Challenges of Secondary Glaucoma Management Following Congenital Cataract Surgery, Penetrating Keratoplasty and Vitreoretinal Surgery.

Glaucoma is one of the world's leading causes of irreversible vision loss. It is often asymptomatic until it reaches an advanced stage, which can have a significant impact on patients' daily lives. This paper describes the case of a 50-year-old female patient who presented with acute onset of ocular pain, photophobia, and loss of visual acuity in her right eye (RE). The patient's medical history includes congenital cataracts, surgical aphakia, nystagmus, strabismus, amblyopia, and secondary glaucoma. Ophthalmological examination showed BCVA RE-hand movement, left eye (LE)-0.08 with an intraocular pressure (IOP) of 30 mmHg in RE and 16 mmHg in LE. Biomicroscopic examination of RE showed corneal graft, epithelial and endothelial edema, endothelial precipitates, corneal neovascularization, aphakia, and Ahmed valve superotemporally. Despite maximal topical and systemic treatment, Ahmed valve, and trabeculectomy, secondary glaucoma in the right eye remained refractory. Reimplantation of an Ahmed valve was performed. This resulted in a favorable outcome with increased visual acuity and controlled intraocular pressure. The combination of aphakia, penetrating keratoplasty, and secondary glaucoma is a challenge for any surgeon. It is important that both the perioperative risks and the possible complications are carefully assessed in each patient, especially if associated pathology is present.

Case report: Introduction of an Ahmed valve implant tube into the ciliary sulcus using a guide-wire.

BACKGROUND: Glaucoma is a progressive optic neuropathy and it is the main cause of irreversible blindness worldwide. Intraocular pressure (IOP) is the only modifiable one and trabeculectomy is commonly considered the surgical "gold standard" to decrease IOP. In particular cases, other kind of surgeries, as the Ahmed Glaucoma Valve (AGV) implant, are a reliable alternative. Usually, the silicone tube of AGV surgery is inserted into the anterior chamber. Sometimes it is necessary to place the AGV silicone tube in the ciliary sulcus, especially in cases of endothelial decompensation. This surgical procedure is not always easy to perform. CASE PRESENTATION: This article describes and presents a technique for inserting the AGV tube into the posterior chamber using a guide-wire, in a total of 12 cases are reported. This procedure has been mostly applied in a group of pseudophakic patients who need AGV placement to control elevated IOP. In exceptional situations, this procedure was applied in pseudophakic patients previously with AGV tube implanted in the anterior chamber and with loss of endothelial cells or in phakic patients with previously implanted AGV anterior chamber tube, simultaneously to cataract surgery. CONCLUSION: The purpose of these cases presentations attended at our service is to demonstrate the passage of the AGV silicone tube was performed with the aid of a guide wire.

Update on Diagnosis and Treatment of Uveitic Glaucoma.

Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.

Vision outcomes in dogs with primary glaucoma surgically treated with lensectomy and endolaser cyclophotocoagulation after an Ahmed valve gonioimplantation failure.

OBJECTIVE: The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure. PROCEDURE: Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months. RESULTS: Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months. CONCLUSIONS: Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.

Long-Term Clinical Outcomes of Ahmed Valve Implantation in Aniridic Glaucoma.

BACKGROUND: This study assessed the efficacy and safety of Ahmed valve implantation in patients with aniridic glaucoma for three consecutive years. METHODS: Six adult patients (seven eyes) with Ahmed valve (AV) implants for aniridic glaucoma were enrolled in the study. The primary outcome measures were intraocular pressure reduction, glaucoma medication use, success rates, and visual acuity after AV implantation. A 30% reduction in IOP from baseline without the need for re-intervention was considered an effective treatment. The cessation of antiglaucoma medications was defined as complete success. Intraoperative and postoperative complications were included as secondary outcome measures. Measurements were performed preoperatively, at the first week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively. RESULTS: A total of seven eyes (6 patients) were evaluated 36 months after AV implantation. The mean ± SD values of IOP preoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively were 30.4 ± 4.0 mmHg, 14.6 ± 4.6 mmHg, 16.1 ± 4.6 mmHg, 20.7 ± 7.0 mmHg, 14.5 ± 2.7 mmHg, 16.5 ± 5.9 mmHg, 16.2 ± 4.0 mmHg, 16.3 ± 4.3 mmHg, 17.2 ± 10.1 mmHg, 17.6 ± 6.9 mmHg, and 18.2 ± 5.5 mmHg, respectively. At the last follow up, the mean IOP was reduced by 40.2%. The qualified success rate was 85.7%. One patient (one eye) at the last follow-up visit did not require antiglaucoma medications, resulting in a complete success rate of 14.3%. Intra- and postoperative mild or moderate subconjunctival bleeding was observed in all the patients. No other major/minor intraoperative or postoperative complications were noted. CONCLUSIONS: In long-term follow up, the AV implantation procedure is well-tolerated and relatively safe for reducing IOP in adult aniridia patients with glaucoma. These results should be validated through studies involving a larger patient cohort.

Comparison between primary Ahmed valve implantation and primary trabeculectomy with mitomycin C in pseudophakic patients with exfoliative glaucoma.

PURPOSE: To compare the efficacy and safety of primary Ahmed valve implantation (AVI) and primary trabeculectomy with mitomycin C (MMC) in patients with pseudophakic exfoliative glaucoma (XFG). METHODS: All enrolled patients were divided into two groups: the TRAB group, comprising patients who underwent trabeculectomy with MMC, and the AVI group, comprising patients who underwent AVI. Intraocular pressure (IOP), mean deviation (MD), endothelial cell density of cornea (ECD), and the number of topical anti-glaucoma agents used during study period were retrospectively analyzed. Surgical success rates were compared between two groups using Kaplan-Meier survival analysis. Three levels of surgical success were defined as follows: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% without medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% without medication; and (3) IOP ≤ 18 mmHg and an IOP reduction of 20%, irrespective of medication. RESULTS: The TRAB and AVI groups comprised 40 and 36 patients, respectively. At 36 months postoperatively, IOP was 15.7 ± 2.8 mmHg in the TRAB group and 16.9 ± 3.3 mmHg in the AVI group (p = 0.140). Surgical success rates in the TRAB group were 47.5, 37.5, and 77.5% and those in the AVI group were 41.6, 33.3, and 75.0% at 36 months for surgical criteria 1, 2, and 3, respectively. There were no statistically significant differences in the success rates between the two groups. However, regarding surgical criteria 2, the success rate of the AVI group at 1 year was significantly better than that of the TRAB group (p = 0.030). CONCLUSIONS: Primary AVI was not inferior to primary trabeculectomy with MMC in medically uncontrolled patients with XFG.

Efficacy and safety of combined 27-G vitrectomy and Ahmed valve using same sclerotomy site for the tube placement: A case series.

We report a retrospective case series describing the feasibility and outcomes of combined 27-G minimally invasive vitrectomy surgery (MIVS) and Ahmed® Glaucoma Valve (AGV) placement. Four eyes of four patients underwent a combined MIVS using 27-G technology and AGV implantation with the tube placement in the vitreous cavity. Preoperative and postoperative data up to 12 months were collected including the type of glaucoma, intraocular pressure (IOP), glaucoma medications, and complications. All AGVs tubes were placed in the vitreous cavity using the same sclerotomy, although a slight wound enlargement was required. After one year, IOP and glaucoma medications were reduced (41.5 ±â€¯19.1-14.5 ±â€¯3.1 mmHg and from 3(3-3) to 1.5 (1.5-3.5). Three patients developed cystoid macular edema. The first-reported cases of combined MIVS-27-G and AGV showed a reduction of IOP and antiglaucoma medication. Placing the tube using the same sclerotomy location is feasible but a slight enlargement may be required.

Pars Plana Ahmed Valve Implantation for Vitrectomized Eyes With Refractory Glaucoma.

This study aimed to analyze the surgical outcomes of pars plana Ahmed valve implantation in vitrectomized eyes with refractory glaucoma. We performed a retrospective case review of consecutive patients with refractory glaucoma after undergoing pars plana vitrectomy who underwent pars plana Ahmed valve implantation between July 2019 and December 2020 at the glaucoma unit of the Affiliated Changshu Hospital of Xuzhou Medical University (Changshu, China). All the patients were followed up for ≥12 months postoperatively. We recorded pre- to postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of anti-glaucoma medication, corneal endothelial count, and surgical complications, if any. There was a significant improvement in the median BCVA from 2.30 (0.87, 2.30) logMAR preoperatively to 1.70 (0.70, 2.30) logMAR at discharge and 1.0 (0.52, 1.85) at final examination (p = 0.011, p = 0.001). Compared with the preoperative IOP level, there was a significant decrease in the postoperative IOP at each postoperative time point (p < 0.001). There was a significant reduction in the median number of anti-glaucoma drugs (including postoperative ocular massage), from 3.00 (2.00, 3.00) preoperatively to 0.00 (0.00, 1.00) at the last follow-up postoperative examination (p < 0.001). A 29-year-old woman with proliferative diabetic retinopathy who underwent surgical treatment at 5 months postoperatively for fibrous wrapping formed around the plate of the Ahmed valve showed an IOP of 14 mmHg at the last follow-up. Our findings indicated that pars plana Ahmed valve implantation can be safely performed for managing vitrectomized eyes with refractory glaucoma.

Surgical Treatment in Silicone Oil-Associated Glaucoma.

Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods.

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma.

We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy (n =16) or Ahmed valve implantation (n = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, p = 0.987). The mean IOPs were similar as well (p = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; p = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group (p = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.

Posterior segment complications of Ahmed valve implantation.

BACKGROUND: To assess the time, incidence, and outcome of posterior segment complications of Ahmed valve implantation (AVI). METHODS: 248 eyes that underwent AVI were reviewed retrospectively. Visual acuity, preoperative characteristics, and postoperative posterior segment complications were assessed. RESULTS: The incidence of posterior segment complications of AVI was 31.4% (78/248). The mean follow-up period was 97.4 ± 53.5 months. The mean time to occur posterior segment complication was 1.5 months. The most common posterior segment complication was choroidal detachment (17.7%) and others included ocular decompression retinopathy (3.2%), hypotonic maculopathy (2.8%), vitreous hemorrhage (2.0%), retinal detachment (1.2%), endophthalmitis (1.2%), suprachoroidal hemorrhage (1.2%), epiretinal membrane (0.8%), cystoid macular edema (0.8%), and proliferative vitreoretinopathy (0.4%). Older age, hypertension, and postoperative hypotony had an increased risk of posterior segment complications of AVI. CONCLUSIONS: The overall incidence of posterior segment complications of AVI was 31.4%. Older age, hypertension, and postoperative hypotony were significantly associated with posterior segment complications of AVI.

Foreign body in the eye of a patient with developmental delay.

Foreign body in the eye is a relatively common emergency department (ED) chief complaint which does not usually lead to ophthalmologic intervention. We report a case of a 35-year-old male with a history of developmental delay who presented to our ED for evaluation of ocular foreign body. His reported foreign body was removed, and subsequently identified as an Ahmed Valve, a device used in the management of glaucoma. After removal in the ED, an exam under anesthesia was performed by ophthalmology the next morning with injection of antibiotics. Even patient presentations for seemingly simple, straightforward chief complaints deserve critical appraisal by emergency clinicians. When suspicions are raised or there is any doubt, specialty consultation should be obtained to ensure patients receive appropriate care and necessary follow up. This is especially true when history and exam are limited by other factors such as developmental delay, incomplete medical history, or altered mental status.

Retinoblastoma in an older Hispanic child masquerading as pars planitis: A case report.

INTRODUCTION: To report a case of a Hispanic girl with late-onset Retinoblastoma (Rb) who was misdiagnosed as a pars planitis prior to referral. Nearly 95% of all Rb cases are detected before age 5, and this patient was 8 years-old. METHODS: Case report of a late-onset Retinoblastoma with anterior chamber (AC) involvement plus the presence of an Ahmed valve. The patient had a history of a couple of months of topical therapy comprising medication for glaucoma, systemic steroids, and a filtration surgery (Ahmed valve), after that a biopsy was performed prior to referral. Upon arrival at our clinic, we performed an examination under anesthesia (EUA) and a B-scan ultrasound (US). RESULTS: Unilateral Retinoblastoma with an Ahmed valve in an AC filled with Rb seeds was diagnosed with the EUA and US in the left eye. An orbital exenteration with map biopsies of the left orbital cavity was performed with confirmation by histopathology of a poorly differentiated endophytic retinoblastoma with Bruch's membrane invasion. Follow-up sessions were then arranged as well as subsequent systemic chemotherapy cycles. CONCLUSION: Given the rare incidence of retinoblastoma in children older than 5 years old, it can be easily mistaken for other differential diagnoses and treated with filtration surgeries that could put the patient's life at risk. In this report, late-onset Rb diagnosis is highlighted as a differential diagnosis in children and adults with atypical uveitis, which required a multidisciplinary approach.

Sequential treatment of neovascular glaucoma with cataract by Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of conbercept injection combined with Ahmed valve implantation and phacoemulsification in the treatment of neovascular glaucoma(NVG).<p>METHODS: Retrospective analysis. Totally 18 patients(18 eyes)with NVG complicated combined with cataract in our hospital from June 2018 to January 2020. All patients received intraocular injection of conbercept at 3-7d before surgery, Ahmed valve implantation and phacoemulsification were performed after meeting the surgical indications. Best corrected visual acuity(BCVA), intraocular pressure(IOP), resolution of iris neovascularization and postoperative complications were followed up after the surgery, and all the cases were followed up 12mo. <p>RESULTS: Compared with preoperation(51.44±8.18 mmHg), IOP was significant decreased at 1, 7d, 1, 3, 6mo, 1a after surgery(25.94±11.82, 15.39±4.97, 15.94±2.69, 15.33±4.54, 18.89±7.95, 16.27±5.22 mmHg)(<i>P</i><0.05). Last follow up after surgery, BCVA was improved in 12 eyes(67%), unchanged in 5 eyes(28%)and decreased in one eye. At 1a after operation, the complete success rate was 83%(15 eyes), conditional success rate was 11%(2 eyes), one eye of losing control of IOP was failed. <p>CONCLUSION: Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification can not only effectively control postoperative IOP, but also improve the visual acuity of the patients as much as possible. It is an effective method for the treatment of NVG with cataract.

Intraluminal stenting versus external ligation of Ahmed glaucoma valve in prevention of postoperative hypotony.

AIM: To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. METHODS: This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP≤21 mm Hg without medications indicated complete success while IOP≤21 mm Hg with medications indicated qualified success; and IOP<6 mm Hg was defined as hypotony. RESULTS: After a year of follow-up, IOP was significantly reduced in the intraluminal stenting group than in the external ligation group (11.67±0.89 vs 14.2±4.0 mm Hg, respectively, P=0.024). Postoperative hypotony was more common in the external ligation group (2 cases, 13.33%) than in the intraluminal stenting group (1 case, 6.67%). CONCLUSION: Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony (transient and persistent) that occurs in conventional AGV surgery.

Simultaneous pars plana vitrectomy, panretinal photocoagulation, cryotherapy, and Ahmed valve implantation for neovascular glaucoma.

AIM: To describe and evaluate the efficacy of Ahmed glaucoma valve implantation (AGV) combined with pars plana vitrectomy (PPV) in a single surgical act for the treatment of advanced neovascular glaucoma (NVG). METHODS: Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV, AGV, and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period (2005-2018). Preoperative, intraoperative and postoperative data at day 1 and months 1, 3, 6, 21, and 24 were systematically collected. Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment. RESULTS: Main indications for surgery were NVG secondary to proliferative diabetic retinopathy (39.2%) and central retinal vein occlusion (37.3%). Mean (±SD) preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12mo and 15.8±9.1 mm Hg at 24mo of follow up. Cumulative incidence of success of IOP control was 76.0% at first postoperative month, reaching 88.3% at 6mo. Prevalence of successful IOP control at long term was 74.4% at 12mo and 71.4% at 24mo. Eye evisceration for unsuccessful NVG management was required in 1 case (2.0%). CONCLUSION: Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.

Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study.

PURPOSE: To investigate the outcomes of transscleral cyclophotocoagulation (TSCPC) after Ahmed glaucoma valve (AGV) implantation failure in patients with familial amyloidotic polyneuropathy (FAP) secondary glaucoma. MATERIALS AND METHODS: In this retrospective study, all patients with secondary FAP glaucoma who underwent AGV implantation between 2010 and 2019 in our tertiary center were assessed. Among all, those patients who needed TSCPC to control intraocular pressure (IOP) after AGV were selected. Demographic data, value of IOP, best-corrected visual acuity (BCVA), number of antiglaucomatous medications, surgical complications, and need for retreatment were collected. RESULTS: From a total of 124 eyes submitted to AGV implantation, 13 eyes (10.48%) needed TSCPC to control IOP. The median age at TSCPC was 49.50 years (43; 55.75), and the median period between AGV implantation and TSCPC was 1.63 years (1.00; 3.65). There was a significant decrease of IOP after the procedure, from 24.33 ± 4.76 to 11.33 ± 2.90 mm Hg at last visit (p < 0.001). A reduction in the number of antiglaucomatous medications was also noticed, from 3.92 ± 0.29 to 1.25 ± 1.42 (p < 0.001). There was no difference in BCVA (p = 0.502). After the procedure, there was an exuberant anterior chamber (AC) reaction in two eyes (16.7%), and one case developed a neurotrophic ulcer (8.3%). There was no need for re-treatment. CONCLUSION: Ahmed glaucoma valve implantation is a promising surgical procedure to treat patients with PAF secondary glaucoma, showing good results. For refractory cases, TSCPC seems to be effective and safe to control IOP. CLINICAL SIGNIFICANCE: There are only a few studies in current literature that address amyloid secondary glaucoma, maybe because it is a rare pathology worldwide. However, it has a high incidence in certain regions, including the north of Portugal. For the record, this is the first study describing the tool of cycloablative procedures in this type of glaucoma. HOW TO CITE THIS ARTICLE: Vieira R, Marta A, Figueiredo A, et al. Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study. J Curr Glaucoma Pract 2021;15(1):32-35.

Biometric Predictability in Combined Cataract Surgery and Ahmed Glaucoma Valve Implantation Depending on Tube Position.

PURPOSE: To compare the predictability of biometric results in patients undergoing cataract surgery combined with Ahmed glaucoma valve (AGV) implantation according to tube position. METHODS: A retrospective cohort study was performed in patients who underwent phacoemulsification surgery combined with AGV implantation with the tube in posterior (group PC) and anterior (group AC) chamber, between November 2012 and April 2020. The main outcome was the mean biometric prediction error, according to tube position, using different formulas. RESULTS: The study included 49 eyes of 36 patients, 23 eyes in group PC and 26 eyes in group AC. Gender (p=0.774), age (p=0.822), type of glaucoma (p=0.168), preoperative correct distance visual acuity (p=0.139), axial length (p=0.765), anterior chamber depth (p=0.351), keratometry (p=0.577) and intraocular lens power (p=0.608) were similar between groups. Only preoperative intraocular pressure was higher in group PC (p=0.005). The mean prediction errors using Haigis, SRK/T, Hoffer Q, Holladay 1, Barrett Universal II, Kane and Hill RBF formulas were all positive in group PC (hyperopic) and all negative (myopic) in group AC. In group PC, there was no significant difference in prediction error between these formulas (p>0.05). In group AC, the formula with the worst prediction error was Haigis (p=0.001), and the best was Barrett Universal II (p=0.043). CONCLUSION: The biometric predictability and expected final refraction in phacoemulsification surgery combined with AGV implantation are modified by the position of the tube.

Análisis de resultados postoperatorios entre trabeculectomia y derivación con válvula ahmed en pacientes con glaucoma primario de ángulo abierto del Hospital Central Militar / Analysis of postoperative results between trabeculectomy and shunt with ahmed valve in patients with primary open-angle glaucoma at Hospital Central Militar

Resumen Introducción: El glaucoma es una enfermedad que afecta al ojo y se caracteriza por la lesión tanto del nervio óptico como de la retina, relacionados con el aumento de la presión intraocular. La detección el tratamiento adecuado ayuda a ofrecer una mejor calidad de vida al paciente. Objetivo: Comparar la presión intraocular posoperatoria entre la trabeculectomía y la derivación con válvula Ahmed en pacientes con glaucoma primario de ángulo abierto del Hospital Central Militar de Enero del 2017 a Enero de 2018. Material y método: Es un estudio observacional, descriptivo y retrospectivo, de pacientes diagnosticados con glaucoma primario de ángulo abierto atendidos en la consulta de oftalmología en el Hospital Central Militar de enero de 2017 a enero del 2018, en quienes se empleó como herramienta de trabajo sus expedientes clínicos electrónicos, utilizando el programa R versión 3.4.4 (R Foundation for Statistical Computing, Vienna, Austria). Resultados: Se identificaron un total de 100 pacientes en el periodo de estudio. Los pacientes presentaron una edad entre 32 y 93 años. El 35 % de los pacientes fueron sometidos a trabeculectomía y el 65 % restante fueron sometidos a derivación con válvula Ahmed donde se observó una mayor reducción con la válvula Ahmed en pacientes con mayor presión prequirúrgica. Conclusiones: Podemos concluir que la derivación con válvula Ahmed resulta en mejores resultados postoperatorios, los cuales se observan después de la segunda consulta de seguimiento, por lo cual esta técnica trae mejores resultados a manejos de la PIO de los pacientes que requieren tratamiento quirúrgico, a pesar de que la trabeculectomía sea el estándar de oro ya no representa mayores beneficios que utilizar una técnica menos invasiva como lo es la válvula Ahmed. Así mismo, la trabeculectomía regula mejor las presiones intraoculares en aquellos pacientes que no tienen tanto aumento de la PIO.

Abstract Introduction: Glaucoma is a disease that affects the eye and at the same time the injury as well as the optic nerve and the retina, related to the increase in intraocular pressure. The detection of adequate treatment helps to offer a better quality of life to the patient. Objective: To compare the postoperative intraocular pressure between the trabeculectomy and the Ahmed valve shunt in patients with primary open angle glaucoma of the Central Military Hospital from January 2017 to January 2018. Material and method: It is an observational, descriptive and retrospective study, patients diagnosed with glaucoma. his electronic clinical records, using the R program version 3.4.4 (R Foundation for Statistical Computing, Vienna, Austria). Results: A total of 100 patients were identified during the study period. The patients present an age between 32 and 93 years. 35% of the patients underwent a trabeculectomy and the remaining 65% underwent a bypass with the Ahmed valve where a greater reduction was observed with the Ahmed valve in patients with higher presurgical pressure. Conclusions: We can conclude that the derivation with the Ahmed valve results in better postoperative results, which are observed after the second follow-up visit, so this technique brings better results to the IOP management of patients who require treatment. surgical, a The work is not related to the use of a less invasive technique. Likewise, trabeculectomy better regulates intraocular pressures in those patients who do not have such an increase in IOP.

Various modalities for management of secondary angle closure neovascular glaucoma in diabetic eyes: 1-year comparative study.

PURPOSE: To compare outcome of 4 methods for management of angle closure neovascular glaucoma (NVG) in diabetic eyes. METHODS: Prospective comparative study, on 40 eyes (40 patients) with NVG. Patients were randomly assigned to group A (Trabeculectomy with MMC), B (Ahmed valve), C (Ex-Press Minishunt with MMC) or D (Diode cyclophotocoagulation). Patients were followed regularly for 1 year. MAIN OUTCOME MEASURES: intraocular pressure (IOP), best corrected visual acuity (BCVA), central foveal thickness (CFT), intraoperative bleeding, postoperative complications and 2ry intervention. RESULTS: Preoperative data were not significantly different between 4 groups. Postoperatively, there was significant drop in IOP in each group at each follow-up. Ahmed valve group showed least mean postoperative IOP and highest mean drop of the IOP at 1 day and 1 week postoperatively, while Ex-Press minishunt group had least mean postoperative IOP at 1 month and 3 months postoperatively. At 6 months and 1 year, there was no significant difference between 4 groups. BCVA was not significantly different between 4 groups. At 1 year, CFT was significantly lower in each of the 4 groups, and it was significantly the least in group A and highest in group D. Highest intraoperative bleeding was observed with trabeculectomy. Success rate was not significantly different among the 4 groups. CONCLUSION: The 4 management options showed a significant long-term effect on IOP, and on long-terms there was no significant difference between them for IOP and BCVA. Trabeculectomy showed highest incidence of intraoperative bleeding, while cyclophotocoagulation showed none.