 22 eyes of 22 patients, who had NVG with vitreous hemorrhage treated with vitrectomy and AVI, were retrospectively reviewed. Surgical success was defined as 6 mm Hg < or = IOP < or = 21 mm Hg, with or without the use of antiglaucoma medications and failure was defined as cases that had no light perception during the study period and which required additional surgery. The authors of the present study evaluated the surgical success rates and factors affecting surgical success between sequential and simultaneous combined vitrectomy and AVI. RESULTS: The cumulative surgical success rate by the Kaplan-Meier survival analysis was 45% in sequential combined vitrectomy and AVI (group1), and 18% in combined vitrectomy and AVI (group 2), at 1 year, a significant difference. Preoperative panretinal photocoagulation was related to surgical success rate by Cox's regression model analysis. CONCLUSIONS: Simultaneous combined vitrectomy and AVI is considered as a primary procedure in a patient who has NVG with vitreous hemorrhage. Panretinal photocoagulation in the preoperative periods, is thought to increase the surgical success rate.

Comparison of Surgical Outcomes between Trabeculectomy and Aqueous Shunt Surgery in Patients with Iridocorneal Endothelial Syndrome

PURPOSE: To compare surgical outcomes and corneal endothelial cell densities in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome who underwent trabeculectomy with mitomycin-C (MMC) versus those who underwent Ahmed Glaucoma Valve (AGV) implantation. METHODS: Twenty-one patients with ICE syndrome who underwent either trabeculectomy with MMC or AGV implantation were included in this study. All patients had more than 12 months of follow-up after glaucoma surgery. Intraocular pressure (IOP), visual acuity (VA) and corneal endothelial cell density were compared according to the method of surgery. RESULTS: Ten eyes had undergone a trabeculectomy with MMC, and 11 eyes had an AGV implantation. In eyes that underwent a trabeculectomy with a MMC, there were no statistically significant differences between preoperative and postoperative month 12 in IOP, VA or corneal endothelial cell density. In eyes that underwent AGV implantation, postoperative IOP, VA and corneal endothelial cell density were statistically significantly lower than the preoperative values. CONCLUSIONS: When determining the method of glaucoma surgery in patients with ICE syndrome, the additional procedures needed to maintain the surgical success of trabeculectomy with MMC and the corneal decompensation which is caused by a decrease in corneal endothelial cell density after AGV implantation should be considered.

Tissue Incarceration after Ahmed Valve Implantation

PURPOSE: To report cases of intraocular pressure that was normalized, after removing the capsule that had incarcerated into the valve after Ahmed valve implantation. CASE SUMMARY: A 34-month-old boy visited our clinic for elevated intraocular pressure of the right eye. The patient had received Ahmed valve implantation 1 year earlier. At the first ophthalmological examination in our hospital, intraocular pressure of the right eye measured by Perkins tonometer was 28 mm Hg using Cosopt(R) and Iopidine(R), and 26 mm Hg after additional digital massage; the authors decided to remove the capsule with surgery. The fibrotic tissue was removed after finding the tissue incarcerated into the valve during the operation. One day after the surgery, without using any glaucoma medication, intraocular pressure of the right eye measured by Perkins tonometer was 15 mm Hg. Three months after surgery, using topical intraocular pressure lowering agents, intraocular pressure of the right eye was 18 mm Hg. Because the intraocular pressure of other patients after Ahmed valve implantation was not regulated well, surgery was performed, and the fibrotic tissue was removed after finding the tissue incarcerated in the valve during the operation.