Ahmed Valve Implantation Research Articles

Graft-free Ahmed valve implantation through a 6 mm scleral tunnel

ObjectiveTo evaluate the safety, efficacy, and cost savings of Ahmed glaucoma valve (AGV) tube implantation through a 6-mm scleral tunnel (graft-free technique). DesignRetrospective cohort study. MethodsThe 95% confidence interval for fractional survival at any particular time was calculated using the Kaplan–Meier method. Failure was defined as (i) intraocular pressure (IOP) <6 mm Hg or >21 mm Hg or <20% IOP reduction on 2 consecutive visits after 12 months; (ii) additional surgical intervention to control IOP; or (iii) no light perception. ResultsEighty-four eyes were implanted with graft-free AGV with a success rate of 83% at 2 years. Fourteen eyes failed: 4 no light perception, 1 hypotony, 1 elevated IOP, 5 secondary glaucoma surgeries, 2 AGV extractions, and 1 corneal decompensation. The rate of transient hypotony peaked at 33% on postoperative day 1, reducing to 4% by 6 weeks. Transient flat anterior chamber developed in 8% of eyes. Eight percent of eyes experienced a hypertensive phase (mean IOP = 28 mm Hg). Preoperatively, eyes received 3.8 units of glaucoma medication on average. Postoperatively, 8 eyes required no medication for IOP control. Of the eyes requiring postoperative glaucoma medication, 33% restarted during week 4; an additional 25% of eyes were restarted 6 weeks postoperatively. By 6 months, eyes were on average using 2.2 units of glaucoma medication. Hyphema (18%) was the most common early postoperative complication. The rates of conjunctival and scleral erosion by 2 years were 2.4% and 0%, respectively. Within our institution, excluding valve cost, there was a 39%–45% ($192–$376) cost reduction with the graft-free technique. ConclusionsThe safety and efficacy of a 6-mm scleral tunnel is comparable to conventional scleral-graft method.

Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy.

ABSTRACTAims: To compare outcomes of resident-performed Ahmed valve surgery vs trabeculectomy in a Veteran Affairs medical facility.Materials and methods: A retrospective cohort of 103 eyes in 91 patients receiving Ahmed valve (valve) or trabeculectomy (trab) performed at a Veterans Administration Medical Center by residents in their third year of training. The primary outcomes included intraocular pressure (IOP), treatment failure, and complications over 1 year.Results: Of 103 eyes, 44 received valve and 59 received trab. Primary open-angle glaucoma was primary diagnosis more often in trab, while neovascular glaucoma predominated in the valve group (p < 0.001). Preoperative mean IOP was 35.1 ± 11.8 and 24.5 ± 7.1 mm Hg for valve and trabeculectomy respectively (p < 0.001), but at 1 year the IOP difference between groups was not statistically significant (p = 0.064). Overall, 11 (25.0%) and 11 (18.6%) eyes met any criteria for failure for valve and trab respectively. At 1 year, 22.5% of valves had IOP > 21 mm Hg vs only 4.3% of trab (p = 0.02). Complications were infrequent. There were no intraoperative complications for valve, whereas five for trab. Most common immediate complication for valve was hyphema. Both groups had low rates of choroidal effusions and reoperation.Conclusion: Ahmed valve implantation and trabeculectomy produce significant reductions in IOP when performed by residents-in-training. Valves tend to be used more frequently in patients with secondary glaucoma. Although complication profiles differ between procedures, both are safe and well tolerated when performed by resident physicians.Clinical significance: This study provides support for evidence-based patient counseling that supervised, resident-performed Ahmed valve implantation and trabeculectomy are indeed safe and effective.How to cite this article: Sharpe RA, Kammerdiener LL, Wannamaker KW, Fan J, Sharpe ED. Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy. J Curr Glaucoma Pract 2016;10(2):60-67.

Intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation for the treatment of neovascular glaucoma

Objective To investigate the efficacy of intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation for neovascular glaucoma(NVG). Methods Twenty-six eyes of 26 cases diagnosed as NVG were treated with intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation which was taken as group A. Injections of bevacizumab (1.25 mg/0.05 ml) for twenty-six eyes were performed under topical anesthesia, and all cases were implanted with Ahmed drainage valve after 1 week. In group B, as the control group, 32 NVG eyes of 32 cases were treated with Ahmed drainage valve implantation and the preoperative or postoperative panretinal photocoagulation. The follow-up time was more than 6 months. Results In group A, the mean intraocular pressure of 26 eyes of 26 cases before and one week after bevacizumab injection was (44.04±1.58) mmHg (1 mmHg = 0.133 kPa) and (43.16±1.50) mmHg, respectively. The mean intraocular pressure at 6 months after Ahmed drainage valve implantation was (13.20±5.70) mmHg. The difference of the mean intraocular pressure before and 6 months after treatment was statistically significant (t=25.41, P=0.000). In group B, the mean intraocular pressure of 32 eyes of 32 cases before and 6 months after treatment was (49.10±14.32) mmHg and (13.80±6.23) mmHg, respectively, and the difference was statistically significant(t=12.79, P=0.001). The success rates of two groups were 69.23% and 62.50%, respectively, and the difference was not statistically significant (χ2=0.288, P=0.62). Seven days after intravitreal injection of Bevacizumab in group A, neovascularization in 21 eyes regressed completely, and partly regressed in 5 eyes. The change of neovascularization before and after operation was not obvious. There were 19 cases(73.08%)had neovascularization after the follow-up 6 months, including the neovascularization regression uncompletely in 5 eyes and the recurred neovascularization in 14 eyes. In group B, neovascularization regressed completely in 21 eyes, partly regressed in 10 eyes, and not regressed in 1 eye.Neovascularization did not regressed completely or recurred after the follow-up of 6 months in 15 cases (46.88%). The differences between two groups were statistically significant(χ2=4.06, P=0.045). Conclusion After intravitreal injection of bevacizumab, neovascularization regressed quickly. It created good conditions for Ahmed drainage valve implantation. As for long-term efficacy, panretinal photocoagulation combined with drainage valve implantation better than intravitreal injection of bevacizumab on treatment of neovascularization in iris. Key words: Glaucoma, neovascular; Bevacizumab, intravitreal injection; Ahmed drainage valve; Photocoagulation, panretinal

A clinical study on Ahmed glaucoma valve implantation through pars plana in treating of secondary glaucoma after lensectomy and vitrectomy

Objective To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation through pars plana for secondary glaucoma following lensectomy and vitrectomy surgery. Methods Thirteen eyes of 13 patients who had been diagnosed as secondary glaucoma after lensectomy and vitrectomy were selected in this study. All cases were treated with AGV implantation through pars plana with follow-up of 6 months. The intraocular pressure (IOP), complications, number of antiglaucoma medications applied and best-corrected visual acuity (BCVA) were evaluated during the followe-up. Results The BCVA of 9 eyes were improved, the visual acuities of 4 eyes were constant postopearatively after 6 months. The mean IOP was (40.6±7.7)mmHg preoperatively, (13.6±3.37)mmHg at 1 day after surgery, (17.6±4.5)mmHg in 1 week, (16.54±2.3)mmHg in 2 weeks, (18.46±1.66)mmHg in 1 month, (16.61±1.92)mmHg in 3 months, and (15.69±3.83)mmHg in 6 months(1 mmHg=0.133 kPa). The postoperative IOP descended noticeably(t=9.65~16.23, P<0.05). The mean number of antiglaucoma medications applied dreaseed from (2.92±0.64) kinds preoperatively to (1.23±0.93) kinds at the last follow-up (t=5.92, P=0.0001). The most common complications occurred were transient hyphema, early postoperative hyponoty, detachment of choroid and drainage tube blocking. Conclusion AGV implantation through pars plana is effective and safe in the management of secondary glaucoma following lensectomy and vitrectomy surgery. Key words: Glaucoma valve, Ahmed; Lensectomy; Vitrectomy; Glaucoma, secondary

Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications.

BackgroundResearches have shown anti-vascular endothelial growth factor (VEGF) agent is effective in treating neovascular eye diseases. The purpose of this study is to evaluate the efficacy and safety of intravitreal ranibizumab (IVR) injection combined trabeculectomy in the treatment of neovascular glaucoma (NVG), and compared it with Ahmed valve surgery.MethodsThirty-six NVG patients (37 eyes) from the First Affiliated Hospital of Zhejiang medical college, between January 1, 2014 and January 31, 2015, were included in this prospective, interventional clinical study. Eighteen NVG eyes were given IVR injection one week before trabeculectomy. Ahmed valve implantation surgery was performed in nineteen eyes. Ocular pain, best corrected visual acuity (BCVA), intraocular pressure (IOP) and surgical complications were evaluated before and after the surgery.ResultsIOP was significantly decreased following IVR injection combined trabeculectomy treatment (baseline 57.1 ± 8.9 mmHg; week 1, 15.2 ± 4.3 mmHg p = 0.000; month 1, 16.9 ± 2.1 mmHg p = 0.000; month 3, 20.3 ± 7.7 mmHg p = 0.000; month 6, 19.7 ± 7.3 mmHg p = 0.000). There was a significant, though modest, BCVA improvement in sighted eyes of IVR group (baseline 2.42 ± 0.68, W1 1.80 ± 0.91, P = 0.013; M1 1.77 ± 0.93, p = 0.011). IVR injection combined trabeculectomy had less postoperative complications and lower failure ratio than Ahmed surgery (IVR 5.6 %, Ahmed 31.6 %).ConclusionsThe study revealed that IVR injection combined trabeculectomy was an effective and safe treatment for NVG. Compared with Ahmed surgery, IVR injection combined trabeculectomy had less complications and higher success ratio. (Chinese Clinical Registry, TRN ChiCTR-OPN-16008147, 3/24/2016, retrospectively registered)

Combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for refractory primary congenital glaucoma in Egyptian patients: a long-term follow-up.

IntroductionPrimary congenital glaucoma (PCG) is the most common type of glaucoma in pediatric patients. The aim of this study was to compare the effectiveness of combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for cases of PCG refractory to traditional incisional angle surgery (goniotomy and trabeculotomy) in the Egyptian population.MethodsThe study was conducted in the Glaucoma Clinic of the Research Institute of Ophthalmology (Egypt). The study included 66 eyes of 66 patients (in two groups) with advanced PCG who had previous failed goniotomy, trabeculotomy, or both. Group 1 included 33 patients who underwent trabeculotomy-trabeculectomy procedures; group 2 included 33 patients who underwent FP 8 Ahmed valve implantation. The main outcome measures were intraocular pressure (IOP) reduction, corneal diameter, and axial length stability in both groups. Secondary outcome measures included detection of complications in both groups.ResultsThe average ages of the patients were 13.5 ± 3.9 months and 15.3 ± 5.8 months in groups 1 and 2, respectively. Ten patients (30.3%) in group 1 and 9 patients (27.3%) in group 2 had family histories of PCG. Positive consanguinity was present in 26 patients (78.8%) in group 1 and in 27 patients (81.8%) in group 2. In group 1, the mean intraocular pressure (IOP) value decreased from 33.6 ± 3.4 mmHg preoperatively to 13.8 ± 0.6, 16.9 ± 1.5, 18.2 ± 2.5, 19.8 ± 3.6, and 20.2 ± 3.1 mmHg in the first postoperative month and after years 1, 2, 3, and 4, respectively (p < 0.001). In group 2, the mean IOP value decreased from 33.4 ± 4.5 mmHg preoperatively to 13.3 ± 1.1, 16.3 ± 1.6, 18.1 ± 1.0, 19.1 ± 3.5, and 19.9 ± 3.7 mmHg in the first postoperative month and after years 1, 2, 3, and 4, respectively (p < 0.001). The average number of medications decreased from 2.2 ± 0.4 preoperatively to 1.8 ± 0.4 postoperatively in group 1, while it decreased from 2.1 ± 0.4 preoperatively to 1.9 ± 0.3 postoperatively in group 2. The success rate in group 1 was 97, 91, 76, and 61% in years 1, 2, 3, and 4, respectively, whereas the success rate in group 2 was 97, 93, 81, and 66% in years 1, 2, 3, and 4, respectively.ConclusionBoth procedures, i.e., combined trabeculotomy-trabeculectomy and Ahmed valve implantation are suitable options in advanced PCG with failed trabeculotomy and goniotomy. Ahmed valve implanation has a better long-term survival, but trabeculotomy-trabeculectomy provides a second chance for surgical intervention.

Surgical Treatment for Tube Erosion after Ahmed Valve Implantation

Purpose: To report serial cases of patients who received surgical treatment for tube erosion after Ahmed valve implantation. Methods: In this retrospective and longitudinal study, surgical outcomes of reconstruction for tube erosion after Ahmed valve implantation were evaluated. Tube erosion occurred in 7 of 125 eyes (121 patients) at 60.5 ± 67.5 months (2 to 196 months). To prevent recurrence of tube erosion, the tube was repositioned backward in 4 eyes. Scleral allograft was used in all cases. Partial thickness scleral flap, collagen matrix implant, or bovine pericardium was used to cover the exposed tube in selected cases. In eyes with large conjunctival defects or severe adhesions between surrounding conjunctiva and episclera, rotational conjunctival flap, conjunctival autograft, or amniotic membrane graft was used to reconstruct the ocular surface. Results: Three of 7 eyes (42.9%) with tube erosion were successfully repaired by the first surgical treatment. No recurrence of tube erosion was found after the second and the fourth surgical procedure in 3 and 1 eyes, respectively. There was no case of explantation of the Ahmed valve in our series. Tube erosion recurred in 1 of the 4 eyes in which tube-repositioning was required and in 3 of the 5 eyes in which a partial thickness scleral flap was made to cover a tube. One eye experienced recurrent tube erosion in a relatively short-term interval and was repaired successfully using both collagen matrix implantation and amniotic membrane transplantation. Conclusions: Tube erosion after Ahmed valve implantation was successfully treated by various methods including tube repositioning, partial thickness scleral flap combined with scleral allograft, biodegradable collagen implant, pericardial graft, and/or amniotic membrane transplantation. J Korean Ophthalmol Soc 2016;57(3):453-460

Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy.

Purpose. To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods. Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown. Results. Ten patients got clear vitreous and controlled IOP only with 2.7 ± 1.8 injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were 36.7 ± 8.1 mmHg on 3.4 ± 0.7 medications and 16.2 ± 4.9 mmHg on 0.67 ± 0.77 medications, respectively. Conclusions. The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered with NCT02647515.

Послеоперационные осложнения имплантации клапана Ahmed

Послеоперационные осложнения имплантации клапана Ahmed

Long-Term Outcome of Ahmed Valve Implantation Combined with 23-Gauge Vitrectomy in Eyes with Neovascular Glaucoma

Long-Term Outcome of Ahmed Valve Implantation Combined with 23-Gauge Vitrectomy in Eyes with Neovascular Glaucoma

Ahmed valve implantation results in neovascular glaucoma patients: Evaluation of short-term and remote

Objective: to evaluate Ahmed valve implantation results in neovascular glaucoma patients. Methods: standard implantation method was used in 87 patients aged 57-86 years. Check-up examinations were performed in 1 week, 1, 3, 6, 9, 12 and 36 months after surgery. Results: during short-term post-op period (one month after surgery), intraocular pressure normalized in 48 patients. During remote post-op period (6-36 months after surgery), intraocular pressure normalization was achieved in 69 patients (79.2 %), among them in 62 patients (71.2 %) - against the background of IOP-lowering treatment. The main complication was a hemorrhage from anterior chamber angle and iris new vessels that was found in 37 patients (42.5 %), in a quarter of cases it required hyphema washout. In three patients, sustained hypotony developed, in one case it brought to globe sub-atrophy. In two of observed patients, enucleation was performed because of pain syndrome rebound. Conclusions: In 79.2 % neovascular glaucoma patients, the valve implantation led to IOP normalization, while in 71.2 % of cases it required a return to IOP-lowering therapy.

Improved Surgical Success of Combined Glaucoma Tube Shunt and Retisert(®) Implantation in Uveitic Eyes: A Retrospective Study.

IntroductionThe purpose of this study was to determine whether the outcomes following placement of a fluocinolone acetonide implant (Retisert®; Bausch & Lomb, Inc.) combined with an Ahmed™ glaucoma valve (New World Medical, Inc.) in eyes with uveitic glaucoma (UG Retisert) were different when compared to an Ahmed valve alone in eyes with uveitic glaucoma or primary open angle glaucoma (UG non-Retisert and POAG, respectively).MethodsRetrospective, interventional study of consecutive uveitic and OAG eyes undergoing Ahmed valve (AV) implantation with or without combined Retisert insertion at a single academic center between 2009 and 2012. Surgical success was defined as intraocular pressure (IOP) between 5 and 18 mmHg and greater than 20% reduction of IOP at two consecutive visits without need for additional IOP-lowering medications or surgical procedures. Secondary outcome measures included IOP and number of glaucoma medications.ResultsSixty eyes of 60 patients (22 UG Retisert, 16 UG non-Retisert, 22 POAG) were included. Mean ± standard deviation surgical success duration was significantly greater in UG Retisert eyes, 629 ± 53 days, compared to those with UG non-Retisert, 361 ± 37 days, and POAG, 472 ± 65 days (P = 0.034). At 24 months, the mean IOP was 11.7, 12.1, and 15.0 mmHg and the average patient was on 1.45, 0.71, and 2.00 medications in the UG Retisert, UG non-Retisert, and POAG valve groups, respectively.ConclusionRetisert implants when combined with AV in uveitic glaucoma had a longer duration of surgical success than uveitic or POAG treated with AV insertion alone.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0041-3) contains supplementary material, which is available to authorized users.

Combined cataract phacoemulsification and aniridia endocapsular rings implantation in a patient with bilateral congenital aniridia and cataract: A case report

The objective of this article was to determine the long-term outcome of surgical treatment in a patient with bilateral congenital aniridia and congenital cataracts. The patient was treated by cataract removal and implantation of a single piece IOL in both eyes. Two aniridia rings were also implanted in the capsular bag. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), stability of the intraocular lens (IOL) and subjective glare reduction were measured for two years after the surgery. After 10months, the IOP in the left eye had increased to 26mmHg despite the fact that anti-glaucoma medication was added. Therefore, the patient was scheduled for an Ahmed valve implantation. These results suggest that good visual outcomes can be achieved in patients with bilateral congenital aniridia and cataracts. Nevertheless, the IOPs must be continuously monitored, and glaucoma screening performed to prevent further complications.

Bleb Analysis and Short-Term Results of Biodegradable Collagen Matrix-Augmented Ahmed Glaucoma Valve Implantation: 6-Month Follow-up.

To evaluate the short-term efficacy of a biodegradable collagen matrix (BCM) as an adjuvant for Ahmed valve implantation surgery to prevent the hypertensive phase. This prospective study included 43 refractory glaucoma eyes, all followed for 6 months. Refractory glaucoma was defined as an IOP higher than 20 mm Hg with antiglaucoma eye drops without previous glaucoma surgery. Conventional method was performed in 21 eyes and BCM-augmented Ahmed valve implantation (BAAVI) in 22 eyes. In the BAAVI group, a 10 × 10 × 2-mm BCM was sutured on an Ahmed glaucoma valve FP7 model. Complete success was defined as an IOP of 21 mm Hg or lower (target IOP 1) or 17 mm Hg or lower (target IOP 2) without antiglaucoma medications and qualified success as an IOP of 21 mm Hg or lower with or without medications. Maximal bleb thickness was measured using anterior segment optical coherence tomography images. The preoperative IOPs and numbers of preoperative antiglaucoma medications were similar for both groups. Complete target IOP 1 success rates were 38.1% and 86.4%, complete target IOP 2 success rates were 19.0% and 59.1%, and qualified success rates were 52.4% and 90.9% in the conventional and BAAVI groups, respectively (P < 0.05). The hypertensive phase rate was lower in the BAAVI group (4.5% vs. 47.6%, P = 0.002). Maximal bleb thickness was increased in the BAAVI group on postoperative days 30 and 180 (P < 0.05). Success rates were higher in the BAAVI group than in the conventional group with the change of bleb morphology. Furthermore, use of BCM significantly decreased the need for antiglaucoma medications for at least 6 months postoperatively.

Trabeculectomy Versus EX-PRESS Shunt Versus Ahmed Valve Implant: Short-term Effects on Corneal Endothelial Cells

To evaluate short-term changes in corneal endothelial cells after trabeculectomy, EX-PRESS device implantation, and Ahmed valve implantation for the treatment of primary open-angle glaucoma. Prospective, interventional, comparative case series with contralateral eye control study. We prospectively evaluated the changes in number, density, and shape of the corneal endothelium cells in 128 eyes of 64 patients divided into 3 groups depending on the treatment received. Corneal specular microscopy was performed with a noncontact specular microscope preoperatively and at 1 and 3months after surgery. The changes at each time point were compared with those of the control group, which consisted of 32 contralateral glaucomatous eyes receiving antiglaucoma medications without any previous glaucoma surgery. In the subjects who underwent trabeculectomy, corneal endothelial cell density (ECD) significantly decreased by 3.5% (P= .012, paired t test) at 1month and 4.2% (P= .007) at 3months after surgery, compared to the baseline values. In the Ahmed valve group ECD did not change at 1month after surgery and had a significant 3.5% decrease at 3months (P= .04). In the patients who underwent EX-PRESS implantation and in the control group ECD did not change either at 1month or at 3months after surgery (P > .05). EX-PRESS shunt, compared to trabeculectomy and Ahmed valve, seems to be a safer procedure regarding the risk of endothelial cell loss. For this reason, it may be the treatment of choice in patients with significant low corneal ECD before surgery or other risk factors forcorneal damage.

Endophthalmitis today: a multispecialty ophthalmology department perspective.

To portray the current scene of endophthalmitis in a multispecialty ophthalmology department regarding etiologies and treatment guidelines. Retrospective chart review of all patients diagnosed with endophthalmitis or suspected endophthalmitis from 2009 to 2012. A total of 24 eyes were diagnosed with endophthalmitis or suspected endophthalmitis during a 4-year period. The etiologies included endogenous endophthalmitis (6), blebitis (3), Ahmed valve implantation (3, 2 of them with late infection), postcataract surgery (3), intravitreal injections (4), penetrating injury (2), and other surgical procedures (3). Of the postcataract surgery cases, 1 was a congenital cataract surgery, and 2 were referrals. There were no endophthalmitis cases in 4603 adults undergoing cataract surgery in our department during this period. There were 14 positive cultures: 1 was candida and the rest bacteria. Ten of the bacteria cases were Gram-positive cocci (predominantly strep species), 3 were Gram-negative, and coagulase negative staphylococci were detected in 2 cases. Our study indicates a significant change in the case mix of endophthalmitis. The past leading cause, cataract surgery, was dramatically reduced, and intravitreal injections became a major cause. The change in etiologies, and possibly in the microbial flora, warrants reconsideration of the rules that guided the management of endophthalmitis since the Endophthalmitis Vitrectomy Study.

Simple Suturing Procedure to Manage a Flat Anterior Chamber Secondary to a Malfunctioned Ahmed Glaucoma Valve

Introduction: Presenting a case with repeated episodes of flat Anterior Chamber (AC) after Ahmed valve implantation, and suggesting a simple suturing procedure to manage these recurrences. Case:A 65-year-old woman presented to our clinic with uncontrolled Neovascular Glaucoma (NVG) in her left eye due to advanced Proliferative Diabetic Retinopathy (PDR) despite full medication to reduce Intraocular Pressure (IOP). After Ahmed valve implantation, anterior chamber became flattened spontaneously on postoperative day one. Therefore, we filled the AC with air at the first attempt but this procedure failed a day later. Then, we filled the AC with an ocular viscoelastic device. Because of these procedures failed to keep the AC formed, we hypothesized that it may be a malfunctioned valve. Therefore, we inserted 5-0 Nylon in Ahmed tube through AC and fixed it to the subconjunctiva two days after the second procedure. Anterior chamber remained deep and its shallowing did not occur despite removing the suture two weeks after the insertion. The IOP was controlled well with a functional filtering device at the last follow–up visit four months after the surgery. Conclusion: Spontaneous episodes of flat AC after Ahmed valve implantation in an eye can be well managed by inserting a removable suture into the Ahmed valve tube.

Bilateral Sturge-Weber Syndrome and glaucoma controlled with Ahmed valve implant

Sturge-Weber Syndrome is a rare neuro-oculocutaneous disorder. The authors describe the case of a 13 years old boy, presented with bilateral Sturge-Weber Syndrome and glaucoma. Surgical treatment with Ahmed valve implantation in both eyes was carried out achieving lower levels of intraocular pressure.

Surgical results of trabeculectomy and Ahmed valve implantation following a previous failed trabeculectomy in primary congenital glaucoma patients.

PurposeTo compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy.MethodsA retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C.ResultsThe preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38).ConclusionsThere was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.

A Case of Malignant Glaucoma in a Vitrectomized Eye

Purpose: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. Case summary: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient’s symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. Conclusions: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation. J Korean Ophthalmol Soc 2015;56(4):638-642