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Background: Glaucoma is one of the major causes of irreversible blindness in the world, with trabeculectomy still being the primary surgical modality for the management of glaucoma. Glaucoma drainage devices (GDDs) have been conventionally used for the treatment of refractory glaucoma and are found to be beneficial in eyes with prior unsuccessful filtration surgeries and primary choice of surgery in certain glaucoma. Aurolab aqueous drainage implant (AADI) is a nonvalved device useful in refractory glaucoma to achieve low intraocular pressure (IOP). The device has been commercially available in India since 2013 and is like the Baerveldt glaucoma implant in design and function. AADI being the most economical and effective GDD in controlling IOP is becoming a popular choice among ophthalmologist in developing countries. AADI surgery has steep learning curve due to large end?plate surface area which needs a rigorous conjunctival dissection, muscle hooking, meticulous plate fixations, and careful tube ligations and insertion. There are different techniques of performing AADI surgery, but the authors have tried to simplify the complex surgery for easy and catchable learning of the procedure by novice surgeon with their experience and have elaborated a step?wise most effective way of performing surgery. Purpose: This video?based skill transfer depicts steps of AADI surgery with compilation of various modifications and authors’ tips and tricks to novice surgeons. Synopsis: This video depicts detailed steps of AADI surgery with micro?points and authors experience. Video also shows various tailor?made modifications of surgical techniques for different case scenarios. Highlights: Steps of AADI surgery, modifications, and surgical pearls.
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Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.
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OBJECTIVE@#To discuss the development of a multifunctional and multipoint fixed support drainage device for the digestive tract, as well as the effect of its application on animal experimental models and patients.@*METHODS@#The digestive tract multifunctional and multipoint fixed support drainage device is designed according to the requirements of the various gastrointestinal surgery and interventional procedures. It has metal flaps and airbags to achieve multi point fixation. The cuffs and shears are used to achieve endoscopic removal. And through different tube diameters and lengths, surgeons can achieve different surgical purposes.@*RESULTS@#A multifunctional and multipoint fixed support drainage device for the digestive tract was successfully designed and developed. The application experiment of the winged pancreatico-intestinal supporting drainage tube on animal models and patients, showed lower drainage fluid amylase level, faster amylase recovery speed, and better perioperative safety.@*CONCLUSIONS@#The support drainage device has the characteristics of simple operation, firm fixation, and good controllability of removal. It is an ideal choice among support drainage tubes in gastrointestinal surgery and interventional operations.
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Drainage , Gastrointestinal Tract , EndoscopyABSTRACT
Objective@#To describe a novel glaucoma drainage device fashioned from a scleral buckle and nasolacrimal silicone tube. @*Method@#This is a case report and a description of a surgical technique.@*Results@#A 6-year-old boy with congenital glaucoma who underwent 2 failed filter surgeries had medically uncontrolled intraocular pressures (IOP). Due to limited funds for a second glaucoma drainage device, the author utilized a portion of a scleral buckle and nasolacrimal silicone tube – the same raw materials used in the Schocket implant – to fashion a novel, non-valved glaucoma shunt that was implanted in the patient’s eye. Post-operatively, IOP was 8-10mmHg. This was sustained for 12 months without the need for supplemental anti-glaucoma medications. Postoperative complications included tube migration resulting in localized corneal decompensation and cataract formation. @*Conclusion@#The alternative GDD made from a portion of a scleral buckle and silicone tube may be an effective and economical alternative to the GDDs available in the market.
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Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non?valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results: Thirty-four eyes were analyzed and the mean follow?up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long?term follow?up studies are needed to assess long?term IOP control and cost?effectiveness.
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Objective@#We described an adjustable traction technique for glaucoma surgeries that provided adequate visualization of the surgical field.@*Methods@#A prototype device was designed to provide good exposure of the surgical site by using a peripheral lamellar trans-corneal suture capable of applying and sustaining tension. Adjustments to the amount of traction required were made through the device.@*Results@#The device was used in 9 cases of glaucoma surgeries: 5 trabeculectomies and 4 glaucoma drainage device implantations. No significant complications were observed.@*Conclusions@#The device was easy to use and allowed more flexibility for the surgeon.
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Glaucoma , TrabeculectomyABSTRACT
@#AIM: To evaluate the efficacy of EX-PRESS drainage device implantation combined with phacoemulsification for chronic primary angle-closure glaucoma(CPACG)with cataract and compare with trabeculectomy combined with phacoemulsification. METHODS: A retrospective case control design was used in this study. The patients underwent combined operation of glaucoma and cataract in the ophthalmology department of our hospital from January 1st, 2017 to January 1st, 2019 were collected and divided into two groups according to different operation methods. The study group(13 cases, 16 eyes)was treated with EX-PRESS drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group(16 cases, 20 eyes)was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The best corrected visual acuity(BCVA)and intraocular pressure(IOP)at 1wk, 1, 3, 6mo after surgery, central anterior chamber depth(ACD)at before surgery, 1, 6mo after surgery, central corneal endothelial cell count, the duration of operation, length of hospital stays after surgery were compared between the two groups. RESULTS:The demography was matched between the two groups(all <i>P</i> >0.05). The number of eyes with visual improvement was significantly raised 6mo after treatment in study group(<i>Z</i>=-2.066,<i>P</i>=0.039). There were no significant differences in BCVA between two groups 6mo after treatment(<i>Z</i>=-0.319,<i>P</i>=0.765). The IOP of study group at 1wk, 1, 3 and 6mo was significantly lower than that before operation(all <i>P</i><0.001). There were no significant differences in IOP between the two groups(<i>F</i>=0.003, <i>P</i>=0.956). The anterior chamber significantly deepened at 1 and 6mo after operation in two groups respectively(all <i>P</i><0.001). There were no significant differences in ACD and central corneal endothelial cells count between two groups(all <i>P</i>>0.05). The duration of operation was 26.1±4.5min in study group and 31.5±5.1min in control group, which showed significant differences(<i>t</i>=-3.307, <i>P</i>=0.002). The length of stays after surgery was 7.2±1.6d in study group and 7.7±1.5d in control group, and there was no significant difference between the two groups(<i>t</i>=-0.880, <i>P</i>=0.388). One eye EX-PRESS touched the iris in study group. Since the IOP was normal, it didn't receive therapy. In control group, the anterior chamber of 2 eyes was 2 degrees shallow after surgery, which recovered in 1wk by pupil dilation and pressurized bandage. At 6mo point after operation, one eye in each group was treated with one IOP drop to maintain normal IOP. In control group, one case received EX-PRESS drainage device implantation again 12mo later for recurrent glaucoma, another case underwent ciliary body photocoagulation 8mo later. CONCLUSION: EX-PRESS drainage device combined with phacoemulsification is effective in improving visual acuity and controlling IOP for CPACG, and it takes shorten operation time compared with trabeculectomy combined with phacoemulsification.
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The treatment of refractory Glaucoma is a difficult problem in clinical ophthalmology. For refractory glaucoma patients with hyphema, shallow anterior chamber, anterior conglutination of peripheral chamber angle, corneal endothelium dystrophy or decompensated, at present, there is no effective treatment. In order to solve this problem, a new type posterior integral glaucoma valve with IOP control device was designed using medical titanium alloy, and the valve model was established by Abaqus software, and the stiffness and preload of the valve were analyzed by finite element method. The results showed that the opening and closing of the valve were controlled automatically by the pressure difference between the front and back of the valve, and the opening and flow rate of the valve increase dynamically with the increase of intraocular pressure, and finally reached the set ideal IOP value of steady state.
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Humans , Finite Element Analysis , Follow-Up Studies , Glaucoma , Glaucoma Drainage Implants , Intraocular Pressure , Treatment OutcomeABSTRACT
Objective Based on the existing clinical drainage device, two novel mechanisms were designed for the connection between the drainage tube of the patient and the drainage tube of the drainage bag, so as to compare such two mechanisms and validate whether the mechanisms can meet the design requirements for clinical use. Methods Mechanism 1 used the method of electromagnetic drive to pull in and Mechanism 2 used the magnetization method of permanent magnet to pull in. The finite element model of static electromagnetic field was established. The force of the two mechanisms under different currents was compared, and the distribution of magnetic field lines and magnetic induction intensity was analyzed. Simulation experiments were designed for preliminary experimental research. Results Under the pull-in state, the maximum magnetic induction of Mechanism 1 and Mechanism 2 at the closed end surface was found in contact area of the two iron cores. The suction force of Mechanism 1 could be adjusted by the current. When the current was 1 A, the maximum magnetic induction intensity at the closed end was 0.76 T, the electromagnetic force measured by the experiment was 6.08 N, the magnetic force of Mechanism 2 was 6.68 N, which was smaller than the 8 N suture tension. Mechanism 2 was separated by supplying the driving coil with a reverse magnetic field. Conclusions When the current was 1 A, Mechanism 1 could meet the magnetic attraction requirements, and Mechanism 2 could be separated when the current reached 1.8 A. Both mechanisms met the requirements of clinical design, but Mechanism 2 was more secure in the process of application. The feasibility of the mechanism structure was verified by finite element analysis and experimental test.
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@#AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.<p>METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi'an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.<p>RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(<i>P</i>>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(<i>P</i><0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(<i>P</i><0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection. <p>CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).
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Se presenta una paciente femenina, de 52 años de edad, con antecedentes de asma bronquial, miopía y glaucoma juvenil diagnosticado a los 22 años de edad. Le fueron realizadas dos trabeculectomías en el ojo izquierdo y una en el ojo derecho. En el año 2008 se le realizó cirugía de facoemulsificación más implante de lente intraocular en ambos ojos. La paciente acudió a nuestro Servicio hace un año, y refirió disminución progresiva de la visión. El examen oftalmológico reveló agudeza visual mejor corregida de 0,4 y presión intraocular de 30 y 23,5 mm/Hg para los respectivos ojos, con terapia hipotensora máxima tolerable. Al fondo de ojo se observó daño glaucomatoso avanzado, mayor en ojo izquierdo. Como opción de tratamiento se realizó ciclofotocoagulación transescleral en 2 cuadrantes del ojo derecho. A los 6 meses se constató presión intraocular de 30 y 18 mm/Hg, y se decidió el implante de la válvula de Baervelt en el temporal superior del ojo derecho. En el posoperatorio a los 7 días el examen oftalmológico arrojó presión intraocular de 5 mm/Hg, atalamia grado III y agudeza visual mejor corregida de 0,2. Se prescribió tratamiento con midriático ciclopléjico y antinflamatorios tópicos y sistémicos, y se logró a los 15 días mejoría del cuadro ocular. Se obtuvo buena agudeza visual y presión intraocular de 12 mmHg a los 3 meses del posoperatorio. El dispositivo del drenaje de Baerveldt es eficaz para lograr la reducción de la presión intraocular en el glaucoma refractario(AU)
A case is presented of a female 52-year-old patient with a history of bronchial asthma, myopia and juvenile glaucoma diagnosed at age 22. Two trabeculectomies were performed on the left eye and one on the right eye. In the year 2008 the patient underwent phacoemulsification surgery plus intraocular lens implantation in both eyes. She attended our service a year ago, reporting progressive vision reduction. Ophthalmological examination revealed best corrected visual acuity of 0.4 and intraocular pressure of 30 and 23.5 mm/Hg for either eye, with maximum tolerated hypotensive therapy. Funduscopy showed advanced glaucomatous damage, greater in the left eye. The treatment option selected was transcleral cyclophotocoagulation in two quadrants of the right eye. At 6 months intraocular pressure was 30 and 18 mm/Hg, and it was decided to implant a Baerveldt valve in the upper temporal quadrant of the right eye. Ophthalmological examination results at 7 days postoperative were intraocular pressure 5 mm/Hg, grade III athalamia and best corrected visual acuity 0.2. The treatment indicated was a cycloplegic mydriatic and topical and systemic anti-inflammatories. Ocular status improvement was achieved at 15 days. Satisfactory visual acuity and an intraocular pressure of 12 mm/Hg were obtained at 3 months postoperative. The Baerveldt drainage device is effective to achieve intraocular pressure reduction in refractory glaucoma(AU)
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Humans , Female , Middle Aged , Trabeculectomy/methods , Glaucoma/diagnosis , Phacoemulsification/methods , Lens Implantation, Intraocular/adverse effects , Vision, Ocular/physiologyABSTRACT
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.
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@#AIM: To observe the clinical efficacy and safety of new EX-PRESS glaucoma drainage device implantation combined with ranibizumab drugs in the treatment of neovascular glaucoma(NVG).<p>METHODS: A total of 78 patients(78 eyes)who were diagnosed with neovascular glaucoma and underwent intravitreal injection of ranibizumab drugs in our hospital from June 2015 to June 2018 were selected. Sixty patients with complete follow-up data were randomly divided in the experimental group(A), 30 patients(30 eyes)underwent EX-PRESS glaucoma drainage device implantation. Postoperative complications were observed early, visual acuity and intraocular pressure were observed at 1wk, 1mo, 3mo, 6mo and 1a, and the success rate of the operation was evaluated at 6mo and 1a. <p>RESULTS:After 1wk, 1, 3mo, 25 eyes, 25 eyes and 23 eyes with BCVA <0.1 in the experimental group, the average intraocular pressure was 16.76±3.21mmHg, 15.63±2.70mmHg and 16.69±3.29mmHg, the control group was 26 eyes, 26 eyes and 25 eyes, the average IOP was 17.31±2.96mmHg, 14.44±2.53mmHg and 16.56±4.14mmHg(all <i>P</i>>0.05); 6mo after operation, 16 eyes and 16 eyes in the 1a test group with BCVA <0.1 were the average IOP 15.49±3.19mmHg, 18.52±4.03mmHg, the control group was 25 eyes and 25 eyes, the average intraocular pressure was 21.96±2.90mmHg, 28.90±4.33mmHg(all <i>P</i><0.05); the experimental group had low intraocular pressure, shallow The number of cases of anterior chamber, anterior chamber hemorrhage, inflammation, choroidal detachment were 0 eyes, 1 eyes, 2 eyes, 1 eyes, 0 eyes, while the control group were 6 eyes, 6 eyes, 5 eyes, 4 eyes, 2 eyes(<i>P</i><0.05); 6mo after operation in the experimental group, the success rate of 1a operation was 83% and 80%, while that in the control group was 60% and 53%, respectively(<i>P</i><0.05).<p>CONCLUSION: EX-PRESS glaucoma drainage implantation combined with ranibizumab drug treatment in the vitreous cavity can effectively reduce the intraocular pressure in patients with neovascular glaucoma and has the advantages of small surgical incision, simple operation, safety, fewer postoperative complications, and high success rate of surgery.
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Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ?6 and ?21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age � standard deviation (SD) of 47.3 � 18.1 years with a mean follow-up of 16.7 � 11.4 months. Mean intraocular pressure reduced from 30.8 � 11.1 mmHg to 13.1 � 4.7, 14.1 � 4.8, 15.7 � 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 � 1 to 0.8 � 1.2, 0.7 � 1.1, 0.8 � 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.
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Introducción: el encapsulamiento de la ampolla o también llamado "quiste de Tenon" alrededor del dispositivo puede comprometer el funcionamiento valvular, aumentando la presión intraocular y así requiriendo procedimientos quirúrgicos adicionales. Objetivo: describir la eficacia y seguridad de la resección de quiste encapsulado en implante valvular de Ahmed en el control de la presión intraocular. Diseño de estudio: estudio observacional, retrospectivo, serie de casos. Método: se hizo un análisis de los pacientes a los que se les realizó resección de quiste encapsulado con un seguimiento a 6 meses, se excluyeron pacientes con antecedente de procedimiento ciclodestructivo, agudeza visual no percepción de luz, alteración del estado de conciencia, cirugía combinada y /o seguimiento postoperatorio menor de 3 meses. Resultados: se analizaron 14 ojos de los cuales 9 (64.3%) eran mujeres. El promedio de edad fue 56.1 con un rango entre 14 83 años. La presión intraocular preoperatoria promedio fue 26.7± 6.6 mmHg con una reducción estadísticamente significativa desde el primer día posoperatorio 9.8 ± 0.93 mmHg y al sexto mes 13.7 ± 0.94 mmHg (p 0.005). En el primer mes posoperatorio se logró reducción significativa en el número de medicamentos hipotensores (p 0.003), el cual se estabilizó al tercer mes y al sexto mes no presentó diferencia estadísticamente significativa (p 0.078). Conclusión: la resección de quiste encapsulado es un procedimiento efectivo para lograr el control de la presión intraocular en pacientes con glaucomas refractarios y/o no controlados con pocas complicaciones asociadas.
Background: the encapsulation of the bleb or so-called (Tenon cyst) around the device can compromise valve function, increasing intraocular pressure and thus requiring additional surgical procedures. Objective: to describe the efficacy and safety of encapsulated cyst resection in Ahmed valve implant for the control of intraocular pressure. Study design: observational study, retrospective cases series. Method: an analysis was made of the patients who underwent encapsulated cyst resection between January 2016 and August 2017 with a 6-month follow-up, patients with a history of cyclodestructive procedure, visual acuity of no light perception, altered state of consciousness, combined surgery and / or postoperative follow-up of less than 3 months were excluded. Results: 14 eyes were analyzed, of which 9 (64.3%) were women. The average age was 56.1 with a range between 14 - 83 years. he average preoperative intraocular pressure was 26.7 ± 6.6 mmHg with a statistically significant reduction from the first postoperative day 9.8 ± 0.93 mmHg and at the sixth month 13.7 ± 0.94 mmHg (p 0.005). In the fi rst postoperative month there was a significant reduction in the number of hypotensive drugs (p 0.003), which stabilized at the third month and at the sixth month did not present a statistically significant difference (p 0.078). Conclusion: encapsulated cyst resection is an effective procedure to achieve control of intraocular pressure in patients with refractory and / or uncontrolled glaucoma with few associated complications.
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Glaucoma/surgery , Ophthalmologic Surgical Procedures , Eye Diseases , Tenon Capsule/surgery , Intraocular PressureABSTRACT
PURPOSE: To investigate the outflow characteristics of silicone tubes with intraluminal stents used in membrane-tube (MT) type glaucoma shunt devices. METHODS: The silicone tubes used in MicroMT (internal diameter of 100 µm with a 7-0 nylon intraluminal stent) and Finetube MT (internal diameter of 200 µm with a 5-0 nylon intraluminal stent) were connected to a syringe-pump that delivered a continuous flow of distilled water at flow rates of 2, 5, 10, and 25 µL/min. The pressures and resistances of tubes were measured at a steady flow rate with full-length, half-length, and absence of intraluminal stents. RESULTS: The mean outflow resistance of the two types of tubes ranged from 3.0 ± 1.9 to 3.8 ± 1.7 mmHg/µL/min with a full-length intraluminal stent, 1.8 ± 1.1 to 2.2 ± 1.1 mmHg/µL/min with a half-length intraluminal stent, and 0.1 ± 0.0 to 0.2 ± 0.0 mmHg/µL/min without an intraluminal stent. Theoretically, for a physiologic state with a flow rate of 2 µL/min and episcleral venous pressure of 6 mmHg, the mean pressures of tubes were expected to be 13.2 ± 3.0, 10.5 ± 2.4, and 6.4 ± 0.2 mmHg in MicroMT with full-length, half-length, and absence of intraluminal stents, respectively, and 12.5 ± 3.9, 9.6 ± 2.4, and 6.2 ± 0.2 mmHg in Finetube MT with full-length, half-length, and absence of intraluminal stents, respectively. The pressure variance also decreased with intraluminal stent retraction (p < 0.01). CONCLUSIONS: The small diameter tubes of 100 and 200 µm internal diameters, with 7-0 and 5-0 nylon intraluminal stents, respectively, used in the MT-type glaucoma shunt device showed safe and effective outflow characteristics.
Subject(s)
Glaucoma , Hydrodynamics , Intraocular Pressure , Nylons , Silicon , Silicones , Stents , Venous Pressure , WaterABSTRACT
Purpose: The purpose of the study is to report the outcomes of simultaneous cataract extraction (CE) and a new nonvalved glaucoma drainage device (GDD), Aurolab Aqueous Drainage Implant (AADI), in eyes with cataract and refractory glaucoma. Methods: This was a non-comparative, interventional, retrospective study. Consecutive patients who underwent AADI together with phacoemulsification from June-2015 to January-2017 by a single fellowship trained glaucoma surgeon with documented 3-months of follow-up were included. The main outcomes were intraocular pressure (IOP), antiglaucoma medication (AGM), visual acuity, and complications. Results: We included 19 eyes of 17 patients with average follow-up of 14.4 ± 8.4 months. IOP and AGM reduced from 36.9 ± 11.1 mmHg and 4 ± 0.8 preoperatively to 12 ± 4.5 mmHg and 0.8 ± 1.2, respectively (P < 0.001). Complications were seen in seven eyes (36.8%). Total success was seen in 17 eyes (89.5%). None of the patients lost vision. Conclusion: Combining cataract extraction with the new non-valved Aurolab Aqueous Drainage Implant, appears to be an effective and safe technique in eyes with refractory glaucoma and cataract. Larger studies and further follow-up is recommended for such patients.
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We present a case of tube endothelial touch where a suture technique for repositioning of the Ahmed glaucoma valve was performed. Advantage of this technique is that it is minimally invasive and anterior chamber stability is maintained during the procedure.
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Glaucoma is one of the main causes of blindness in China. The higher the intraocular pressure, the severer the optic nerve injury. Lowering the intraocular pressure is the main treatment of delaying the progression in glaucoma optic nerve damage, and surgery is the chief strategy of lowering the intraocular pressure. At present, the device implantation has become more and more popular among different types of surgical treatment of glaucoma due to its safety, efficacy, fewer complications. This article introduces briefly the new device implantation--XEN gel stent drainage device.
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AIM: To observe the clinical efficacy of different treatment modalities and the influence on the levels of pigment epithelium-derived factor ( PEDF ) and vascular endothelial growth factor ( VEGF ) in patients with neovascular glaucoma ( NVG) in high altitude area.?METHODS: Ninety cases of patients ( 90 eyes ) with NVG treated in our hospital were selected as the study objects, and they were divided into Group A and Group B according to different surgery methods, 45 cases in each groups. Group A was given Ex-press glaucoma drainage device implantation, and Group B was given trabeculectomy combined with cyclocryotherapy. We observed the clinical efficacy, intraocular pressure and visual acuity in the two groups, detected the PEDF and VEGF levels in the aqueous humor, and recorded the postoperative complications.?RESULTS:The total effective rate of Group A was 91％, significantly higher than that of Group B 76％ (P<0. 05). At 2wk, 2 and 4mo after surgery, IOP levels were significantly lower than that before surgery (P<0. 05), and those in Group A were significantly lower than those in Group B (P<0. 05). There was no significantly difference in IOP levels at 6mo after surgery between the two groups (P>0. 05). At 1wk after operation, the incidence of visual reduction in Group A was 7％, significantly lower than that in Group B 22％ (P<0. 05). At 1wk after operation, PEDF levels were significantly higher than those before operation in the two groups (P<0. 05), and that in Group A was significantly higher than that in Group B (P<0. 05);VEGF levels were significantly lower than that before operation in the two groups (P<0. 05), and that in Group A was significantly lower than that in Group B (P<0. 05). The incidence rate of complications in Group A was 4％, significantly lower than that of 18％ in Group B at 6mo postoperatively (P<0. 05).?CONCLUSION: Ex- press glaucoma drainage device implantation, trabeculectomy combined with cyclocryotherapy can both be used to treat patients with NVG in high altitude area. But the former can effectively maintain visual acuity, and improve PEDF and VEGF levels in aqueous humor, with fewer complications and more accurate curative effect.