RESUMO
Glaucoma drainage devices are mostly used for refractory glaucoma. Early postoperative complications include flat anterior chamber, choroidal effusion, and suprachoroidal hemorrhage. An 8-year-old male patient with a prior history of vitreous surgery for traumatic vitreous hemorrhage, presented to us with angle recession glaucoma in his right eye. His intraocular pressure (IOP) was 44 mmHg despite maximum antiglaucoma medication. Ahmed glaucoma valve (AGV) surgery was performed to control his IOP. In the early postoperative period, the patient developed premacular subinternal limiting membrane (ILM) hemorrhage, which did not resolve even after 4 weeks. Vitreoretinal intervention involving removal of the thickened ILM and sub-ILM bleed had to be performed. To the best of our knowledge, no case has been reported with sub-ILM bleed post aqueous humor shunts. Here, we report a case of premacular sub-ILM bleed following AGV in vitrectomized eye.
RESUMO
CONTEXT: Visual disability is categorised using objective criteria. Subjective measures are not considered. AIM: To use subjective criteria along with objective ones to categorise visual disability. SETTINGS AND DESIGN: Ophthalmology out-patient department; teaching hospital; observational study. MATERIAL AND METHODS: Consecutive persons aged >25 years, with vision <20/20 (in one or both eyes) due to chronic conditions, like cataract and refractive errors, were categorized into 11 groups of increasing disability; group-zero: normal range of vision, to group-X: no perception of light, bilaterally. Snellen's vision; binocular contrast sensitivity (Pelli-Robson chart); automated binocular visual field (Humphrey; Esterman test); and vision-related quality of life (Indian Visual Function Questionnaire-33; IND-VFQ33) were recorded. STATISTICAL ANALYSIS: SPSS version-17; Kruskal-wallis test was used to compare contrast sensitivity and visual fields across groups, and Mann-Whitney U test for pair-wise comparison (Bonferroni adjustment; P < 0.01). One-way ANOVA compared quality of life data across groups; for pairwise significance, Dunnett T3 test was applied. RESULTS: In 226 patients, contrast sensitivity and visual fields were comparable for differing disability grades except when disability was severe (P < 0.001), or moderately severe (P < 0.01). Individual scales of IND-VFQ33 were also mostly comparable; however, global scores showed a distinct pattern, being different for some disability grades but comparable for groups III (78.51 ± 6.86) and IV (82.64 ± 5.80), and groups IV and V (77.23 ± 3.22); these were merged to generate group 345; similarly, global scores were comparable for adjacent groups V and VI (72.53 ± 6.77), VI and VII (74.46 ± 4.32), and VII and VIII (69.12 ± 5.97); these were merged to generate group 5678; thereafter, contrast sensitivity and global and individual IND-VFQ33 scores could differentiate between different grades of disability in the five new groups. CONCLUSIONS: Subjective criteria made it possible to objectively reclassify visual disability. Visual disability grades could be redefined to accommodate all from zero-100%.
