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Background: Pars plana vitrectomy with implantation of an Ahmed glaucoma valve in the vitreous cavity has been reported with a success rate in the management of refractory and neovascular glaucoma. This study aimed to present the outcomes of pars plana Ahmed glaucoma valve (PPAV) surgical implantation in cases with refractory glaucoma. Methods: In this single-center, retrospective, comparative study, 87 consecutive patients diagnosed with refractory glaucoma who underwent PPAV surgical implantation between October 2015 and October 2019 were evaluated. A successful postoperative outcome was defined as intraocular pressure (IOP) ≤ 21 mmHg upon examination and a reduction in the number of anti-glaucoma agents used at the latest follow-up. Results: Finally, 81 eyes of 78 patients with refractory glaucoma were included; 54 (66.66%) of the eyes had neovascular glaucoma. The mean follow-up was 20.65 ± 12.17 months (range: 2-52 months). The mean preoperative IOP was 40.01 ± 1.19 mmHg and reduced significantly to 16.73 ± 0.82 mmHg at the latest follow-up (P < 0.001); a successful IOP outcome was achieved in 88.89% of eyes. The mean number of anti-glaucoma agents decreased significantly from 2.86 ± 0.09 preoperatively to 1.46 ± 0.11 at the latest follow-up (P < 0.001); while 61 (75.31%) of eyes had a reduction in the number of IOP lowering eye drops, and 14 (17.28%) had no need for IOP lowering eye drops. Conclusions: PPAV surgery is a successful procedure for IOP reduction in patients with refractory glaucoma. Our study demonstrated either reduction or elimination of IOP lowering eye drops postoperatively. Large scale studies with a comparison group, a longer follow-up, and having various subtypes of glaucoma are required as future research to confirm these outcomes.
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Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (-0.04 to 1.32) at 1 month, 0.52 (-0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P = 0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P = 0.6377). Median CMT measured 203 µ m preoperatively, which temporarily increased to 238 µ m at 1 month after surgery (P = 0.0093) and then spontaneously returned to baseline, measuring 212.5 µ m at 3 months postoperatively (P = 0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.
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PURPOSE: To compare the clinical outcomes in patients who had triamcinolone acetate-assisted anterior vitrectomy and patients who had anterior vitrectomy without triamcinolone acetate after phacoemulsification complicated by posterior capsule rupture and vitreous loss. SETTING: Arrowe Park Hospital, Wirral, United Kingdom. DESIGN: Retrospective consecutive case note review. METHODS: Consecutive case notes of patients who had anterior vitrectomy assisted by triamcinolone acetonide (triamcinolone group) or without triamcinolone acetate (no-triamcinolone group) after posterior capsule rupture between January 2007 and January 2011 were identified and examined. Data recorded at the clinic visit preoperatively and 1 day and 3 months postoperatively were collated. Information recorded on the pro forma included visual acuity, ocular comorbidities, intraocular pressure (IOP), vitreous strands in the anterior chamber, and other adverse events. RESULTS: No statistically significant difference was found in the visual acuity or IOP between 17 patients in the triamcinolone group and 34 patients in the no-triamcinolone group at any time point. Vitreous strands in the anterior chamber were noted in 1 patient in the triamcinolone group and 7 patients in the no-triamcinolone group. Cystoid macular edema (CME) was present in 3 patients in the no-triamcinolone group, including 1 patient with vitreomacular traction. CONCLUSIONS: There was no significant increase in IOP after triamcinolone acetate-assisted anterior vitrectomy. Higher rates of CME and residual anterior chamber vitreous strands in the no-triamcinolone acetate group support the clinical use of triamcinolone acetate.
