Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control

ABSTRACT Purpose: As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. Methods: This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant--Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. Results: Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). Conclusion: The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.

Aurolab aqueous drainage implant implantation made easy: A video-based step-by-step guide

Background: Glaucoma is one of the major causes of irreversible blindness in the world, with trabeculectomy still being the primary surgical modality for the management of glaucoma. Glaucoma drainage devices (GDDs) have been conventionally used for the treatment of refractory glaucoma and are found to be beneficial in eyes with prior unsuccessful filtration surgeries and primary choice of surgery in certain glaucoma. Aurolab aqueous drainage implant (AADI) is a nonvalved device useful in refractory glaucoma to achieve low intraocular pressure (IOP). The device has been commercially available in India since 2013 and is like the Baerveldt glaucoma implant in design and function. AADI being the most economical and effective GDD in controlling IOP is becoming a popular choice among ophthalmologist in developing countries. AADI surgery has steep learning curve due to large end?plate surface area which needs a rigorous conjunctival dissection, muscle hooking, meticulous plate fixations, and careful tube ligations and insertion. There are different techniques of performing AADI surgery, but the authors have tried to simplify the complex surgery for easy and catchable learning of the procedure by novice surgeon with their experience and have elaborated a step?wise most effective way of performing surgery. Purpose: This video?based skill transfer depicts steps of AADI surgery with compilation of various modifications and authors’ tips and tricks to novice surgeons. Synopsis: This video depicts detailed steps of AADI surgery with micro?points and authors experience. Video also shows various tailor?made modifications of surgical techniques for different case scenarios. Highlights: Steps of AADI surgery, modifications, and surgical pearls.

Management of glaucoma with Boston type 1 keratoprosthesis / Manejo do glaucoma em olhos com ceratoprótese Boston tipo 1

ABSTRACT Purpose: To describe the frequency, clinical characteristics, complications, and management of glaucoma in eyes that underwent keratoprosthesis implantation. Methods: Patients who underwent keratoprosthesis surgery between June 2010 and January 2020 were retrospectively evaluated for glaucoma association and prognoses. Results: Among 17 patients who underwent keratoprosthesis surgery, 9 (52.9%) were associated with underlying or keratoprosthesis-induced glaucoma. Five eyes (29.4%) had underlying glaucoma and underwent a glaucoma drainage device implantation at least 6 months before keratoprosthesis surgery. One eye (5.9%) with normal intraocular pressure had glaucoma drainage device implantation at the same session with keratoprosthesis surgery due to high-risk characteristics of anterior segment structures. Four eyes with preexisting glaucoma showed progression after keratoprosthesis surgery. Additional antiglaucomatous treatment was commenced in two eyes whereas implantation of 2nd glaucoma drainage device was performed in two eyes. Postoperative complications in three eyes (100%) with glaucoma drainage device implanted 6 months before or at the same session with aphakic type keratoprosthesis surgery with partial vitrectomy included rhegmatogenous retinal detachment in two eyes and bacterial endophthalmitis in one eye. Migration of silicone oil through the tube to the subconjunctival area was seen after pars plana vitrectomy in one eye. None of the three eyes (0%) that underwent glaucoma drainage device implantation years before keratoprosthesis surgery experienced a posterior segment complication other than glaucomatous progression. Out of 11 eyes with no previous history of glaucoma, 3 (27.3%) showed high intraocular pressure and glaucomatous disc changes after keratoprosthesis surgery, which could be pharmacologically controlled. Conclusions: In this cohort, eyes with preexisting glaucoma were more difficult to manage compared to eyes with de novo glaucoma after keratoprosthesis surgery. Retinal complications appeared more often when glaucoma drainage device implantation was performed no more than 6 months before aphakic type keratoprosthesis surgery with partial vitrectomy.

RESUMO Objetivo: Descrever a frequência, as características clínicas, as complicações e o manejo do glaucoma em olhos submetidos a implantes de ceratoprótese. Métodos: Pacientes submetidos à cirurgia de ceratoprótese entre junho de 2010 e janeiro de 2020 foram avaliados retrospectivamente em termos de glaucoma associado e prognóstico. Resultados: Dos 17 pacientes submetidos à cirurgia de ceratoprótese, em 9 (52,9%) foi constatado glaucoma subjacente ou induzido por ceratoprótese. Cinco olhos (29,4%) tinham glaucoma subjacente e receberam a implantação de um dispositivo de drenagem de glaucoma pelo menos 6 meses antes da cirurgia de ceratoprótese. Um olho (5,9%) com pressão intraocular normal teve implantado um dispositivo de drenagem de glaucoma na mesma sessão da cirurgia de ceratoprótese, devido às características de "alto risco" das estruturas do segmento anterior. Quatro dos olhos com glaucoma preexistente apresentaram progressão após a cirurgia de ceratoprótese. Foi iniciado um tratamento antiglaucomatoso adicional em 2 olhos, enquanto outros 2 olhos receberam o implante de um segundo dispositivo de drenagem de glaucoma. Foram observadas complicações pós-operatórias em 3 olhos (100%) com dispositivo de drenagem de glaucoma implantado 6 meses antes ou na mesma sessão da cirurgia de ceratoprótese tipo afácica com vitrectomia parcial, incluindo descolamento de retina regmatogênico em 2 olhos e endoftalmite bacteriana em 1 olho. Em 1 olho observou-se migração do óleo de silicone para a área subconjuntival através do tubo após vitrectomia via pars plana. Nenhum dos 3 olhos (0%) implantados com dispositivo de drenagem de glaucoma anos antes da cirurgia de ceratoprótese apresentou complicações do segmento posterior, exceto progressão glaucomatosa. Dos 11 olhos sem história prévia de glaucoma, 3 (27,3%) apresentaram alta pressão intraocular e alterações do disco glaucomatoso após cirurgia de ceratoprótese, condições que podem ser controladas clinicamente. Conclusões: Nesta coorte, os olhos com glaucoma pré-existente foram mais difíceis de manejar, comparados àqueles que desenvolveram glaucoma após a cirurgia de ceratoprótese. Apareceram mais complicações retinianas quando o implante do dispositivo de drenagem de glaucoma foi realizado no máximo 6 meses antes da cirurgia de ceratoprótese do tipo afácico com vitrectomia parcial.

Incidence, outcomes, and risk of surgical failure after development of early hypotony following Aurolab aqueous drainage implant surgery

Purpose: To report the incidence, outcomes, and risk of surgical failure after early postoperative hypotony following Aurolab Aqueous Drainage Implant (AADI) surgery for adult and pediatric refractory glaucoma. Methods: Medical records of patients who underwent AADI between January 2013 and March 2017 with a minimum of 2?years follow?up were retrospectively reviewed. Early postoperative hypotony was defined as IOP ?5 mmHg within the first 3 months after AADI. Surgical failure of AADI was defined as IOP >21 mmHg or reduced <20% below baseline on two consecutive follow?up visits after 3 months, IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Results: Early postoperative hypotony was seen in 15/213 eyes (7%) in the adult group and in 6/101 eyes (6%) in the pediatric group. The onset of hypotony was significantly earlier in the pediatric group (median = 39 days post AADI, IQR = 20–58 days) compared with adult eyes (median = 51 days post AADI, IQR = 30–72 days) (P = 0.02). Eyes with early postoperative hypotony did not have an increased risk of cumulative surgical failure as compared with eyes without hypotony in both adult (33.3% vs. 23.7%; P = 0.48) and pediatric (33.3% vs. 13.7%; P = 0.16) refractory glaucoma. All eyes recovered from hypotony, though one adult eye developed retinal detachment and one pediatric eye developed corneal decompensation and lost vision. Conclusion: Early postoperative hypotony was an infrequent complication post AADI and occurred earlier in pediatric eyes. Early postoperative hypotony did not increase risk of surgical failure up to 2 years.

Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study

Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non?valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results: Thirty-four eyes were analyzed and the mean follow?up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long?term follow?up studies are needed to assess long?term IOP control and cost?effectiveness.

Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes

Purpose: To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings. Methods: Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best?corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively. Results: Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6� years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days?72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 � 0.15 which improved to 2.29 � 0.58 at final follow?up; however, only one eye had vision ? 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ? 21 mmHg in 5 out of 6 eyes with anatomic success. Conclusion: The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma

Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique

Purpose: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. Methods: A retrospective study was done between April 2016 and April 2018 on patients with ?12 months of follow?up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. Results: The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti?glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow?up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan–Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8–33.5%) at 3 months, 18.7% (95% CI; 8.9–37.0%) at 6 months, and 25.0% (95% CI; 13.4–43.8%) at 12 months. Conclusion: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti?glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology

Study on dynamic expression of IL-10 on scarring after implantation of glaucoma drainage material / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the dynamic expression characteristics of interleukin-10(IL-10)after implantation of glaucoma drainage material, and to reveal the role of IL-10 on scarring formation.METHODS:Totally 75 New Zealand white rabbits were randomly divided into three groups, which were implanted with different types of material-Polymethyl methacrylate coated Parylene C(PMMA group), silicone together with injection of Mitomycin C(MMC)(silicon-MMC group)and silicone(silicone group). Aqueous humor were collected at 1, 3d, 1, 2, 3, 4 and 8wk after operation and enzyme-linked immunosorbent assay(ELISA)were utilized to detect the expression of IL-10 in the aqueous humor. The connective tissue surrounding the material were collected at 1, 2, 3, 4 and 8wk postoperatively. Hematoxylin-eosin(HE)staining was applied to evaluate the proliferation of fibroblasts and the infiltration of inflammatory cells. The protein expression and mRNA of IL-10 in the connective tissue were detected by immunohistochemistry and real-time PCR.RESULTS:Compared with PMMA and silicon-MMC group, silicone group showed significantly increased proliferation of fibroblasts and infiltration of inflammatory cells according to the HE staining result. The result of ELISA showed the expression of IL-10 in the aqueous humor increased significantly at the early stage after surgery, and then decreased gradually,the highest appeared on the third day after operation,and in silicone group there was higher than the other two groups in the early stage postoperatively(1d-3wk)(all <i>P</i><0.05), and there was no significant difference in the late stages(4-8wk). The protein expression and mRNA of IL-10 in connective tissue were the highest in the first week after operation, decreased gradually at 2-3wk after operation, and increased again at 4-8wk after operation by immunohistochemistry and real-time PCR. And the expression was higher in silicone group than in the other two groups at each time point(all <i>P</i><0.05). Furthermore, there was a positive correlation between the expression of IL-10 protein and the proliferation of fibroblasts in the late stages(4-8wk).CONCLUSION: After implantation of glaucoma drainage material, the process of IL-10 increased first, then decreased gradually, and increased again 4wk later, thus IL-10 may be a potential target for inhibiting the scar formation.

Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber

Purpose: To evaluate the outcome of a nonvalved Aurolab aqueous drainage implant (AADI) in the management of refractory glaucoma. Methods: Retrospective case series of patients with refractory glaucoma underwent AADI implantation in posterior segment (PS group) or anterior chamber (AC group) with minimum follow-up of 1 year. Primary outcome criterion was success, defined as intraocular pressure (IOP) <18 or >6 mm Hg or IOP reduced to <20% from baseline, for two consecutive visits after 3 months. Failure was defined as inability to meet IOP criteria, any additional glaucoma surgery, loss of light perception, and implant explantation. Secondary outcome criteria compared groups based on mean IOP, mean glaucoma medication use, best-corrected visual acuity, and complications at each postoperative visit. Results: In the AC and PS group of 64 patients, 32 tubes each were placed. Preoperative mean IOP was 37.41 ± 8.6 and 43.38 ± 10.3 mm Hg in AC and PS, respectively. Postoperatively IOP reduced to 14.22 ± 4.9 and 15.21 ± 8.1 mm Hg in AC and PS groups, respectively (P < 0.001). Preoperative mean antiglaucoma medication changed from 2.56 ± 0.9 and 3.44 ± 0.5 to 1.03 ± 0.9 and 1.67 ± 0.5 in AC and PS, respectively, postoperatively (P < 0.001). No significant change in VA was noted in either group. At 12 months, success rate was 84% in AC group and 72% in PS group, with PS group having 2.63 times higher hazard (risk) of failure than AC group. Conclusion: AADI implantation in PS or AC is a safe and effective method for IOP control in refractory glaucoma with its low cost being of significance in developing countries.

A novel simplified method for managing inadvertent tube cut during aurolab aqueous drainage implant surgery for refractory glaucoma

We report a novel simplified method for managing inadvertent tube cut in a patient undergoing the Aurolab aqueous drainage implant (AADI) surgery for refractory neovascular glaucoma. Tube cut occurred while applying the polyglactin ligature suture used to avoid early postoperative hypotony. The short end of the cut tube was removed and the long end reinserted into the base plate of AADI. The surgery was then completed as usual. Following the surgery, the intraocular pressure reduced to 20 mmHg which stabilized and was maintained at 10 mmHg till the last follow-up at 12 months without any glaucoma medication.

Intermediate-term outcome of Aurolab aqueous drainage implant

Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ?6 and ?21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age � standard deviation (SD) of 47.3 � 18.1 years with a mean follow-up of 16.7 � 11.4 months. Mean intraocular pressure reduced from 30.8 � 11.1 mmHg to 13.1 � 4.7, 14.1 � 4.8, 15.7 � 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 � 1 to 0.8 � 1.2, 0.7 � 1.1, 0.8 � 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.

A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study

Purpose: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. Methods: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ?5–?18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. Results: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). Conclusion: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.

Combined cataract extraction with a new nonvalved glaucoma drainage device in adult eyes with cataract and refractory glaucoma

Purpose: The purpose of the study is to report the outcomes of simultaneous cataract extraction (CE) and a new nonvalved glaucoma drainage device (GDD), Aurolab Aqueous Drainage Implant (AADI), in eyes with cataract and refractory glaucoma. Methods: This was a non-comparative, interventional, retrospective study. Consecutive patients who underwent AADI together with phacoemulsification from June-2015 to January-2017 by a single fellowship trained glaucoma surgeon with documented 3-months of follow-up were included. The main outcomes were intraocular pressure (IOP), antiglaucoma medication (AGM), visual acuity, and complications. Results: We included 19 eyes of 17 patients with average follow-up of 14.4 ± 8.4 months. IOP and AGM reduced from 36.9 ± 11.1 mmHg and 4 ± 0.8 preoperatively to 12 ± 4.5 mmHg and 0.8 ± 1.2, respectively (P < 0.001). Complications were seen in seven eyes (36.8%). Total success was seen in 17 eyes (89.5%). None of the patients lost vision. Conclusion: Combining cataract extraction with the new non-valved Aurolab Aqueous Drainage Implant, appears to be an effective and safe technique in eyes with refractory glaucoma and cataract. Larger studies and further follow-up is recommended for such patients.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy. METHODS: Thirty - six patients (36 eyes) with prior failed sequential trabeculectomy who underwent Ahmed glaucoma valve implantation were included. The intraocular pressure ( IOP), best corrected visual acuity (BCVA) and complications were ovserved and all the patients were followed up at least for 12mo. RESULTS: Mean preoperative IOP was 35. 20±7. 28mmHg and reduced to 10. 15±3. 34, 11. 23±3. 56, 15. 63±5. 72, 17. 17±5. 47, 17. 73±6. 23,19. 76±5. 43mmHg at 1, 2wk, 1, 3, 6 and 12mo after surgery, which was significant different from the preoperative level (t = 12. 643, 11. 837, 10. 324, 8. 839, 8. 462, 8. 046, all P 0. 05). At 12mo after operation, the complete success rate reached 78% and the conditional success rate reached 92%. There were 5 eyes complicated with shallow anterior chamber, 3 eye complicated with anterior chamber hemorrhage, which all recovered after additional treatments. Late complications included valve exposure and encapsulated cystic blebs around the plate. Severe corneal endothelium loss occurred in 1 patient. CONCLUSION: Ahmed glaucoma valve implantation is effective in reducing IOP at 1-year follow-up in refractory glaucoma patients with prior sequential failed trabeculectomy, but we should fully understand and attach great importance to all kinds of complications that may occur.

Clinical evaluation of FP-7/FP-8 Ahmed glaucoma valve implantation for childhood refractory glaucoma / 中华实验眼科杂志

Background Clinical study showed that FP-7/FP-8 Ahmed glaucoma valve implantation is effective and safe for the adult refractory glaucoma.However,it is welt-known that childhood glaucomatous eyes have different pathogenesis and protean clinical manifestations.So the efficacy of FP-7/FP-8 Ahmed glaucoma valve implantation in child deserves some attention.Objective This study was to retrospectively evaluate the efficacy and safety of FP-7/FP-8 Ahmed glaucoma valve implantation for refractory glaucoma in children.Methods The clinical data of 30 eyes of 26 children with refractory glaucoma who undergone FP-7/FP-8 Ahmed glaucoma valve implantation in the Center Hospital of Cangzhou from October 2008 to April 2011 were retrospectively analyzed.The age of patients was 4 months to 16.5 years.The patients included ocular hypertension after trabculectomy/goniotomy for cogenital glaucoma,later stage of cogenital glaucoma,aphakic or pseudophakic glaucoma,traumatic glaucoma and Sturge-Weber syndrome.The follow-up ranged from 1 week to 24 months to obverse the changes of intraocular pressure (IOP),postoperative complications and cumulative success rate.Results The mean IOP was significantly different among various time points (F=58.929,P＜0.05).The IOP was (36.93± 10.56) mmHg in preoperation and (13.13± 3.34),(14.13±3.15),(15.93±4.76),(17.96±5.37),(19.74±5.43) mmHg 1 week,1 month,6 months,12 months,24 months following surgery,showing significant reduce after operation.Compared with preoperative IOP,the IOP of 1 week,1 month,6,12,24 months after AGI was significant decreased,with significant differences between them (t =11.641,11.458,10.688,7.988,8.018,all at P ＜ 0.05).The total cumulative success rate after Ahmed glaucoma valve implant was 100％,96.67％,93.21％,85.76％ and 71.46％ 1 week,1 month,6 months,12 months,24 months after surgery.The postoperative complications occurred in 8 eyes,including shallow anterior chamber,drainage tube obstruction,hyphema of anterior chamber and valve exposure,and these were cured by medicine and surgery.No serious complication appeared in all patients after operation.Conclusions FP-7/FP-8 Ahmed glaucoma valve implantation is an effective and safe method for the treatment of refractory glaucoma,and it can be considered as one of the first choices for management of refractory glaucoma in childhood.

Boston keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma.

Congenital anterior staphyloma entails grave visual prognosis. The majority of reported patients have undergone enucleation. We report a promising result of staphylectomy with implantation of a keratoprosthesis and a glaucoma drainage device in a seven-month-old child with a large, congenital anterior staphyloma.

Experimental study of silicone-rubber membrane implant drainage in rabbits / 西安交通大学学报(医学版)

ObjectiveAfter performed the silicone-rubber membrane implantation in rabbits, we investigated the efficacy and security of the silicone-rubber membrane implant through observed intraocular pressure, bleb and morphologic result. MethodsForty rabbits were divided into 4 groups by randomized fashiones. Each group consisted of 10 rabbits. Subscleroflapectomy and the silicone membrane implantation were operated in one eye of each rabbit. And the other eye was only performed subscleroflapectomy, which be controlled eye. The change of intraocular pressure, bleb were observed postoperatively. And every eye for histopathologic examination. ResultsThe lasted time of lower intraocular pressure and filtration bleb in implanted eyes were longer than controlled eyes in two groups. Light microscope revealed that patent drainage tract and bite site could be seen in cilicone membrafe implant eyes. The activity and regularity of fibroblast proliferation in implanted eyes and controlled eyes were similarly. The excessive expression of fibroblast proliferation was not excit ed by silicone membrane. ConclusionIt is characterized by safely, effectively and operate simply that silicone membrane implant drainage surgery act as a new drainage surgery.

The Effects of Topical Cyclosporin A on Glaucoma Drainage Implant Surgery in Rabbits

To assess the effects of topical cyclosporin A(Csa) on the function of fibrous capsule and fibroblast proliferation after glaucoma drainage implant surgery in rabbits, we compared intraocular pressure(IOP), outflow resistance through the capsule and fibroblast density in capsule and fibroblast density in capsule among three groups: group A(12 eyes) that received implant surgery only, group B(11eyes) trated with topical 2% CsA twice a day for 2 weeks after implant surgery, and group C(14 eyes) with intraoperative subcon-junctival soaking of 2% CsA for S minutes and postoperative topical 2% CsA twice a day for 2 weeks. There was significant postoperative IOP decreases at 2, 4 and 8 weeks in group B(7.3 +/- 2.0. 7.1 +/- 1.7, and 6.6 +/- 1.8 mmHg, respectively) and group C(7.8 +/- 2.6, 7.1 +/- 1.7, and 6.8 +/- 1.6 mmHg, respectively) compared with group A(5.1 +/- 1.7, 5.0 +/- 1.0, and 4.8 +/- 1.5 mmHg, respectively)(p0.05 for each). Fibroblast density was not significantly lower in group B and Group C than in group A(n=3, p=0.08). These results suggest adjunctive topical CsA may enhance the effectiveness of glaucoma drainage implant surgery.

New Technique of Anterior Chamber Tube Shunt to an Eneircling Band for Refractory Glaucoma

New techniques of anterior chamber tube shunt to an encircling band (ACTESB) were used in 49 eyes of 47 patients with neovascular glaucoma and other types of refractory glaucoma. In 34 eyes of 33 patients (Group A), by using Isingle slit incision and end suturing technique at the distal portion of tube, intraocular bressure was controlled less than 21mmHg in 21 eyes (61.8%) with a follow-up of 6 months to 18 months (mean, 13 month). The mean intraocular pressure of 36.38mmHg was reduced. Visual acuity was maintained or improved in 61 %. In 15 eyes of 14 patients (Group B), by using multiple slit incision at the distal portion of tube and single slit incision of the tube beneath scleral flap and external occlusion of tube with 8-0 vicry1, successful outcome was obtained in 86.6% of eyes after average follow up of 6 months. The mean intraocular pressure of 41.47mmHg reduced. Visual acuity was maintained or improved in 86.8%. The incidence of flat anterior chamber was decreased markedly and hyphema was not found in group B. In 4 eyes, there was evidence of blockage of the distal end of tude. Thus we think that the pattern of one piece valved implant is better than the other technique.