Two Cases of Malignant Glaucoma after Ahmed Valve Implantation

Purpose@#To report two cases of malignant glaucoma after Ahmed valve implantation.Case summary: (Case 1) A 76-year-old female with angle closure glaucoma in the right eye underwent Ahmed valve implantation. To reduce the risk of corneal endothelial failure, the tube tip was located in the sulcus. Eight days after surgery, surgical iridectomy was performed due to intraocular pressure elevation and a shallow anterior chamber. Three weeks later, vitrectomy was performed due to intraocular pressure elevation with a shallow anterior chamber. Recurrent intraocular pressure elevation was resolved after tip reposition into the vitreous cavity. (Case 2) A 93-year-old female with pseudoexfoliation glaucoma underwent Ahmed valve implantation in the left eye. Five days after surgery, the intraocular pressure increased with a shallow anterior chamber; the remnant cortex and prolapsed vitreous body were present in the anterior chamber. She underwent anterior chamber washing and surgical iridectomy; however, the increase in intraocular pressure with a shallow anterior chamber worsened after 1 month; thus, anterior vitrectomy was performed. @*Conclusions@#Malignant glaucoma after Ahmed valve implantation is considered very rare. However, if risk factors such as short axial length, zonular weakness, old age, or female gender are present, as in these cases, there may be an increased risk of malignant glaucoma developing after Ahmed valve implantation.

Diffuse Lamellar Keratitis after Trabeculectomy in a Patient with Laser in situ Keratomileusis

PURPOSE: In the present study, a case of diffuse lamellar keratitis after trabeculectomy in a patient who had received laser in situ keratomileusis many years prior is reported. CASE SUMMARY: A 54-year-old male diagnosed with binocular primary open-angle glaucoma underwent trabeculectomy in the left eye because of poor intraocular pressure control and visual field defect progression even with maximal medical treatments. Faint, non-progressing subepithelial opacities pre-existed in the left cornea but no treatment was administered. The patient had a history of laser in situ keratomileusis in both eyes 12 years prior. On the first postoperative day, conjunctival buttonhole was found and because leaking from the hole continued, topical steroid was discontinued on the fourth postoperative day. On the seventh postoperative day, diffuse lamellar keratitis developed on the central cornea without intraocular pressure elevation, and diffuse infiltration under the corneal flap was observed in the anterior segment on optical coherence tomography. The patient was treated with topical steroid eye drops every 3 hours for the first 2 days and the frequency was increased to every hour because the keratitis did not improve. On the ninth postoperative day, keratitis began to improve and 2 months postoperatively, subepithelial lamellar infiltration improved significantly but did not show complete remission. CONCLUSIONS: Diffuse lamellar keratitis can develop in an eye with laser in situ keratomileusis after trabeculectomy if appropriate treatment with topical steroid eye drops is not administered.

Retinal Vascular Caliber Changes in Diabetic Retinopathy after Panretinal Photocoagulation and Additive Bevacizumab Injections

PURPOSE: To evaluate the effect of panretinal photocoagulation and additive intravitreal bevacizumab injections on central retinal vessel diameters and characteristic retinal vascular caliber changes in diabetic retinopathy. METHODS: Changes in central retinal vessel diameters were retrospectively analyzed before and 6 months after panretinal photocoagulation with or without additive intravitreal bevacizumab injections in 64 eyes first diagnosed with diabetic retinopathy. Vessel diameters and arteriovenous ratio (AVR) were measured using Interactive Vessel Analysis (IVAN) software and the Big six formula. RESULTS: There were significant decreases in central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) in both groups, with and without additive intravitreal bevacizumab injections, 6 months after completion of panretinal photocoagulation (p < 0.001, p = 0.008), but no significant change in AVR (p = 0.338). Additive intravitreal bevacizumab injections did not produce significant changes in central retinal vessel diameters after 6 months compared to vessel diameters treated with panretinal photocoagulation only. Retinal vascular caliber of progressed diabetic retinopathy showed smaller CRAE, larger CRVE, and smaller AVR compared to those of normal or diabetic Korean subjects in a previous study and showed no significant association with age. CONCLUSIONS: CRAE and CRVE decreased significantly 6 months after panretinal photocoagulation in diabetic retinopathy, but additive intravitreal bevacizumab injections did not cause significant additive changes to central retinal vascular calibers in this study. We established the standard retinal vascular caliber of Korean subjects in diabetic retinopathy and analyzed the effects of retinopathy on retinal vessel caliber.