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A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: 'Scleral Sleeve Method'.

ABSTRACT: Purpose:To present a new surgical technique 'Scleral Sleeve Method' which would reduce the risk of Ahmed Glaucoma Valve (AGV) tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA) for refractory glaucoma. Design:Prospective, Non-Randomized, hospital based interventional case series. Subjects:A total of 16 eyes of adult patients (10 males and 6 females) with refractory glaucoma. Methods:Instead of using sutures to fix the AGV tube to sclera, we devised a novel method of intra-scleral tube fixation by creating a scleral tunnel fashioned in form of sleeve. Main outcome measure:Post-operative tube related complications. Result:There were no tube related complications such as exposure, extrusion or retraction in any of the cases. Conclusion:Use of scleral sleeve method for tube fixation, along with graft to cover the tube, will provide additional safety measure and reduce the risks of tube related complications.

SUBMITTER: Kalamkar C

PROVIDER: S-EPMC5717499 | biostudies-literature | 2017 Oct-Dec

REPOSITORIES: biostudies-literature

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A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: 'Scleral Sleeve Method'.

Kalamkar Charudutt C Radke Nishant N Mukherjee Amrita A Radke Snehal S

Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society 20170409 4

<h4>Purpose</h4>To present a new surgical technique 'Scleral Sleeve Method' which would reduce the risk of Ahmed Glaucoma Valve (AGV) tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA) for refractory glaucoma.<h4>Design</h4>Prospective, Non-Randomized, hospital based interventional case series.<h4>Subjects</h4>A total of 16 eyes of adult patients (10 males and 6 females) with refractory glaucoma.<h4>Methods</h4>Instead of using sutures to fix ...[more]

PMID: 29234225

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Project description:PurposeTo compare the effects of the Ahmed glaucoma valve (AGV; New World Medical, Rancho Cucamonga, CA) with sulcus versus anterior chamber (AC) tube placement on the corneal endothelial density and morphology over time.DesignNonrandomized, interventional study.ParticipantsThis study included 106 eyes from 101 pseudophakic patients who had the AGV tube placed in the AC (acAGV) and 105 eyes from 94 pseudophakic patients who had the AGV tube placed in the ciliary sulcus (sAGV).MethodsAll patients underwent preoperative specular microscopy, which was repeated postoperatively in 2019. The patients' demographic information, glaucoma diagnoses, and basic ocular information were obtained on chart review. Anterior segment OCT was conducted for patients who underwent sAGV to evaluate the sulcus tube position. Gonioscopy was performed to document peripheral anterior synechiae (PAS). Linear mixed-effects models were used to compare the different ocular and endothelial measurements between the 2 groups and to identify risk factors for endothelial cell density (ECD) loss over time.Main outcome measuresMonthly change in corneal endothelial measurements, including ECD and coefficient of variation (CV), calculated as the difference between preoperative and postoperative measurements divided by the number of months from the time of surgery to postoperative specular microscopy.ResultsThe acAGV and sAGV groups were comparable in all baseline characteristics except that the acAGV group had longer follow-up (37.6 vs. 20.1 months, respectively, P < 0.001). Mean monthly loss in central ECD was significantly more in the acAGV group (mean ± standard deviation: 29.3±29.7 cells/mm2) than in the sAGV group (15.3±20.7 cells/mm2, P < 0.0001). Mean monthly change in CV was similar between the 2 groups (P = 0.28). Multivariate analyses revealed that younger age and tube location in the AC were associated with faster central ECD loss (P = 0.02, P < 0.0001, respectively). For patients with sAGV, while PAS was associated with faster central ECD loss (P = 0.002), a more forward tube position tenting the iris was not (P > 0.05).ConclusionsCompared with anterior segment placement, ciliary sulcus tube implantation may be a preferred surgery approach to reduce endothelial cell loss in pseudophakic patients.

Dataset Information

A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: 'Scleral Sleeve Method'.

Publications

A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: 'Scleral Sleeve Method'.

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