Management of Ahmed glaucoma valve tube exposure after scleral patch graft shrinkage

Background: Ahmed glaucoma valve (AGV) is an useful modality in the management of medically refractory glaucoma. Human donor scleral patch graft (SPG) can be employed to cover the external portion of the tube to prevent its exposure and associated sight?threatening complication. Purpose: To report the management of a case of AGV tube exposure due to SPG shrinkage in the right eye (RE) of a patient. Synopsis: Under peribulbar anesthesia, the conjunctiva is undermined posteriorly, on either side of the exposed tube. The AGV tube is noted to lay firmly against the sclera without any excessive movement. The shrunk and displaced SPG is excised, and a larger, 6 × 8 mm, full?thickness, human donor SPG is placed on the episcleral bed, over the exposed segment of the tube, to ensure its adequate coverage. The SPG is sutured with four interrupted, 10?0 nylon sutures. The SPG is adequately covered with conjunctiva, by conjunctival mobilization and advancement to avoid excessive tension over the tube and closed with interrupted, 8?0 Vicryl suture. Highlights: SPG shrinkage and overlying conjunctival erosion can occur after AGV implantation. This can cause AGV tube exposure, which can be managed by donor SPG to cover the exposed tube

Anterior staphyloma repair following trauma and surgery – A retrospective review of techniques and outcomes over 25 years

Purpose: To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. Methods: This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Results: Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3–159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Conclusion: Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

Plug it, fill it and forget it!

Background: Management of posterior scleral perforation is commonly done with cryotherapy/laser or scleral patch graft depending on the size of perforation. However, for large perforations, the availability of donor sclera is always an issue. To overcome this problem, we tried using absorbable gelatin sponge to plug the perforation as an alternative. Purpose: To evaluate the efficacy of gelatin foam as an alternative to scleral patch graft in cases with perforation of posterior sclera. Synopsis: Here we report the case of a 27?year?old male, who sustained penetrating injury to right eye with two metallic intraocular foreign bodies with visual acuity of hand movement close to face. Primary wound repair was done, followed by retrieval of the first piece of metallic foreign body that measured 11X3mm in size. The second foreign body visualized at posterior pole adjascent to the disc was removed using Machemar forceps and it measured 10X3 mmin size. Leakage of PFCL at the site confirmed a posterior scleral perforation. Cryotherapy was avoided due to its proximity to optic nerve head, and donor sclera was not readily available at that moment. We managed the case by plugging the defect with absorbable gelatin foam, followed by silicone oil injection into the vitreous cavity. Post operative outcome was good with restoration of anatomical integrity of the globe along with improvement in visual acuity upto 6/18. Highlights: Gelatin foam being absorbable and inciting less reaction aids in sealing the perforation and maintenance of globe contour with the advantage being readily available, cost?effective and it can be left in situ without the need for additional surgery for its removal. This would be of use in situations where the donor sclera is not readily available, and thus can be a potential alternative. However, further studies with larger sample size need to be done to evaluate and compare its effectiveness over donor scleral grafts

Preserved scleral patch graft for unexpected extreme scleral thinning found at the scleral buckling procedure: A case report.

Pre-existing scleral pathology is an important risk factor for globe rupture during scleral buckling procedures. We report here, the surgical management of an unexpected scleral pathology found at the scleral buckling procedure in a retinal detachment patient. A 77-year-old white female with retinal detachment underwent a scleral buckling procedure. The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively. An alcohol-preserved donor sclera graft was used. The second surgery for definitive retinal alignment was performed two weeks later. The presented case of an unexpected scleral pathology in a retinal detachment patient was managed with a combination of scleral grafting and pars plana vitrectomy, without any major complications. The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory. A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study.

Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG). Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 <IOP <21 mmHg and qualified success as 5 <IOP <21 mmHg with medications or minor procedures. Results: The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P <0.001) and the use of medications dropped from 2.92 to 0.39 (P <0.001) after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy. Conclusions: Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.

Hydrox yapatite Implantation with Scleral Patch Graft in Eviseration

When inserting an orbital implant, evisceration allows suitable movement of the eyeball making it a better method cosmetically than enucleation; performing hydroxyapatite implantation after evisceration preserving the cornea sometimes causes the complication of cornea melting. To reduce complications after evisceration and hydroxyapatite implantation,scleral patch graft with corneal excision was performed in 15 eyes of 15 patients. In all 15 eyes, 20 mm-sized hydroxyapatite implants were inserted. Fourteen eyesshowed no complications, but in one eye scleral suture was exposed and 2months later the implant was exposed around that area. Also, there developed conjunctival wound dehiscence and exposure of the central portion of the scleral graft in two eyes. But the exposed sclera was fibrovascularized by the surrounding conjunctival tissue and did not lead to exposure of the implant. This study suggests that when performing evisceration and hydroxyapatite implantation, scleral pach graft with cornea excision is helpful in reducing the incidence of exposure of hydroxyapatite implant.