Ahmed Glaucoma Valve Implant for Neovascular Glaucoma

We studied retrospectively the results of the Ahmed glaucoma valve implant surgery in 20 eyes with neovascular glaucoma. All cases were failed with medical or surgical glaucoma interventions. Mean follow-up period was 15.1 +/-14.9 months (3~56 months). The criteria for success included a postoperative intraocular pressure (IOP) of less than or equal to 21 mmHg and greater than or equal to 6 mmHg, and no additional glaucoma therapy or devastating visual complications. Mean IOP was significantly reduced from pre- operative 36.9 +/-5.2 mmHg to 17.6 +/-8.7 mmHg at the last visit. In respect with IOP control,success rate was 80%at final follow-up.The causes of failure were loss of light perception in 3 eyes (25%), inadequate IOP control in 2 eyes (10%), tube removal due to malfunction in 1 eye (5%). Complete success rate was 70%at a final follow-up.Complication included hyphema in 15 eyes,hypotony in 7 eyes, fibrous membrane formation and anterior synechiae in 3 eyes, tube obstruction in 2 eyes, flat anterior chamber in 1 eye, corneal decompensation in 1 eye, tube malposition in 1 eye, temporary choroidal detachment in 1 eye. These results indicate that Ahmed glaucoma valve implant for neovascular glaucoma can be a good successful IOP control device and comparable to the other drainage device.

A Case of Late Onset Bleb-Related Endophthalmitis after Trabeculectomy with Mitomycin C

Adjunctive use of Mitomycin C (MMC)in trabeculectomy has greatly improved the success rate. Trabeculectomy with MMC, however, has resulted in a cystic and thin-walled filtering bleb, which may be more susceptible to infection. Late onset bleb-related endophthalmitis developed in a glaucoma patient at 40 months after MMC trabeculectomy. Filtering bleb in this patient had been avascular, thin-walled and cystic prior to the occurrence of endophthalmitis. Patient complained of decreased visual acuity with ocular discomfort and conjunctival injection and showed a mucopurulent infiltrate within the bleb, hypopyon and vitritis. Visual acuity was hand motion. An intensive treatment included anterior chamber irrigation, lensectomy,par plana vitrectomy, intravitreal and subconjunctival antibiotics (vancomycin,gentamycin) injection and topical and systemic corticosteroid (dexamethasone) and antibiotics,which led to a resolution.

Laser Suture Lysis after Trabeculectomy

We studied the efficacy of laser suture lysis in the promotion of filtration and bleb formation during the early postoperative period after trabeculectomy. Laser suture lysis was performed on thirty-two eyes of thirty patients considered overtight scleral flap suture among patients who underwent trabeculectomy with mitomycin-C, using an argon laser and a Hoskins lens. Patients were entered into the study if, after ocular massage, the intraocular pressure(IOP) was greater than our target pressure(8-12mmHg) 48 Hours after surgery, deep quiet anterior chamber, weak or no bleb formation, no bleb leakage, and a patent internal ostium on gonioscopy. Intraocular pressure measured within 5 minutes of lysis and gentle ocular massage was employed if there was no sopontaneous bleb formation. A further suture was lysed if at this stage there was still no bleb associated with a high IOP. Suture lysis was successful in all cases in the early postoperativy period. The mean IOP before lysis was 22.1mmHg and after serial lysis 9.8mmHg. Complications were noted with laser suture lysis: shallowing of anterior chamber, ocular hypotony, sunconjunctival hemorrhage, hyphema and cataract. All resolved with appropriate management. Laser suture lysis is a safe, effective, and non-invasive method, It can avoid surgical manipulation and increase long term success rate of trabeculectomy.