Value of Intravitreal Gas Injection With Ahmed Valve Implantation in the Prevention of Suprachoroidal Hemorrhage in Aphakic, Aniridic, and Vitrectomized Glaucomatous Eyes: A Pilot Study.

PURPOSE: The aim of this study was to assess the value of intravitreal injection of nonexpansile C3F8 12% in the prevention of suprachoroidal hemorrhage (SCH) after Ahmed valve implantation for the treatment of secondary glaucoma in vitrectomized, aphakic, and aniridic eyes following blunt trauma. PATIENTS AND METHODS: This is a case series of 5 patients who presented with traumatic secondary glaucoma in vitrectomized, aphakic, and aniridic eyes. Vitrectomy was performed in all eyes after trauma for the treatment of the vitreous hemorrhage. Ahmed valve implantation with complete filling of the vitreous cavity with nonexpansile C3F8 was carried out 2±0.2 months after vitrectomy. The outcome measures were evaluating the value of intraoperative filling of the vitreous cavity with gas in preventing SCH after Ahmed valve implantation and the ability of Ahmed valve implantation to control the intraocular pressure (IOP) in vitrectomized, aphakic, and aniridic eyes. All patients were examined up to 6 months. RESULTS: Inspite of the multiple risk factors present in our patients in the form of aphakia, vitrectomized eyes, and aniridia, no patient developed postoperative hypotony or SCH during the postoperative period. The gas was absorbed over 2 months and the IOP was maintained during the early postoperative period. Mean postoperative IOP was 15.2±1.09, 12.2±1.09, 18.4±7.12, 15.2±2.28, and 14.8±1. 09 mm Hg at 1 day, 1 week, 1 month, 3 months, and 6 months, respectively. The final postoperative best-corrected visual acuity was 0.66±0.13. CONCLUSIONS: Complete filling of the vitreous cavity with nonexpansile gas can prevent postoperative SCH after Ahmed valve implantation in the treatment of secondary glaucoma in vitrectomized, aphakic, and aniridic eyes.

Surgically induced astigmatism following glaucoma surgery in Egyptian patients.

PURPOSE: The altered visual function induced by changes in corneal curvature following filtration surgery is distressing to patients. The aim of this study was to evaluate surgically induced astigmatism following trabeculectomy in comparison with deep sclerectomy. METHODS: In a prospective interventional comparative study, patients with primary open-angle glaucoma were randomly allocated to either group A or B; deep sclerectomy with mitomycin C 0.2 mg/mL and trabeculectomy with mitomycin C 0.2 mg/mL, respectively. Keratometry was performed using Topcon KR-7000P autokerato-refractometer preoperatively and at 6 months postoperatively. Vector analysis was used to analyze the surgically induced astigmatism. RESULTS: Sixty eyes of 45 patients in group A, and 60 eyes of 42 patients in group B were enrolled for vector analysis. The mean preoperative astigmatic vector power was -0.49±1.65 D and +0.47±2.18 D in groups A and B, respectively. The mean postoperative astigmatic vector power was -1.14±1.55 D in group A and -0.35±1.8 D in group B. The mean change in astigmatic vector powers was -0.67±1.63 D in group A and -0.82±2.0 D in group B. When compared with preoperative data in either group, the differences were significant, P=0.001 & 0.007 in groups A and B respectively, whereas the postoperative difference between either group was insignificant (P=0.723). A total of 40% of corneas got flatter in group B compared with 25% in group A, P=0.057. CONCLUSIONS: Both trabeculectomy and deep sclerectomy induced considerable postoperative astigmatism. A longer follow-up period is recommended to study the different patterns of astigmatism in either procedure.