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Intracameral vent and flush technique for silicone oil blockade in Ahmed glaucoma valve.

ABSTRACT: The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post-AGV silicone oil tube occlusion was treated with semi-conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral "vent and flush" offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow-ups.

SUBMITTER: Namdev V

PROVIDER: S-EPMC9332948 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Comparison of Silicone- and Porous-Plate Ahmed Glaucoma Valves.

Project description:Purpose:Our aim was to evaluate and compare the clinical outcomes after implantation of the silicone-plate (model FP7) and porous polyethylene-plate (model M4) Ahmed Glaucoma Valves. Patients and Methods:This was a prospective, multicenter, comparative series. A total of 52 eyes (52 patients) were treated with either the silicone or porous plate Ahmed Glaucoma Valve implant. Hypertensive phase was defined as intraocular pressure >21 mmHg during the first 3 months postoperatively. Success was defined as 5 mmHg ?intraocular pressure ?21 mmHg (with or without additional glaucoma medications), without loss of light perception and without additional glaucoma procedures. Patients were monitored for 1 year after surgery. Results:The pre-operative intraocular pressure was 29.9 ± 6.6 mmHg and 33.8 ± 10.5 in the silicone-plate and porous-plate groups, respectively (P = 0.118). At 12 months after surgery, the mean intraocular pressure was 13.6 ± 4.7 mmHg in the silicone-plate group and 17.9 ± 10.9 mmHg in the porous-plate group (P = 0.141). The mean number of glaucoma medications at 12 months was 1.64 ± 1.40 mmHg and 1.89 ± 1.54 mmHg in the silicone- and porous-plate groups, respectively (P = 0.605). Hypertensive phase was not significantly different in the two groups (50.0% of the silicone-plate and 57.7% of the porous-plate groups, P = 0.578). At 12 months after surgery, the percent success for the silicone-plate and porous-plate groups was 88.5% and 53.8%, respectively (P = 0.005). Complications were similar in the two groups. Conclusion:The porous-plate Ahmed Glaucoma Valve showed similar average intraocular pressure reduction compared with the silicone-plate model. At 12 months after surgery, there was a significantly lower success rate in the porous-plate compared with the silicone-plate group.

| S-EPMC7371999 | biostudies-literature

Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma.

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| S-EPMC8068818 | biostudies-literature

Is Ahmed Glaucoma Valve Consistent in Performance?

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| S-EPMC6016431 | biostudies-literature

Pars plana placement of Ahmed glaucoma valve tube through sclerotomy port in refractory glaucoma: A novel surgical technique.

Project description:We describe a case of 34-year-old male with post penetrating keratoplasty glaucoma, post trabeculectomy with aphakia in the only seeing eye, in which a modified surgical technique of inserting Ahmed glaucoma valve (AGV) tube in vitreous cavity was done to reduce the risks associated with pars plana incision during pars plana vitrectomy (PPV). A hybrid 20-25 gauge PPV was done concurrently, implant fixed to sclera, and tube inserted through the 25 gauge sclerotomy port in supero-temporal quadrant. Visual acuity and intraocular pressure remained stable during 1-year follow-up.

| S-EPMC6951159 | biostudies-literature

A case involving an Ahmed™ glaucoma valve transferred from the vitreous into the anterior chamber of the eye with a silicone oil tamponade for the treatment of neovascular glaucoma.

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Clinical outcomes of Ahmed glaucoma valve implantation without fixation of a plate: The free plate technique.

Project description:ObjectiveThis study compared surgical outcomes between free plate Ahmed glaucoma valve (FPAGV) implantation without plate fixation and conventional Ahmed glaucoma valve (CAGV) implantation with plate fixation.MethodsA retrospective, comparative case series study. Patients with refractory glaucoma who underwent FPAGV or CAGV implantation and were followed >1 year were enrolled consecutively. We reviewed medical records, including data on postoperative intraocular pressure (IOP) and postoperative complications. The success rate and early postoperative hypertensive phase were compared between groups.ResultsA total of 74 patients with CAGV implantations and 36 patients with FPAGV implantations were studied. The average follow-up periods were 23.3 ± 2.6 months (CAGV) and 22.8 ± 2.8 months (FPAGV; p = 0.424). The surgery time was significantly shorter in the FPAGV group than in the CAGV group (42.6 ± 4.1 vs. 47.3 ± 5.4 min; p < 0.001). Postoperative IOP at 1 week and 1 month were significantly lower in the FPAGV group than in the CAGV group (11.8 ± 3.6 and 14.0 ± 5.3 mmHg vs. 18.7 ± 5.5 and 22.2 ± 5.2 mmHg; p = 0.012 and p = 0.002, respectively). An early postoperative hypertensive phase occurred in 62 eyes, and the frequency was greater in the CAGV group (50 eyes) than the FPAGV group (12 eyes; p = 0.001). There was no significant difference in postoperative complications between the two groups (p = 0.735). The success rate was 84.2% in the FPAGV group and 80.6% in the CAGV group 24 months after surgery (p = 0.367).ConclusionFPAGV implantation was associated with a shorter surgery time, without any change in the extent of IOP reduction or complication rate. This procedure may be considered a good alternative for CAGV implantation in patients with refractory glaucoma.

| S-EPMC7647454 | biostudies-literature

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

Project description:PurposeTo 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.DesignProspective, Non-Randomized, hospital based interventional case series.SubjectsA total of 16 eyes of adult patients (10 males and 6 females) with refractory glaucoma.MethodsInstead 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 measurePost-operative tube related complications.ResultThere were no tube related complications such as exposure, extrusion or retraction in any of the cases.ConclusionUse 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.

| S-EPMC5717499 | biostudies-literature

Intraocular Endoscopy Resolved Tube Occlusion of an Ahmed Glaucoma Valve.

Project description:We report a case in which intraocular endoscopy clarified the cause of Ahmed glaucoma valve (AGV) failure with a cloudy cornea. A 42-year-old patient with glaucoma underwent AGV implant surgery to treat secondary glaucoma due to chronic iridocyclitis in his left eye. After AGV, he developed bullous keratopathy (BK) in that eye. After Descemet stripping automated endothelial keratoplasty (DSAEK) was performed to treat BK, the intraocular pressure (IOP) increased and early failure of the DSAEK resulted again in a cloudy cornea. We could not precisely detect any cause of AGV failure with ordinary imaging instrumentation. An intraocular endoscope was used to determine that cause, and we found that the fibrous tissue occluded the tube of the AGV. The IOP decreased soon after the tissue was removed. We conclude that intraocular endoscopy was useful for diagnosing AGV failure with BK.

| S-EPMC8436709 | biostudies-literature

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma.

Project description:Refractory glaucoma still represents a challenge for ophthalmologists to manage intraocular pressure. The present study aimed to evaluate long term efficacy and safety of a second Ahmed valve implantation after the failure of a first implant in patients with refractory glaucoma and elevated intraocular pressure (IOP). Retrospective, multicenter non-comparative case series. Twenty-eight patients were retrospectively recruited between January 2011 and December 2017. Demographic data, glaucoma type, visual acuity, intraocular pressure, medical therapy, and complications were registered. Three criteria of success were established: Type 1 surgical success: IOP ≤ 15 mmHg and a reduction of IOP ≥ 40% from baseline; Type 2 surgical success: IOP ≤ 18 mmHg and a reduction of IOP ≥ 30% from baseline; and Type 3 surgical success: IOP ≤ 21 mmHg and a reduction of IOP ≥ 20% from baseline. Surgical failure has been established as IOP less than 5 mmHg or over 21 mmHg and less than a 20% reduction of IOP from baseline despite medications in two consecutive visits, light perception loss referable to glaucoma, and the necessity for further glaucoma surgery. Failure was observed in six (21%) patients. (3) Results: Mean IOP and mean glaucoma medication number significantly reduced from baseline after the second implantation, and the surgical success rate at 72 months ranged from 10% to 78% based on the different criteria of success. Failure was observed in six (21%) patients. This study confirmed the safety and efficacy of a second Ahmed valve implantation in patients with refractory glaucoma and elevated IOP at baseline.

| S-EPMC7408983 | biostudies-literature

Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma.

Project description:Results:The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6?mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline (P < 0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%). Conclusion:An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.

| S-EPMC7125488 | biostudies-literature

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