Swept-Source Anterior Segment Optical Coherence Tomography Imaging and Quantification of Bleb Parameters in Glaucoma Filtration Surgery.

This paper describes a technique for using swept-source anterior segment optical coherence tomography (AS-OCT) to visualize internal bleb microstructure and objectively quantify dimensions of the scleral flap and trabeculo-Descemet window (TDW) in non-penetrating glaucoma filtration surgery (GFS). This was a cross-sectional study of 107 filtering blebs of 67 patients who had undergone deep sclerectomy surgery at least 12 months prior. The mean post-operative follow-up duration was 6.5 years +/- 4.1 [standard deviation (SD)]. The maximal bleb height was significantly greater in the complete success (CS) blebs compared to the qualified success (QS) and failed (F) blebs (1.48 vs. 1.17 vs. 1.10 mm in CS vs. QS vs. F, one-way ANOVA, p < 0.0001). In a subcohort of deep sclerectomy blebs augmented by intraoperative Mitomycin-C, the trabeculo-Descemet window was significantly longer in the complete success compared to the qualified success group (613.7 vs. 378.1 vs. 450.8 µm in CS vs. QS vs. F, p = 0.004). The scleral flap length, thickness, and width were otherwise similar across the three outcome groups. The quantification of surgical parameters that influence aqueous outflow in non-penetrating GFS can help surgeons better understand the influence of these structures on aqueous outflow and improve surgical outcomes.

Long-term surgical outcomes of two different Ahmed Valve implantation techniques in refractory glaucoma: Scleral flap vs scleral tunnel.

PURPOSE: To compare the outcomes and complications of the partial-thickness scleral flap technique to the long scleral tunnel technique in patients who underwent mitomycin C (MMC)-augmented Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS: In this retrospective study, we reviewed 139 eyes of 137 patients with refractory glaucoma who underwent AGV-Model FP7 implantation. The eyes were divided into the scleral flap group (n = 74) and the scleral tunnel group (n = 65). RESULTS: The mean follow-up was 57.91 ± 18.18 months for the flap and 61.18 ± 15.13 months for the tunnel group (p = 0.2499). The postoperative intraocular pressure (IOP) at 1 to 6 years was significantly lower than the baseline IOP in each group (p < 0.001). The average number of postoperative glaucoma medications decreased in the tunnel group (p = 0.0001) and in the flap group (p = 0.6194) compared to baseline. No statistically significant differences in postoperative visual acuity (p = 0.6396) and cumulative success (p = 0.054) were noted between the two groups. Conjunctival erosion or tube migration only occurred in the flap group. Significantly more reoperations were performed in the flap than in the tunnel group (p = 0.048). CONCLUSIONS: Both MMC-augmented AGV tube implantation methods lowered IOP. The flap technique was associated with higher rates of postoperative serious complications and more reoperations than the tunnel technique. Previous glaucoma surgery and the technique used to implant the surgical tube proved to be significant risk factors for conjunctival erosion.

Statistical Analysis of Factors Affecting Surgically Induced Astigmatism Following Trabeculectomy.

Purpose: To objectively evaluate surgically induced astigmatism (SIA) after trabeculectomy with mitomycin C and investigate the relationships between SIA and various factors. Patients and Methods: This retrospective study included the right eyes of 66 consecutive patients who underwent standard trabeculectomy performed in the superior temporal quadrant for the first time by a single surgeon. Keratometry recordings made before surgery and 3 months after surgery were collected to calculate the SIA in each patient. The arithmetic mean of SIA (M-SIA) and the centroid of SIA (C-SIA) were determined using vector analysis. The relationships between the magnitude of SIA and the following possible related factors were assessed: age, sex, pre-operative corneal astigmatism, pre-operative intraocular pressure (IOP), 3-month postoperative IOP, pre-operative best-corrected visual acuity (BCVA), 3-month postoperative BCVA, the number of total scleral flap sutures (T-SFS), the number of leftover scleral flap sutures without laser suture lysis at 3 months postoperatively (L-SFS), shape of the scleral flap (triangle or trapezoid), and incision type of the conjunctival flap (fornix- or limbal-based). Results: The mean (± standard deviation) M-SIA was 1.00 ± 0.85 D, and the mean C-SIA was 0.34 ± 1.28 D at 104°. The direction of C-SIA showed a trend of corneal steepening to the superior temporal location, in the direction of the scleral flap location. There were significant correlations of the magnitudes of SIA with the number of T-SFS (P = 0.001) and the number of L-SFS (P < 0.001). Conclusion: Trabeculectomy induced SIA in the direction of the scleral flap location, and scleral sutures are significantly associated with the SIA. The scleral suture may play a key role in steepening the cornea toward the scleral flap direction in post-trabeculectomy patients.

Scleral Flap Wound Dehiscence with Valsalva Maneuver After Trabeculectomy with Mitomycin C.

Incisional surgeries such as trabeculectomy reduce the resistance of the eye to trauma. Trabeculectomy is often performed together with mitomycin C, and late onset hypotony is already an expected complication in these eyes. This case report presents a patient who developed dehiscence of the scleral flap and hypotony maculopathy after Valsalva maneuver after 5.5 years of trabeculectomy. In a 6-month period, the patient's hypotonic maculopathy became evident, and vision was affected after this period. Thereupon, the wound site was explored, and dehiscence of the scleral flap at the temporal wound site and increased aqueous outflow were detected. Repair was done with sterile pericardium patch. Post-operative vision, intraocular pressure, and hypotony maculopathy recovered very quickly. After incisional surgeries, patients should be warned against both external trauma and minor traumas such as eye rubbing and Valsalva maneuver.

Modified small-incision cataract surgery for combined extraction - A comparative study of two techniques.

Purpose: To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified "frown" incision with triangular scleral flap technique. Methods: This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified "frown" incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann-Whitney U test for averages and Chi-square test for categorical values. Results: Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative - postoperative) for group A was 20.8 ± 8.3 mm Hg and that for group B was 17.2 ± 13.5 mm Hg. Conclusion: Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified "frown" incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.

Surgical technique: Autologous scleral flap for optic disk pit maculopathy.

PURPOSE: To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy. METHODS: Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade. RESULTS: After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP). CONCLUSION: In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.

The results of Baerveldt glaucoma implant surgery performed with the scleral flap and patch technique.

BACKGROUND: We report the results of Baerveldt glaucoma implant (BGI) surgery performed with the scleral flap and patch technique. PATIENTS AND METHODS: This was a retrospective analysis of 97 consecutive patients (107 eyes) who underwent BGI surgery with the scleral flap and patch, and were followed up for >1 year. We evaluated the patients' post-operative intraocular pressure (IOP), corneal endothelial cell density, and complications (corneal edema, Hoffmann elbow exposure). RESULTS: The preoperative IOP was 32.9 ± 8.6 mmHg. BGI surgery significantly decreased the IOP to 11.1 ± 3.8, 11.3 ± 3.6, 11.3 ± 4.2, 10.7 ± 3.8, and 11.4 ± 3.2 mmHg at 1, 2, 3, 4, and 5 years post-surgery (p < 0.001), respectively. The success rates at 1, 2, 3, 4, and 5 years were 96.3%, 94.8%, 94.8%, 88.5%, and 88.5%, respectively. Failure occurred in six eyes. The reasons for failure were as follows: a postoperative IOP ⩾21 mmHg in one patient, and loss of light sensation in five patients. No patients required additional glaucoma surgery. There were no cases of Hoffmann elbow erosion. Corneal edema occurred in five patients. CONCLUSION: BGI surgery performed with the scleral flap and patch significantly decreased the IOP, and no case of Hoffmann elbow erosion was observed over the 5-year post-operative period.

Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma.

OBJECTIVE: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. METHODS: One hundred primary glaucoma patients (120 eyes) in Xinyu People's Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. RESULTS: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P<0.05). There was 93.33% formation of functional filtering blebs in the study group, which was significantly higher than that in the control group (60.00%, P<0.001). Moreover, normal anterior chamber formation was significantly higher in the study group (91.67%) than in the control group (71.67%, P<0.01). There was 95.00% operation success in the study group, relative to 68.33% success in the control group (P<0.001). CONCLUSION: Microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique has better curative effect on primary glaucoma than compound trabeculectomy. Moreover, it does not exacerbate complications. Therefore, the combination treatment technique merits clinical application.

Simple Technique for Transscleral Fixation of a Foldable Posterior Chamber Intraocular Lens Using a Single Suture.

Objective: To explore the simplified technique for transscleral fixation of a foldable posterior chamber intraocular lens (IOLs) in patients with aphakia or inadequate posterior capsule support. Methods: A review was conducted of 18 eyes of eighteen patients with the absence of-or inadequate-capsule support, after the simplified technique of using a foldable posterior chamber intraocular lens (PC IOLs) with stable four-point transscleral fixation, as performed by a skilled surgeon. This technique uses only a single suture and a knot to fix a PC IOL firmly without creating a scleral flap. The mean follow-up time was 18 ± 5.8 months (ranging from 12 to 24 months). Results: All patients exhibited improved visual acuity. No IOL tilt or dislocation or iris capture was observed, and all patients exhibited stable and centered IOL after surgery. No complex complications, such as suture shedding and exposure, corneal endothelial decompensation, persistent uveitis, or retinal detachment and endophthalmitis were observed. Conclusion: The simplified technique proposed here is a reliable, economical, and reproducible method of treating patients with aphakia or inadequate posterior capsule support. It provides excellent IOL stability, reduces surgical duration and complexity, and prevents certain complications.

Baerveldt tube shunt implantation through a long scleral tunnel.

PURPOSE: To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel. MATERIALS AND METHODS: Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications. RESULTS: Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases. CONCLUSION: We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.

Efficacy of ciliary sulcus suture fixation of intraocular lens through reverse partial-thickness scleral flap / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess the application of ciliary sulcus suture fixation of intraocular lens(IOL)through reverse partial-thickness scleral flap.<p>METHODS: The clinical data of 14 patients(14 eyes )who needed secondary IOL implantations due to different reasons in our department were retrospectively analyzed. All cases underwent ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap. One or two reverse partial-thickness scleral flap were made during the surgery. Preoperative and postoperative visual acuity, intraoperative and postoperative complications and the stability of the IOLs were observed.<p>RESULTS: The mean follow-up time was 3.5-6mo. The preoperative best-corrected visual acuity(BCVA)(LogMAR)was 0.50±0.54, and the uncorrected visual acuity(UCVA)at 1mo after surgery was 0.46±0.39(<i>P</i>>0.05). The BCVA at 1mo after surgery was 0.36±0.35, which was improved compared with the preoperative one, but the difference was not statistically significant(<i>P</i>>0.05). Three cases had transient intraocular hypertension postoperatively. One case had vetrious hemorrhage. One case had moderate anterior chamber inflammatory response. There were serious complications, such as cystoid macular edema, choroidal detachment, retinal detachment during the follow-up period.<p>CONCLUSION: Ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap is a effective and safe method for aphakia.

Scleral Thinning after Transscleral Biopsy for Uveal Melanoma Using Lamellar Scleral Flap.

PURPOSE: The purpose of the study is to describe the clinical history and histopathologic findings of three cases of scleral thinning after lamellar scleral flap, including one case with confirmed extraocular tumor extension. METHODS: The medical records and pathology specimens of three patients with scleral thinning after biopsy and plaque brachytherapy and lamellar scleral flap performed during a transscleral biopsy were reviewed. RESULTS: The first two patients developed scleral thinning and visible pigmentation, but had tumors that were regressing in size on ultrasound. The two patients were followed by serial observation. The third patient exhibited scleral thinning and evidence of tumor growth on ultrasound, raising the suspicion for extraocular tumor extension. Histopathologic examination of the enucleated eye confirmed extrascleral tumor extension and showed necrotic and intact melanoma with associated pigmented macrophages. CONCLUSIONS: Patients with scleral flaps created for biopsy of uveal melanoma are at risk for scleral thinning and extrascleral extension of tumor recurrence through the flap.

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication.

BACKGROUND: To describe a new technique and present its long-term outcome for prevention of Ahmed glaucoma valve (AGV) tube exposure in patients with refractory glaucoma. METHODS: Twenty-seven eyes of 24 patients (mean age, 50 years; age range, 16-78 years; 8 females, 16 males) with refractory glaucoma who had the AGV implant were retrospectively reviewed. For AGV implantation, a long scleral flap combined with Tenon advancement and duplication was used. In this technique, a long scleral flap is created to completely cover the extraocular part of valve's tube, and the flap surface is covered with duplicated Tenon's tissue. The average follow-up after AGV implantation was 21.7 months (range, 12-36 months). RESULTS: The mean intraocular pressure before the operation, which was 44.1 mmHg (range, 26-62 mmHg), decreased to 14.2 mmHg (range, 8-20 mmHg) at the last follow-up visit, showing 67% reduction with AGV implantation. The mean number of antiglaucomatous medications was 4.1 before the AGV implantation and decreased to 0.9 after the operation, showing 88% reduction. In 14 eyes (51.9%), there was no change in the best corrected visual acuity (BCVA), and in 11 eyes (40.7%), the BCVA increased by 2 lines on the Snellen chart postoperatively. No patient developed postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, or tube/plate migration. CONCLUSIONS: The long scleral flap augmented with Tenon advancement and duplication is an effective and safe surgical technique for the implantation of AGV and preventing tube exposure in cases of refractory glaucoma.

Safety and efficacy of fibrin glue versus infinity suture in SICS with extended scleral flap.

Purpose: To study the safety and efficacy of biologic fibrin glue (FG) in comparison with infinity suture in SICS with compromised scleral flap. Methods: A retrospective comparative study of patients who were treated with FG (Group A) with 10-0 nylon (Group B) as sealing agent for intraoperative compromised tunnels in SICS. Parameters noted were postoperative inflammation, wound integrity, anterior chamber (AC) depth, intraocular pressure (IOP), and surgically induced astigmatism (SIA) at postoperative day 1, 4 weeks, 6 weeks, and 6 months, respectively. Epi Info 7 software and SIA calculator, Version 2.1 were used to analyze the result. Results: We reviewed the two groups of 18 patients each and noted that there was no statistically significant difference in postoperative inflammation (P > 0.05), AC depth (P > 0.05), and IOP (P > 0.05) between both groups at each postoperative visit. One patient in Group A showed postoperative shallow AC and subconjunctival bleb. Exposed sutures causing foreign body sensation had to be removed in five patients in Group B. At the end of 6-month postoperative period, no statistically significant difference was found in SIA (P = 0.92) between the two groups. Conclusion: Biologic FG can be safely used in securing the compromised scleral incisions in SICS. It also avoids suture-related complications.

A novel suturing technique for filtering glaucoma surgery: the accordion suture.

AIM: To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure (IOP). METHODS: Description of 'the accordion suture' technique for mitomycin C augmented trabeculectomy. In cases of postoperative high IOP, pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges. By means of this technique, the scleral flap opens up in an "accordion" manner, thus preventing flap obstruction and providing adequate aqueous flow. RESULTS: Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma. Mean age of the subjects was 67.42±8.21y and female/male ratio was 4/4. Mean preoperative IOP was 37±7.48 mm Hg. Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications. The scleral flap closure is performed with three separate sutures; initially, our accordion suture through the center of the flap, and two releasable sutures on both corners. All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture, without any complications. The average traction time was 3.5±0wk postoperatively. The mean postoperative IOP was 11.37±2.72 mm Hg. No suture related complications were observed. CONCLUSION: This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.

Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors.

AIM: To investigate surgical outcomes and success predictors of transconjunctival scleral flap resuturing for the management of hypotony due to overfiltration following trabeculectomy with mitomycin C. MATERIALS AND METHODS: Noncomparative, retrospective, interventional case series in which all glaucoma patients from two glaucoma services undergoing transconjunctival scleral flap resuturing between May 2012 and July 2016 were enrolled. Included eyes had to have hypotony [intraocular pressure (IOP) < 6 mm Hg] and/or hypotony maculopathy caused by excessive filtration following trabeculectomy. Key exclusion criteria were wound/bleb leaking and postoperative ocular trauma or infection. Preoperative and postoperative IOP, best-corrected visual acuity (BCVA), fundus imaging, surgical complications, and any subsequent related events or procedures were recorded. Rates of postsurgical hypotony and/or maculopathy resolution and possible success predictors were investigated. RESULTS: A total of 22 patients (22 eyes) with a mean age of 56.4 ± 15.2 years were included. Median follow-up was 245 days [interquartilerange (IR); 120-817 days] and mean IOP was increased from 2.9 ± 1.5 mm Hg (1-6 mm Hg) to 8.5 ± 3.1 mm Hg (2-16 mm Hg) at the last follow-up visit (p < 0.01). Approximately 75% of the cases (16 out of 22) had an IOP between 7 and 18 mm Hg at the end of the follow-up period. Median BCVA (log MAR) at last follow-up visit [0.1 (IR; 0.0- 0.3)] was significantly better than preoperative BCVA [0.4 (IR; 0.11.0); p < 0.01]. Hypotony resolved in 81% of the cases, while maculopathy resolution was found in 85% of the cases. Time interval between trabeculectomy and flap resuturing was the only factor significantly associated with patient's IOP at last follow-up visit (R2 = 0.23; p = 0.036). Success rates (IOP > 6 mm Hg at last follow-up visit) were halved in those left untreated for more than 6 months. No serious adverse event was recorded. CONCLUSION: Our findings support the use of transconjunctival scleral flap resuturing as an effective and safe alternative for hypotony management due to overflitration following trabeculectomy. As time interval seems to influence the odds of hypotony resolution, early intervention is recommended. HOW TO CITE THIS ARTICLE: Scoralick ALB, Almeida I, Ushida M, Dias DT, Dorairaj S, Prata TS, Kanadani FN, Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017;11(2):58-62.

Baerveldt® glaucoma implant surgery with the double scleral flap technique to prevent Hoffman elbow exposure.

OBJECTIVE: To compare the efficacy and safety of the Baerveldt® glaucoma implant (BGI) between a preserved donor scleral patch alone and double scleral flaps, comprising a preserved donor scleral patch and an autologous scleral pedicle flap. METHODS: This was an open-label retrospective study. We analyzed the cases of 52 consecutive patients (56 eyes) who underwent BGI surgery with the Hoffman elbow (#BG 102-350, Abbott) and were followed up for >1 year. Twenty-one eyes underwent BGI surgery with a preserved donor scleral patch alone (donor-patch group), and the other 35 eyes underwent BGI surgery with a preserved donor scleral patch and an autologous scleral pedicle flap (double-flap group). The main outcome was the incidence of Hoffman elbow exposure associated with each surgical approach. RESULTS: Three patients in the donor-patch group (14.3%) developed Hoffman elbow exposure, whereas in the double-flap group, no cases had Hoffman elbow exposure (p = 0.048). CONCLUSIONS: The use of the double scleral flaps technique was more efficient in preventing Hoffman elbow exposure.

Reconstruction of delayed scleral flap melting with bovine pericardium after trabeculectomy with mitomycin C.

Aim: To present a challenging case of hypotony after trabeculectomy and its treatment. Case description: A 22-year-old woman with juvenile glaucoma underwent a conventional trabeculectomy with mitomycin C on the right eye (OD). In the immediate postoperative period, we observed a hyperfiltration bleb with hypotony refractory to conservative measures leading to hypotony maculopathy. A surgical revision with scleral flap resuture and conjunctival graft was performed with a satisfactory result and resolution of hypotony maculopathy. After two years, the patient complained of low visual acuity (VA) of the OD. During examination, we observed a fine and avascular bleb with Seidel and visualization of the underlying uveal tissue, an intraocular pressure (IOP) of 5 mmHg, and chorioretinal folds. A new revision of the trabeculectomy was performed. During the procedure, it was not possible to identify the scleral flap, so the fistula was closed with a patch of collagenous membrane derived from bovine pericardium (Tutopatch® graft). A good clinical evolution occurred. After 2 months, IOP was 15 mmHg without Seidel or changes in the fundus and VA was 20/20. After 8 months of follow-up, the IOP remains stable without further complaints. Conclusion: This case illustrates the difficulties faced in the management of a common complication of trabeculectomy and highlights some of the options available for its treatment. There are few reports of scleral melting after trabeculectomy. However, trauma and scleral necrosis associated with mitomycin are listed as the main causes. The use of a scleral patch derived from bovine pericardium allows effective suturing and closure of the aqueous leak.

Risk factors for conjunctival tube erosion in eyes implanted with Ahmed glaucoma valve in a private eye institution in the Philippines

Objective@#To identify the risk factors for conjunctival tube erosion (CTE) in eyes implanted with Ahmed® glaucoma valve (AGV) device@*Method@#This is a retrospective study conducted at a private eye institution. Medical records of patients who underwent AGV implantation surgery from January 2004 to December 2013 were reviewed. Eyes with at least 24 months of follow-up and complete records were included. Several variables from the pre-, intra-, and postoperative periods were collected. The primary outcome was development of CTE after AGV surgery. Univariable logistic regression and multivariable analysis were employed.@*Results@#Forty-six (46) eyes of 45 patients were included in the study. The mean follow-up was 50.2 months (range: 24-140 months). Eight (8) eyes developed CTE (17.4%). Univariable logistic regression analysis identified female gender (P =0.064), presence of diabetes (P =0.083), prior intraocular surgeries (P =0.09), and postoperative use of antiglaucoma medications (P =0.086) to be marginally significant risk factors for CTE. On multivariable analysis, only female gender (OR=15.4, P =0.033) and diabetes (OR=14.1, P =0.031) were found to be significantly associated with CTE.@*Conclusion@#Risk factors for CTE following AGV implantation include female gender and presence of diabetes.

Clinical observation of the glaucoma trabeculectomy with tunnel knife making the double-deck scleral flap / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To study the trabeculectomy clinical effect of use tunnel knife to make double - deck scleral flap and to cut off the layer scleral flap of glaucoma.METHODS: Using the random grouping method to divide 46 cases (60 eyes) of glaucoma into the treatment group of 24 cases (32 eyes) and control group of 22 cases (28 eyes). The treatment group, tunnel knife was used to make double- deck sclera flap and superficial scleral flap about the size of 5mm×5. 5mm, 1/3 scleral thickness, under the sclera flap made another one about the size of 3. 5mm× 4mm, 1/3 scleral thickness, resected the middle layer of the sclera flap, removed 2mm×2mm trabecular tissue, underwent routine peripheral iridectomy, could adjust suture the superficial scleral flap, sutured Ball fascia and bulbar conjunctiva. ln control group, routine glaucoma trabeculectomy was undergone.RESULTS:Patients were followed up for 1a, the vision in treatment group was obviously better than that in the control group, with a statistically significant difference (P0. 05). But after 6 and 12mo, the intraocular pressure of the treatment group were significantly lower than that of the control group, with statistically significant difference (P<0. 05). Postopeartive 1a, the cumulative complete success rate and conditions for successful rate were 90. 63% and 96. 88% in the treatment group, and those were 75% and 89. 29% in control group. There was significant difference between two groups(P<0. 05).CONCLUSlON:The trabeculectomy have a good effect to lower the intraocular pressure by use tunnel knife to make double-deck scleral flap and to cut off the layer scleral flap. The scleral flap have uniform thickness, smooth surface, and the function of the filtering bleb maintained for a long time, less postoperative complications, suitable for various types of glaucoma, so it is worthy of clinical promotion.