Combined Pars Plana Vitrectomy and Ahmed Implantation for Refractory Glaucoma

Eyes with neovascular glaucoma often times present with vitreous hemorrhage which makes subsequent panretinal photocoagulation difficult to impossible. These eyes can benefit from pars plana vitrectomy combined with glaucoma shunt procedure. Other candidates are those refractory galucomatous eyes with severe vitreoretinal diseases that require surgical intervention. We performed standard pars plana vitrectomies in combination with Ahmed Glaucoma Valve implant and analyzed the surgical outcome in 11 eyes of 11 patiens with severe refractory galucoma. With the surgical success defined as an achievement of intraocular pressure(IOP) less or equal to 21 mmHg with anatomical reattatchment of retina, nine eyes(81.8%) became qualified in the success group. Complications included hyphema and/or severe fibrinous reaction (3 eyes), temporary IOP increase (3 eyes), recurrent vitreous hemorrhage (1 eye) and loss of light perception (1 eye). No eye showed postoperative hypotony, choroidal effusion or hemorrhage. In conclusion, in those eyes with refractory glaucoma accompanied with severe vitreoretinal disease that do not respond to the conventional IOP lowering procedures, combined pars plana vitrectomy with Ahmed Glaucoma Valve implantation may serve as a useful surgical alternative.

Excimer Laser Photorefractive Keratectomy: Two-year follow-up

Excimer laser photorefractive keratectomy(PRK) for myopia has been performed recently by refractive surgeons, in spite of myopic regression and corneal opacity following excimer PRK. We analyzed refractive change, corneal opacity, and uncorrected visual acuity of 313 eyes (233 patients) for one year and 115 eyes(83 patients) for two years after excimer PRK. The patients were divided tnto 3 groups accordign to theit refractive errors [group 1 (n=123 eyes): from -2.25D to -6D, group 2 (n=145 eyes) : from -6.25D to -10D, and group 3 (n=45 eyes): less than -19.25D]. Mean refractive errors one year after excimer PRK were -0.31+/-0.57D, -0.54+/-0.90D, and -1.71+/-2.01D in group 1, 2, and 3, respectively. These errors were increased to -0.45+/-0.68D, -0.90+/-1.20D, and -3.37+/-3.20D two years after excimer PRK in group 1, group 2, and group 3, respectively. These changes were staistically significant in group 2 (p=0.000) and group 3 (p=0.015), not in group 1 (p=0.426). Corneal opacity was more severe in group 3 than in group 1 and 2 and decreased depending on time passing by. Diopteric error within +/-1.0D from the attempted correction one year after excimer PRK was found in 89% of group 1, 74% of group 2, and 40% of group 3. These percentages were after excimer PRK. Uncorrected visual acuity equal to or better than 0.5 were 95% in group 1, 87% in group 2, and only 44% in group 3 two years after excimer PRK. With these results we thought that excimer PRK was effective and safe for myopia more than -6D, while unpredictable for myopia less than6D.

Excimer Laser Photorefractive Keratectomy: Two-year follow-up

Excimer laser photorefractive keratectomy(PRK) for myopia has been performed recently by refractive surgeons, in spite of myopic regression and corneal opacity following excimer PRK. We analyzed refractive change, corneal opacity, and uncorrected visual acuity of 313 eyes (233 patients) for one year and 115 eyes(83 patients) for two years after excimer PRK. The patients were divided tnto 3 groups accordign to theit refractive errors [group 1 (n=123 eyes): from -2.25D to -6D, group 2 (n=145 eyes) : from -6.25D to -10D, and group 3 (n=45 eyes): less than -19.25D]. Mean refractive errors one year after excimer PRK were -0.31+/-0.57D, -0.54+/-0.90D, and -1.71+/-2.01D in group 1, 2, and 3, respectively. These errors were increased to -0.45+/-0.68D, -0.90+/-1.20D, and -3.37+/-3.20D two years after excimer PRK in group 1, group 2, and group 3, respectively. These changes were staistically significant in group 2 (p=0.000) and group 3 (p=0.015), not in group 1 (p=0.426). Corneal opacity was more severe in group 3 than in group 1 and 2 and decreased depending on time passing by. Diopteric error within +/-1.0D from the attempted correction one year after excimer PRK was found in 89% of group 1, 74% of group 2, and 40% of group 3. These percentages were after excimer PRK. Uncorrected visual acuity equal to or better than 0.5 were 95% in group 1, 87% in group 2, and only 44% in group 3 two years after excimer PRK. With these results we thought that excimer PRK was effective and safe for myopia more than -6D, while unpredictable for myopia less than6D.

The Short Term Effect of Ocular Digital Massage and its Echographic Evaluation Following Ahmed Glaucoma Valve Implantation

We performed a prospective study to evaluate the effect of ocular digital massage (ODM) on intraocular pressure (IOP) in eyes that underwent implantation of Ahmed Glaucoma Valve (AGV) for refractory glaucoma. Echographic study(B scan) was also used to visualize the formation of bleb around the implant and change of its size following ODM. There were 14 eyes(13 patients) in which pre-massage IOP was 17.79 +/- 6.19 mmHg and the immediate post-massage lOP showed 11.00 +/- 6.11 mmHg . IOP in 6 hours after ODM was 15.43 +/- 7.32 mmHg . These reductions in lOP were statistically significant (paired t-test, p=0.005). When classified into two groups based on the type of glaucoma and IOP reduction after ODM was compared, there was no statistically significant difference between the group with neovascular glaucoma (NVG) and that with chronic angle closure glaucoma (t-test, p=0.328). The ultrasound study showed well formed bleb around the implant in those eyes with good IOP control. Increase in the size of bleb was shown even in those with marginal/poor IOP control following ODM. There was no significant complication associated with ODM except in one eye with persistent hypotony. In conclusion, ODM showed a significant IOP reduction in short term in eyes with AGV and its relationship with bleb size was well documented with the use of echograph.

Ocular Cicatricial Pemphigoid

Ocular cicatricial pemphigoid isa chronic, progressive disease characterized by cicatricial shrinkage of the conjunctiva, entropion, trichiasis, xerosis, and finally reduced vision from corneal opacification. It is a relatively rare, autoimmune disease. In the early stages, it can be easily overlooked as simple chronic conjunctivitis, so it can be untreated. We report a case of ocular cicatricial pemphigoid that resulted in significant morbidity. We were able to control the progression of cicatrization with aggressive immunosuppressive therapy.

Pseudomonas Keratitis Due to Mishandling of Soft Contact lenses

Causative bacterias of keratitis due to mishandling of contact lenses are mainly Gram negative rods, and large percentage of them are Pseudomonas. We experienced 6 cases of culture-proven Pseudomonas keratitis due to mishandling of soft contact lenses and wetting solution can be cultured. They are lack of education as how handle the contact lenses safely. And they did not done disinfection of the soft contact lens cases. To prevent contact lens related keratitis, we think it is very important for users to know its possible complication and how to use it and disinfect it safely.

Clinical Results of Ahmed Glaucoma Implantation in Refractory Glaucoma

24 eyes of 20 patients with increased intraocular pressure(IOP) or glaucoma that were not medically controlled or those who failed with previous glaucoma surgeries underwent Ahmed glaucoma valve implantation with intraoperative mitomycin C application. Mean follow-up period was 4.5 months (2-9 months) and mean preoperative IOP was 38.0 +/- 11.5mmHg. Mean IOP at last visit was 16.5 +/- 6.2mmHg and it was significantly lower compared to preoperative IOP (p<0.0001). One eye (4.2%) showed IOP less than 5mmHg at first postoperative day. When surgical success was defined as IOP less than 22mmHg and greater than 4 mmHg for 2 months or longer, IOP lowered by at least 20% from preoperative values (in eyes with preoperative IOP less than 22mmHg), and no additional glaucoma surgery or visually devastating complications, cumulative probability of success at 7 months was 69.1%. Qualified success (defined as lOP less than 22mmHg and greater than 4mmHg at last visit) rate was 83.3%. Complete success (IOP controlled as above without medication) rate was 66.7%. The complications included temporary shallow anterior chamber in 3 eyes, choroidal detachment in 3 eyes, fibrous membrane formation in anterior chamber in 3 eyes, hyphema in 2 eyes, tube malposition in 1 eye, corneal decompensation in 1 eye and tube blockage in 1 eye. This study suggests that Ahmed glaucoma implant provides good IOP control without significant postoperative complications including immediate postoperative period, and its success rate is comparable to the other seton implants.