Pars plana vitrectomy combined with phacoemulsification versus pars plana vitrectomy only for treatment of phakic rhegmatogenous retinal detachment: a systematic review and meta-analysis.

PURPOSE: To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD). METHODS: Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error. RESULTS: Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95-1.10; P = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00-0.12; P = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5-5.41; P = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = -0.31; 95% CI -0.55--0.07; P = 0.01). CONCLUSION: There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.

Retinal displacement following pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

PURPOSE: To evaluate the frequency of retinal displacement after pars plana vitrectomy (PPV) using silicone oil tamponade in patients with rhegmatogenous retinal detachment (RRD). METHODS: Patients with fresh RRD were enrolled in this prospective interventional case series. A standard 3-port PPV with silicone oil tamponade was performed in all cases. A complete ocular examination, optical coherence tomography and fundus autofluorescence (FAF) imaging were performed at 1 and 3 months follow-up. Orthoptic examinations including synoptophore and light on-off tests were also performed at 3 months. RESULTS: Twenty-three eyes from 23 patients with mean age of 56.6 ± 11 (range: 38-82) years were included. All patients were pseudophakic. Downward retinal displacement was found in 2 eyes (8.7%) showing hyperautofluorescent lines parallel to retinal vessels in FAF image. The patients with retinal displacement did not complain of metamorphopsia and did not show abnormality in orthoptic tests. CONCLUSION: Unintentional retinal shift following PPV with silicone oil tamponade for RRD is uncommon and might have little clinical significance.

Outcomes of Descemet-Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy.

OBJECTIVES: To evaluate the outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) in children with congenital hereditary endothelial dystrophy (CHED). METHODS: Eighteen eyes from 10 children with CHED who underwent standard phakic DSAEK were enrolled in this retrospective interventional case series. Medical records including slit-lamp biomicroscopy, cycloplegic refraction, visual acuity, and measurements of central corneal thickness, corneal topography, and endothelial cell density were evaluated. All complications were recorded. RESULTS: The mean age of cases was 8.1±4.2 (range: 3-16) years at the time of surgery. Descemet-stripping automated endothelial keratoplasty was performed successfully in all eyes, which survived in 16/18 (88.9%) of cases during a median follow-up period of 38 (range 19-64) months. In patients with clear graft, best-corrected visual acuity was improved to a range of 20/100 to 20/40 and improved to fix and follow in one younger child. Endothelial cell density decreased by an average of 42.1%, comparing baseline and 6-month follow-up and was relatively stable thereafter. A marked flattening of the anterior corneal curvature (mean change of anterior K reading: +2.56±3.14 diopters) was observed after DSAEK. The only major complication in patients with clear graft was intraocular pressure elevation in 61.1% of the eyes, which was easily controlled with one antiglaucoma medication. None of the eyes developed cataract. CONCLUSION: Descemet-stripping automated endothelial keratoplasty is a safe and successful procedure in children with an acceptable graft survival in a mid-term follow-up period. A marked hyperopic shift could occur after DSAEK in children with CHED.

Clinical and Ultrasonographic Evaluation of Infantile Periocular Hemangioma Treated With Oral Propranolol.

PURPOSE: To evaluate the clinical and ultrasonographic response of periocular infantile capillary hemangioma during treatment with oral propranolol. METHODS: Patients with infantile periocular hemangioma and visual or cosmetic concerns were enrolled in this prospective interventional case series. Propranolol was given at a dose of 2 mg/kg per day for at least 6 months. Evaluation of treatment response was performed at month 3 (time point 1) and month 6 (time point 2). Gray scale ultrasonography and color Doppler imaging were performed at baseline and month 3. RESULTS: Thirty-one patients with mean age of 4.1 ± 2.3 months were eligible for analysis. Complete or near complete clinical resolution was observed in 4 patients (12.9%) at time point 1 and 21 patients (67.7%) at time point 2. Longitudinal diameter, transverse diameter, thickness, arterial peak systolic velocity, and end diastolic velocity reduced significantly from baseline to 3-month follow up. Complete clinical response at time point 2 was significantly higher in patients with peak systolic velocity reduction >50% from baseline to month 3 than patients with peak systolic velocity reduction of 10% to 50% and <10%. CONCLUSIONS: Propranolol is safe and effective for infantile periocular hemangioma. Ultrasonography and color Doppler imaging are useful modalities to monitor and predict the treatment response.

Color Doppler imaging of orbital vasculature before and after orbital decompression in thyroid eye disease.

Purpose: To measure alterations in orbital blood flow parameters using color Doppler imaging (CDI) before and after orbital decompression in patients with moderate to severe thyroid eye disease (TED). Methods: Resistance index (RI) and maximum and minimum velocity of ophthalmic artery (OA), superior ophthalmic vein (SOV), and central retinal artery (CRA) of 24 eyes (14 patients) with TED were measured before and at least 3 months after cosmetic orbital decompression procedure (single or double walls) using CDI. Complete eye examination was performed to define the severity (EUGOGO classification) and activity (clinical activity score) of TED. Results: Median OA (p = 0.003) and CRA (p = 0.001) resistance indices were significantly reduced postoperatively. Significant differences were found in maximum (p = 0.001) and minimum (p = 0.014) velocity of SOV before and after surgery. While a significant decrease in exophthalmometry was observed after the orbital decompression (p = 0.031), intraocular pressure changes were not significant (p = 0.182). Conclusion: Orbital decompression procedure led to a significant reduction of RI in both CRA and OA in patients with TED.

Color Doppler imaging in thyroid eye disease and its correlation to disease activity.

Purpose: To evaluate alterations in orbital color Doppler imaging (CDI) parameters and their correlation to disease activity and severity in patients with thyroid eye disease (TED). Methods: Seventy-six orbits of 45 TED patients and 40 orbits of 40 normal controls were enrolled in this cross-sectional study. According to clinical activity score (CAS), patients were categorized to active (CAS ≥ 3) or inactive disease (CAS < 3). Patients were also classified as having mild, moderate or severe disease. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) in ophthalmic artery and central retinal artery, and maximum and minimum velocity in superior ophthalmic vein and central retinal vein were determined in all subjects. Results: There was a significant difference in maximum velocity of superior ophthalmic vein and EDV and RI of ophthalmic artery between patients with TED and normal subjects. Superior ophthalmic vein maximum and minimum velocity and ophthalmic artery RI were significantly higher in patients with active disease than inactive cases. Disease severity did not affect the blood flow parameters independently. A cutoff point of 3.99 cm/s in superior ophthalmic vein maximum velocity yielded a sensitivity of 91.2% and specificity of 81.2% in detecting active disease. Conclusion: Retrobulbar blood flow is altered in TED and is related to disease activity. Superior ophthalmic vein maximum velocity could be helpful in differentiation of active and inactive cases.

Transscleral vs transpupillary diode laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity: Anatomical and refractive outcomes.

PURPOSE: To compare the anatomical and refractive outcomes of transscleral diode versus transpupillary laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity (ROP). METHODS: In this prospective comparative interventional case series, infants with type 1 ROP in zone II were assigned to either transpupillary or transscleral laser based on the surgeons' expertise area. The rate of regression, need for retreatment, and structural and biometric outcomes at month 6 were evaluated and compared between the two treatment groups. RESULTS: In total, 209 eyes were enrolled; 145 eyes of 77 infants and 64 eyes of 33 infants and were in transscleral and transpupillary groups, respectively. There was no significant difference in baseline characteristics between the groups. There was no significant difference in retreatment rates (1.6% vs. 3.4%; P = 0.669) and progression to stage 4 (1.6% vs. 2.8%; P = 0.999) between the transpupillary and transscleral groups, respectively. At month 6, the mean spherical equivalent was 0.31 ± 3.57 and 0.44 ± 2.85 diopters, and the axial length was 18.28 ± 6.22 and 18.36 ± 6.87 mm in the transpupillary and transscleral groups, respectively, without a significant difference between groups. There was no significant difference in the rate of myopia (43.8% vs. 33.8%; P = 0.169) and high myopia (4.7% vs. 4.8%; P = 0.965) in transpupillary and transscleral groups at month 6. CONCLUSION: The transpupillary and transscleral laser photocoagulation routes are both effective in the treatment of zone II type 1 ROP and show no significant differences in anatomical or refractive outcomes in relation to the route chosen.

Reliability and Validity of the Persian Version of Quality of Life Impact of Refractive Correction Questionnaire.

PURPOSE: To evaluate the psychometric properties of the Persian version of quality of life impact of refractive correction (QIRC) questionnaire and its utility in assessment of refractive error-related quality of life (QoL) following photorefractive keratectomy (PRK). METHODS: Patients with low-to-moderate myopia (-0.75 to - 6.0) were enrolled in this study. Standard alcohol-assisted PRK was performed in all patients. The QIRC questionnaire was translated into a Persian version using the standard method. Patients completed QIRC questionnaire preoperatively and 3-month postoperatively. A group of patients completed the questionnaire twice preoperatively. Psychometric properties were evaluated by internal consistency (Cronbach's α), item-total correlation, and known group construct validity. Intraclass correlation coefficient (ICC) were used to examine the repeatability. RESULTS: One hundred forty-seven patients (60 males and 87 females) with a mean age of 26.3 ± 5.5 (range, 18-39) years were enrolled. Cronbach's α for total score was 0.923. Item-total correlation was above 0.3 for all items. ICC was 0.978 for total score. Preoperatively, predominantly contact lens wearers showed significantly better total QIRC score than predominantly spectacle wearers (P = 0.017), which showed good known group validity. Total QIRC score significantly increased from 41.31 ± 6.69 preoperatively to 50.47 ± 7.26 postoperatively (P < 0.0001). Improvement in total QIRC score was observed both in contact lens wearers and spectacle wearers. CONCLUSION: The Persian version of QIRC questionnaire is a valid and reliable tool. Refractive error-related QoL assess by QIRC was significantly improved after PRK in an Iranian population.

Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series.

PURPOSE: To compare the success rate and complications of pulled versus pushed monocanalicular intubation in adults with incomplete lacrimal drainage system obstruction (lacrimal drainage system stenosis). METHODS: Patients with lacrimal drainage system stenosis (Munk grade ≥3), including both nasolacrimal duct (NLD) stenosis and common canalicular stenosis, were recruited in this prospective comparative case series. Patients underwent probing and either Monoka (51 eyes) or Masterka (48 eyes) intubation under general or local anesthesia. Tubes were removed 4-14 weeks after the procedure. Six months after tube removal, Munk grades 0 and 1 were defined as a complete success, Munk grade 2 was defined as a partial success, and Munk grade ≥3 was defined as failure. All complications were recorded. RESULTS: Ninety-nine eyes from 89 patients with lacrimal drainage system stenosis who underwent either Monoka (51 eyes) or Masterka (48 eyes) intubation were included. The mean (SD) age of the patients was 55.4 (12) years in the Monoka group and 53.5 (12.9) in the Masterka group. Groups were matched on demographics. Masterka intubation could not be performed in one eye. Complete and partial successes were observed in 52.9% (27/51) and 17.6% (9/51) of eyes in the Monoka group and 42.6% (20/47) and 12.8% (6/47) of eyes in the Masterka group, respectively (p=0.29). There was a trend toward a higher total success rate in patients with NLD stenosis treated with Monoka 66.7% (26/39) than Masterka 45.5% (15/33) intubation (p=0.07). This trend also existed in patients with common canalicular stenosis (83.3% (10/12) vs. 76.6% (11/14), p=0.75). Age, sex, bilateral involvement, and duration of intubation did not have a significant impact on the success rate. Early tube loss, slit puncta, and temporary superficial punctate keratopathy were observed complications. CONCLUSION: Intubation with the pulled monocanalicular silicone tube was associated with a slightly but not significantly higher success rate in adults with lacrimal drainage system stenosis. Patients with NLD stenosis may achieve better results with pulled silicone tubes.

Treatment of Acute Corneal Hydrops With Combined Intracameral Gas and Approximation Sutures in Patients With Corneal Ectasia.

PURPOSE: To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH). METHODS: This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset. RESULT: Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310 (Equation is included in full-text article.)556 µm, which significantly reduced to 660 ± 148 µm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period. CONCLUSIONS: Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.

Effect of Adding Losartan to Bevacizumab for Treating Diabetic Macular Edema.

INTRODUCTION: Diabetic retinopathy is the most common cause of visual loss and blindness in the age group of 20 to 64 years. This study aimed to evaluate the efficacy of oral Losartan adjuvant therapy in combination with intravitreal injection of Bevacizumab in the treatment of diabetic macular edema. METHODS: In this randomized clinical trial, 61 eyes of 47 patients with normal blood pressure and diabetic macular edema and nonproliferative diabetic retinopathy were studied. Patients were randomly divided into Losartan (n = 33) and control (n = 28) groups. All patients received 3-6 intravitreal injections of Bevacizumab over 6 months. General examination including blood pressure and glycosylated hemoglobin measurements were performed in all patients. Complete ophthalmologic examination and macular OCT were performed at the first, third, and sixth months of treatment in all patients. RESULTS: The mean age of the patients studied was 57.1 ± 7.4 years and 37.7% of the patients were male. There was no significant difference between the two groups in terms of initial visual acuity, central macular thickness, and frequency of injections. There was no significant difference in visual acuity and central macular thickness between the two groups at the first, third, and sixth months of treatment. Age, frequency of injection, and initial macular thickness less than 450 microns were effective in patients' final visual acuity. CONCLUSION: Short-term adjuvant treatment with Losartan in patients with diabetic macular edema and nonproliferative diabetic retinopathy has no greater effect than the standard treatment.

The Interaction of Helicobacter pylori Infection and Type 2 Diabetes Mellitus.

Helicobacter pylori is one of the most common human pathogens that can cause gastrointestinal (GI) disorders, including simple gastritis, gastric ulcer, and malignant gastritis. In some cases, such as immunodeficiency and underlying diseases, it can be problematic as opportunistic infections. Diabetes mellitus (type 2) (T2DM) is one of the H. pylori underlying diseases. Since GI problems are observed in diabetic patients, it is necessary to treat H. pylori infection. In this review, we aimed to evaluate the possible relationship between H. pylori and T2DM according to epidemiological surveys of 70 studies retrieved from databases, including Scopus, PubMed, and Google Scholar about the relationship between H. pylori and T2DM, and discuss the reported background mechanisms of this correlation. According to the results of our study, the different studies have shown that H. pylori is more prevalent in Type 2 diabetic patients than healthy individuals or nondiabetic patients. The reason is development of H. pylori infection-induced inflammation and production of inflammatory cytokines as well as different hormonal imbalance by this bacterium, which are associated with diabetes mellitus. On the other hand, by tracing anti-H. pylori antibodies in patients with diabetes mellitus and occurrence of symptoms such as digestive problems in >75% of these patients, it can be concluded that there is a relationship between this bacterium and T2DM. Considering the evidence, it is crucially important that the probability of infection with H. pylori is evaluated in patients with T2DM so that medical process of the patient is followed with higher cautious.

Lens exchange for management of accommodative intraocular lens tilting.

Accommodative intraocular lens (IOL) tilting, the so-called Z syndrome, is a rare complication of Crystalens (Bausch and Lomb) implantation. We report a significant IOL tilting and subsequent high lenticular astigmatism due to posterior capsular fibrosis 2 months after uncomplicated cataract surgery and Crystalens (AT50AO) implantation. The attempt to correct IOL position with neodymium-yttrium-aluminum garnet laser was unsuccessful, and Crystalens exchange with in-the-sulcus, three-piece monofocal IOL was performed. Accommodative IOL tilting could occur early after the surgery. Laser capsulotomy may be the first intervention to restore IOL position, but patients with a higher amount of lenticular astigmatism may require surgical intervention and IOL exchange.

Oral Mineralocorticoid-Receptor Antagonists: Choroidal Parameters Changes Using OCT in Central Serous Chorioretinopathy.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of oral eplerenone in the treatment of acute and chronic central serous chorioretinopathy (CSCR). PATIENTS AND METHODS: Treatment-naïve patients with acute (< 3 months) and chronic (≥ 3 months) CSCR were enrolled in this prospective, nonrandomized, interventional, comparative case series. Patients with acute CSCR were either treated with oral eplerenone (acute case group; n = 16) or observed only (acute control group; n = 8). All chronic patients (chronic group; n = 25) were treated with oral eplerenone. Eplerenone was prescribed 25 mg twice per day for 3 months. Best-corrected visual acuity (BCVA) and optical coherence tomography measures, including subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), central CT, central choroidal volume (CV), and total CV, were assessed at baseline and 3-month follow-up (FU) visit. RESULTS: BCVA improvement and SRF reduction at 3-month FU relative to baseline were observed in all three study groups. SRF was completely resolved in 13 patients (81.2%) in the acute case group, four patients (50%) in the acute control group, and eight patients (32%) in the chronic group. The acute case group showed greater SRF decrease relative to baseline compared to the chronic group (P = .009), but the resolution of SRF between acute cases and an acute control group was not statistically significant (P = .076). Subfoveal CT, central CT, total CV, and central CV were significantly reduced at the 3-month FU compared to baseline in both affected and the fellow eyes in the acute case and chronic groups, whereas no change was observed in either eyes in the acute control group. At 3 months' FU, the mean logMAR visual acuity demonstrated no significant difference among the study groups (P = .08). Eplerenone was well-tolerated, and no serious side effect was detected. CONCLUSIONS: Oral eplerenone is a safe and effective treatment option for both acute and chronic CSCR. Resolution of SRF was more significant in acute CSR cases comparative to chronic cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:726-733.].

Incidence and Risk Factors for Post-Intravitreal Injection Endophthalmitis in a Modified Operating Room Setting.

Purpose: To evaluate the incidence and risk factors of post-intravitreal injection (IVI) endophthalmitis in a single center modified operating room (OR) setting.Methods: In a retrospective chart review study, patients who underwent IVI in a modified OR between September 2014 and November 2016 were included. Cases of post-IVI endophthalmitis were identified from the Hospital Infection Control Committee records, which tracks all post-procedure infections.Results: 51 472 IVIs (37 814 patients) including 13 658 bilateral simultaneous injections were performed during the study period. There were 17 cases of endophthalmitis (0.033%, 95% CI 0.019%-0.052%). There were no cases of bilateral endophthalmitis. Age, sex, indication for IVI, simultaneous bilateral injections, number of previous injections, and type of injected drug were not significantly associated with incidence of endophthalmitis.Conclusion: Post-IVI endophthalmitis is rare in this modified OR setting. Simultaneous bilateral IVIs and on-site preparation of injections are safe under these conditions.

Additional Intrastromal Corneal Ring Segments in Keratoconus.

PURPOSE: To evaluate the outcome of additional KeraRing (Mediphacos, Belo Horizonte, Brazil) implantation in patients with keratoconus with previously implanted INTACS (Addition Technology Inc, Fremont, CA) segments. METHODS: The KeraRing was implanted in 5 eyes of 3 patients with keratoconus without removal of previous intrastromal corneal ring segments. Tunnels were created manually. Snellen uncorrected distance visual acuity (UDVA), corrected distance visual acuity, refractive and keratometric values, and higher-order aberrations were recorded before and after KeraRing implantation. RESULTS: UDVA, corrected distance visual acuity, subjective refraction, and keratometric values were improved in 4/5 of cases and remained stable during a median follow-up of 36 months. UDVA improved from 20/200 and 20/100 to 20/100 and 20/40 in the right and left eyes of patient 1, respectively, and from 20/200 to 20/40 in both eyes of patient 2. The reduction in mean keratometric value was 2.1 and 4.4 D in the right and left eyes of patient 1, and 1.4 and 1.9 D in the right and left eyes of patient 2, respectively. In patient 3, UDVA (20/100) and mean keratometric value (52.4) remained unchanged after second intrastromal corneal ring segment implantation. Total higher-order aberrations were improved in all cases. No intraoperative or postoperative complication was observed. However, one of the cases reported glare under scotopic conditions. CONCLUSIONS: KeraRing implantation in properly selected eyes with previously implanted INTACS could enhance final visual and refractive outcomes.

Changes in in vivo confocal microscopic findings of ocular surface squamous neoplasia during treatment with topical interferon alfa-2b.

PURPOSE: To evaluate in vivo confocal microscopy (IVCM) findings of ocular surface squamous neoplasia (OSSN) during treatment with topical interferon alfa-2b (IFN alfa-2b). METHODS: In this prospective interventional case series, 20 eyes from 20 patients with OSSN were treated with topical IFN alfa-2b 3 million IU/mL four times a day. Treatment was continued for 2 or 3 months after clinical resolution. IVCM was done at baseline, on a monthly basis, and at the end of treatment. Confocal images were evaluated in conjunction with clinical findings during treatment. Limbal dendritic cell (DC) density within the involved areas was calculated manually in confocal images. RESULTS: Topical therapy resulted in clinical resolution of neoplasia in 80% of eyes. Main features of OSSN on IVCM were hyper-reflectivity of epithelium, demarcation line between neoplastic and normal epithelium, and pleomorphic cells. These findings became less prominent in response to IFN alfa-2b therapy. However, some degree of residual epithelial hyper-reflectivity could be detected in 9 (56.2%) subjects who responded to therapy at time of treatment cessation. Limbal DCs density within involved areas was significantly increased at month 1 follow-up compared to baseline only in responders (P < .0001). There was a trend toward higher limbal DCs density in responders to topical IFN alfa-2b than non-responders (208.6 ± 53.5 vs. 153.1 ± 48.2 cell/mm2, respectively; P = .08) at month 1 follow-up. CONCLUSIONS: IVCM is proposed as an adjunctive tool for monitoring OSSN during topical treatment. IVCM documents epithelial cell response as well as limbal DC density increase during topical IFN therapy.

Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve.

PURPOSE: To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV). PATIENTS AND METHODS: In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded. RESULTS: Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (P<0.001). Average number of glaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (P<0.001). Qualified and complete success rates at 12-month follow-up were 65.5% and 6.9%, respectively. Younger age and higher number of previous glaucoma surgeries were significantly associated with the failure of excisonal bleb revision. CONCLUSION: Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.