Management Of Refractory Glaucoma Research Articles

Ahmed glaucoma valve implantation for refractory glaucoma

Objective To evaluate the efficacy of Ahmed valve implantation for refractory glaucoma and discuss the postoperative complications and management.Methods A retrospective study was conducted to documents of 23 eyes with refractory glaucoma from 21patients who undergone Ahmed valve implantation.The subject had a minimum 6 months of follow-up after surgery.Results The follow-up ranged from 6 to 24months (mean 20.1 ±7.2months).There was no significant change in visual acuity during follow-up.Intraocular pressure was reduced from a preoperative mean of (45.70 ± 11.44) mmHg(1 mmHg =0.133 kPa)to a postoperative mean of(26.28 ± 12.02) mmHg( P ＜ 0.01 ) . The cumulative probabilities of success at 1and 2 years were 40％ and 16.7％ and of total success at 1 and 2 years were 70％ and 50％ respectively.The postoperative complications occurred in 19eyes( 82.6％ )include 13 eyes within 1 week after surgery and 6 eyes during 6 to 24 months follow - up. Conclusion Ahmed valve implantation is effective method in the management of refractory glaucoma in spite of its unnegligible complications. Key words: Glaucoma, refractory; Ahmed valve; Surgery; Complications

Modified Ahmed aqueous humor drainage device implantation for refractory glaucoma

Objective To evaluate the efficacy of the implantation of modified Ahmed aqueous drainage device for refractory glaucoma.Methods 20 cases ( 20 eyes) of refractory glaucoma underwent modified aqueous humor drainage device implantation.The intraocular pressure (IOP),filtrating bleb and the disc were observed.Results The postoperative follow-up period was eight months.There was significant statistical difference between the preoperative and postoperative IOPs (P ＜ 0.05 ).There was significant statistical difference between the preoperative and postoperative RA,RV and mRNFL (P ＜ 0.05).Conclusion Aqueous humor drainage device implantation is an effective method in management of refractory glaucoma. Key words: Ahmed aqueous humor drainage device; Glaucoma; Refractory

A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas

BackgroundEndoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas.AimTo evaluate the safety and efficacy of ECP in the management of refractory glaucomas.Settings and DesignProspective interventional non-comparative study.Materials and MethodsFifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP ≤ 22 mmhg, with or without use of medications.Statistical analysis usedStudent's t test and repeated measures ANOVA were used to evaluate change in IOP and Student's t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications.ResultsPatients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 ± 9.16 mmHg to 13.96 ± 7.71 mmHg at last follow-up (P<0.001, student's t test). BCVA was significantly improved in the postoperative period (P<0.001, student's t test). The average number of antiglaucoma medications decreased from 2.51 ± 0.97 to 1.09 ± 1.16 (P<0.001, Wilcoxon signed rank test). ECP had a success rate of 82.2%.ConclusionEndoscopic cyclophotocoagulation is an effective procedure in this subset of refractory glaucomas.

Initial experience of the Ahmed valved implant in the management of refractory glaucoma

Initial experience of the Ahmed valved implant in the management of refractory glaucoma

The clinical study of endoscopic cyclophotocoagulation on the management of refractory glaucoma

To evaluate the efficacy and safety of endoscopic cyclophotocoagulation (ECP) in the management of refractory glaucoma. ECP procedures were performed on fifty-one eyes of 47 patients with refractory glaucoma by using the Microprobe (Endo Optiks, URAM E2) integrated laser endoscope system. All patients were followed-up from 6 to 16 months (mean 10.8 months), with four eyes receiving a second treatment. The changes of intraocular pressure (IOP), visual acuity and complication were pre- and post-operatively observed. Compared to preoperation, the IOP of postoperation was significantly (P < 0.01) decreased at week 1, 4, 12, and 24 [(35.3 +/- 13.0) mm Hg (1 mm Hg = 0.133 kPa) vs (19.9 +/- 13.2) mm Hg, (22.0 +/- 11.6) mm Hg, (17.6 +/- 11.6) mm Hg, and (17.0 +/- 10.4) mm Hg, x +/- s, respectively]. The mean number of IOP-decreased drugs used was significantly (P < 0.01) reduced from 3.3 to 1.0 of postoperation. 51.0% of all 51 eyes with the postoperative IOP less than 21 mm Hg did not receive any drug, and 25.5% with supplemental drug treatment. The visual acuity was significantly (P < 0.01) improved postoperatively. Postoperative hyphema were found in 4 eyes, fibrous exudates in 23 eyes, and exudative choroids detachment in 2 eyes, all of which occurred at the early postoperative stage and were healed within 2-16 days. No other complications were observed. ECP is a safe and effective procedure for the management of refractory glaucoma without serious complications.

Management of refractory glaucoma in childhood.

Glaucoma in children is characterized by marked intraocular pressure (IOP) elevation with resultant atrophy of the optic nerve and loss of retinal ganglion cells. In very young children, secondary expansion of the globe with damage to anterior segment structures, such as the cornea and zonule, often occurs. Permanent, severe visual dysfunction may result from optic nerve damage as well as from amblyopia arising from anisometropia and corneal opacification. The treatment of childhood glaucoma often involves surgery. Goniotomy and trabeculotomy remain the first line surgical procedures for open-angle glaucoma in children. Trabeculectomy with adjunctive antifibrosis therapy, aqueous shunt surgery, and cyclodestructive procedures are undertaken when angle surgery fails to control the IOP or is unlikely to succeed. The choice of surgical procedure is individualized according to factors such as the age of the patient, the specific type of glaucoma, the number of prior surgical procedures, and the visual potential of the eye. Achieving and maintaining an adequate IOP to prevent progressive optic nerve damage, avoiding complications, and preserving vision are the goals that must be considered in deciding on a surgical plan.

Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty

Objective This study analyzes the results of intraocular pressure (IOP) reduction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty. Design Retrospective noncomparative, interventional case series. Participants Twenty-eight eyes in 28 patients attending the Moorfields Eye Hospital. Intervention Cyclodiode (40 applications × 1.5 W × 1.5 seconds over 270–300°) was used to control the IOP in refractory glaucoma after penetrating keratoplasty. Main outcome measures Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment. Results Cyclodiode resulted in a reduction of IOP from a median of 33 mmHg (interquartile range [28, 40.5]) to a median of 15 mmHg (interquartile range [12, 20.5]). Most patients had a significant lowering in IOP with a median reduction of 16 mmHg (interquartile range [12, 25]; P < 0.0001). IOPs of 6 to 21 mmHg were achieved in 22 patients (79%). Sixteen patients (57%) required more than one treatment with cyclodiode to control the IOP, with three patients (11%) requiring three treatments and two patients (7%) requiring four treatments. Visual acuity improved (> two Snellen lines of acuity) in three patients (11%) and remained the same (± one Snellen line) in 17 patients (61%). The mean number of antiglaucoma medications before cycloablation was 2.6 and was 1.8 after treatment ( P < 0.001). Of the 19 patients (68%) with originally clear grafts, three grafts (16%) developed opacification. One patient (4%), with a history of nanophthalmos and recurrent uveal effusion, had delayed hypotony (IOP < 6 mmHg) occurring 46 months after the diode treatment. All patients had at least 6 months follow-up. Conclusions These patients have often undergone multiple previous complicated ocular interventions and are often not suitable for filtration surgery. Reduction of IOP with maintenance of visual acuity and a good safety profile was achieved in most patients in this study but may require multiple treatments. We propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty.

Complications of glaucoma drainage implant surgery.

Glaucoma drainage implants play an important role in the management of refractory glaucoma. It may be considered as a primary procedure in eyes with severe scarring of the conjunctiva and the limbus, neovascularization, multiple previous, failed filtering procedures, and severely glaucomatous eyes for which corneal graft is planned. Recommendations have been made regarding improving the biocompatibility of the materials used in the manufacture of these implants. The current state of development of glaucoma drainage implants is likened to that of intraocular lenses in the 1970s. Further development of devices and techniques will only serve to improve our armamentarium and success against glaucoma, specifically refractory glaucoma. Glaucoma posterior tube shunts have proved to be safe, with the majority of complications either nonsight-threatening, spontaneously resolving, or reversible. Considered primarily in the most severe cases of refractory glaucoma, it has otherwise changed the outlook for such patients.

Modified Schocket Implant for Refractory Glaucoma: Experience Of 55 Cases

Fifty-five eyes of 51 patients with different forms of refractory glaucoma (15 aphakic,12 neovascular, 9 postpenetrating keratoplasty, 8 congenital, 5 secondary to uveitis, 4 associated with aniridia, 1 pseudophakic, and 1 traumatic) underwent antiglaucomatous surgery using a modified 90° Schocket implant. In 25 eyes (45.4%), this was the first surgical procedure. Follow-up ranged from 3 to 27 months (mean, 10.3 ± 5.4 months). The mean preoperative intraocular pressure (IOP) was 39.5 ± 8.6 mmHg (range, 22 to 66 mmHg). The mean postoperative IOP was 17.8 ± 7.6 mmHg (range, 4 to 50 mmHg). Intraocular pressure remained less than 21 mmHg in 50 eyes (90.9%) during the follow-up period. In 13 of these eyes (26.0%), IOP remained under control without any medication. Complications were observed in 13 eyes (23.6%) and were successfully treated in 11 of them. Complications included iris-tube block (5.4%), vitreous-tube block (3.6%), early postoperative flat anterior chamber (1.8%), choroidal effusion (3.6%), tube exteriorization from anterior chamber (3.6%), tube displacement from silicone band (1.8%), retinal detachment (1.8%), tubecornea touch (1.8%), vitreous hemorrhage (1.8%), infectious endophthalmitis (1.8%), and phthisis bulbi (1.8%). Modified 90° Schocket implants are an effective technique in the management of refractory glaucoma.