1
|
Senthilkumar VA, Wala N, Rajendrababu S, Mishra C, Kannan NB, Uduman MS. Clinical Presentation and Treatment Outcomes of Pupillary Block Glaucoma Following Vitreoretinal Surgery. Semin Ophthalmol 2024; 39:381-386. [PMID: 38810666 DOI: 10.1080/08820538.2024.2323117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/23/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To describe the clinical presentation and treatment outcomes of pupillary block glaucoma (PBG) following vitreoretinal surgery (VR surgery). MATERIAL AND METHODS Retrospective observational study of 6941 patients, who underwent VR surgery at a tertiary eye care centre in South India between January 2015 and December 2019. Amongst them, clinical data of 61 patients who developed PBG were taken for statistical analysis. RESULTS Mean (SD) age was 53.90 (13.4) years and the incidence of PBG was .87%. Median (IQR) time of onset of PBG following VR surgery was 3.33 (1.1-6.6) months and majority were pseudophakic (75%). PBG resolved with Nd:YAG laser peripheral iridotomy (LPI) alone in 50 (82%) patients, whereas 11(18%) patients required additional interventions like surgical iridectomy, trabeculectomy or diode laser cyclophotocoagulation (CPC) either as a stand-alone procedure or in combination with silicone oil removal (SOR). Mean (SD) intraocular pressure at the onset of PBG was 41.61 (14.5) mmHg, which reduced drastically following LPI to 24.28 (14.9) mmHg which further dropped significantly at 6 months follow up to 20.34 (13.9) mmHg. CONCLUSIONS Incidence of secondary PBG after VR surgery was .87%, and we observed diabetes mellitus, combined cataract and VR surgery, use of 1000cs SO endotamponade, intraoperative endolaser and multiple VR surgical interventions as common associations. Majority of the patients with PBG after VR procedures resolved with LPI and medical management. Few individuals (18%) required additional laser or surgical intervention for IOP control.
Collapse
Affiliation(s)
- Vijayalakshmi A Senthilkumar
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Narendra Wala
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Sharmila Rajendrababu
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Chitaranjan Mishra
- Department of Retina and Vitreoretinal surgery, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
| | - Naresh Babu Kannan
- Head of the department, Department of Retina and Vitreoretinal surgery, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
| | - Mohammed Sithiq Uduman
- Department of Biostatistics, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
| |
Collapse
|
2
|
Santos GH, Fernandes RAB, Fernandes AG. Comparison of Ahmed glaucoma drainage implant outcomes in the anterior chamber versus pars plana. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:160-165. [PMID: 36965507 DOI: 10.1016/j.jcjo.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To compare long-term outcomes of eyes undergoing Ahmed glaucoma drainage implants in the anterior chamber versus the pars plana.Retrospective cohort study. PARTICIPANTS Operated patients were divided into anterior-chamber or pars plana groups. METHODS Follow-up data included intraocular pressure (IOP), need for antiglaucoma medications (AGMs), and postoperative complications. Treatment success was evaluated based on the following criteria: IOP ≤21 mm Hg and no AGM use, IOP ≤21 mm Hg with or without AGM use, IOP ≤18 mm Hg and no AGM use, IOP ≤18 mm Hg with or without AGM use, IOP ≤15 mm Hg and no AGM use, and IOP ≤15 mm Hg with or without AGM use. RESULTS A total of 170 eyes were selected and split into an anterior-chamber group (n = 57) and a pars plana group (n = 113). No differences between groups were found on the decrease in IOP (p = 0.612) or number of AGMs (p = 0.695) in the postoperative period. No differences regarding corneal decompensation (p = 0.554) or retinal detachment (p = 0.168) were observed between groups. The 1-year success rates for all the criteria were, respectively, 89%, 96%, 88%, 92%, 88% and 90%; the 3-year success rates for all the criteria were, respectively, 33%, 61%, 32%, 55%, 28%, and 45%; and the 5-year success rates for all the criteria were, respectively, 7%, 48%, 7%, 36%, 4% and 17%. CONCLUSIONS No differences between the groups were observed for long-term outcomes of IOP, AGM use, or postoperative complications. Success rates were comparable between groups, decreased along the follow-up time, and were higher when associated with AGM use.
Collapse
Affiliation(s)
| | - Rodrigo Antonio Brant Fernandes
- From the Ophthal Hospital Especializado, São Paulo, Brazil; Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- From the Ophthal Hospital Especializado, São Paulo, Brazil; Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Department of Anthropology and Archaeology, University of Calgary, Calgary, AB..
| |
Collapse
|
3
|
Mendoza-Moreira AL, Voigt AM, Stingl JV, Rezapour J, Wagner FM, Schuster AK, Hoffmann EM. Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort. J Clin Med 2024; 13:2914. [PMID: 38792454 PMCID: PMC11122222 DOI: 10.3390/jcm13102914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The aim of this study was to evaluate the short-term efficacy and safety of the Paul Glaucoma Implant (PGI) in pediatric eyes diagnosed with glaucoma following congenital cataract surgery (GFCS). Methods: A retrospective, single-center, descriptive study was conducted on consecutive children diagnosed with GFCS who underwent PGI implantation between July 2022 and November 2023 at the University Medical Center Mainz. The primary outcome measure was the reduction in IOP at the last follow-up visit. Results: Ten eyes of nine children were included in the study. The mean follow-up time was 7.70 ± 4.22 months (4.68-10.72 months). At the end of the study follow-up, the mean (95% CI) reduction in IOP was -14.8 ± 8.73 mmHg (-8.56 to -21.04 mmHg, p < 0.001). At the last follow-up, 30.0% (3/10) of patients achieved an IOP (intraocular pressure) of ≥6 and ≤21 mmHg with a reduction in IOP of ≥25% without treatment, while 90.0% (9/10) achieved this target IOP regardless of glaucoma medication treatment. The mean number of antiglaucoma medications was significantly reduced from 3.50 (IQR = 1) to 2.0 (IQR = 2, p = 0.01), and the visual acuity logMAR improved from 1.26 ± 0.62 to 1.03 ± 0.48 (p = 0.04). Only one eye experienced numerical hypotony (4 mmHg) without choroidal detachment or anterior chamber shallowing within the first 24 h. No other adverse events were observed during the follow-up period. Conclusions: PGI implantation significantly lowered IOP and the number of antiglaucoma eye drops with a favorable safety profile in children diagnosed with GFCS, thereby achieving a high rate of qualified surgical success in the short term.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (A.L.M.-M.); (A.M.V.); (J.V.S.); (J.R.); (F.M.W.); (A.K.S.)
| |
Collapse
|
4
|
Two Year Randomized Prospective Comparison of Ahmed Valve Versus Baerveldt Implant in Vitrectomized Eyes. J Glaucoma 2023; 32:27-33. [PMID: 36223288 DOI: 10.1097/ijg.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
PRCIS Ahmed Valve and Baerveldt shunt are efficacious options in vitrectomized eyes. Baerveldt implant achieves a lower mean intraocular pressure (IOP) at 2 years, with fewer medications and a higher percentage of medication-free patients. PURPOSE To investigate and compare the efficacy and complications between Ahmed FP7 Glaucoma Valve (AGV) and Baerveldt 101-350 Glaucoma Implant (BGI) in vitrectomized eyes. MATERIALS AND METHODS In this single-center randomized clinical trial, 43 vitrectomized eyes (39 patients) underwent glaucoma drainage device implantation. Eyes were randomized to receive either an AGV (FP7) or a BGI (101-350) and were followed for 2 years. Surgical success was defined as an IOP measurement≤18 mm Hg and≥5 mm Hg with or without glaucoma medication at 2 or more sequential visits after 3 months. The primary outcome was the comparison of the success rate at 2 years, while mean IOP, mean number of medications, and number of complications were considered secondary outcomes. RESULTS Kaplan-Meier estimates of the 2-year success rates in IOP control after GDD implantation were similar between the 2 groups; AGV group 81.8% (95% CI: 67.2%-99.6%) and BGI group 85.7% (95% CI: 72.0%-100.0%), (log-rank test P value = 0.74). Patients in the BGI group had a statistically significant lower mean IOP compared with the AGV group in all follow-up visits at 2, 6, 12, and 24 months (11.62 vs. 17.45 mm Hg at the latter P value <0.001). The BGI group required a significantly lower number of medications for IOP control at the 2-year visit compared with the AGV group (0.76±0.99 vs. 1.5±1.06 P value = 0.02) but had a higher number of complications (62% vs. 41%, respectively). CONCLUSIONS GDDs provide a viable solution for IOP control in vitrectomized eyes. Based on our prospective comparison, both Ahmed FP7 Glaucoma Valve and Baerveldt 101-350 Glaucoma Implant are efficacious options.
Collapse
|
5
|
Kader MA, Dabke SB, Shukla AG, Reddy V, Abdul Khadar SM, Maheshwari D, Ramakrishnan R. Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique. Indian J Ophthalmol 2022; 70:839-845. [PMID: 35225526 PMCID: PMC9114538 DOI: 10.4103/ijo.ijo_1791_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. METHODS A retrospective study was done between April 2016 and April 2018 on patients with ≥12 months of follow-up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. RESULTS : The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti-glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow-up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan-Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8-33.5%) at 3 months, 18.7% (95% CI; 8.9-37.0%) at 6 months, and 25.0% (95% CI; 13.4-43.8%) at 12 months. CONCLUSION Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti-glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology.
Collapse
Affiliation(s)
- Mohideen A Kader
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shylesh B Dabke
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Aakriti G Shukla
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Venugopal Reddy
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Syed M Abdul Khadar
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Devendra Maheshwari
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rengappa Ramakrishnan
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| |
Collapse
|
6
|
Khurana M, Sudhir RR, Rishi E, Sakaria P, Vijaya L. Tube Obstruction of a Nonvalved Glaucoma Drainage Device by a Dislocated Soemmering's Ring. J Glaucoma 2021; 30:e372-e374. [PMID: 33337720 DOI: 10.1097/ijg.0000000000001760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
The authors report a case of tube obstruction of a nonvalved glaucoma drainage device (Aurolab aqueous drainage implant; AADI) with a dislocated Soemmering's ring (SR) leading to a postoperative intraocular pressure (IOP) spike after an initial IOP reduction. A 24-year-old man with bilateral aphakia, bilateral secondary glaucoma developed corneal decompensation in the left eye. The IOP in the left eye was 22 mm Hg with 3 topical IOP-lowering medications (timolol 0.5%, brimonidine 0.2%, and latanoprost 0.005%). To control the IOP before performing a penetrating keratoplasty, AADI was implanted. A good bleb and an IOP of 10 mm Hg were noted at 6.5 weeks postoperatively. The following day the patient developed an acute rise in IOP (42 mm Hg) because of tube obstruction of the AADI by a SR. The IOP spike was initially controlled with oral acetazolamide and topical IOP-lowering medications (fixed combination of timolol 0.5% and brimonidine 0.2%). Six days later, pars plana vitrectomy, SR removal, penetrating keratoplasty, and tube trimming were performed. Following this, the patient had good IOP control and a clear corneal graft at 1-year follow-up. In aphakic eyes undergoing nonvalved glaucoma drainage device implantation, a complete pars plana vitrectomy combined with any lens remnant removal may be considered. It helps to avoid tube obstruction because of these lens remnants, which can migrate anteriorly along with the aqueous currents.
Collapse
Affiliation(s)
- Mona Khurana
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services
| | | | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | | |
Collapse
|
7
|
Chang EK, Gupta S, Chachanidze M, Miller JB, Chang TC, Solá-Del Valle DA. Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series. BMC Ophthalmol 2021; 21:106. [PMID: 33632169 PMCID: PMC7905981 DOI: 10.1186/s12886-021-01872-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.
Collapse
Affiliation(s)
- Enchi Kristina Chang
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sanchay Gupta
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - John B Miller
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - David A Solá-Del Valle
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
8
|
Gupta R, Varshney A. Pars plana placement of Ahmed glaucoma valve tube through sclerotomy port in refractory glaucoma: A novel surgical technique. Indian J Ophthalmol 2020; 68:234-236. [PMID: 31856536 PMCID: PMC6951159 DOI: 10.4103/ijo.ijo_870_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Richa Gupta
- Department of Glaucoma, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Abhishek Varshney
- Department of Glaucoma, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| |
Collapse
|
9
|
Maheshwari D, Dabke S, Rajagopal S, Kadar MA, Ramakrishnan R. Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber. Indian J Ophthalmol 2019; 67:1303-1308. [PMID: 31332114 PMCID: PMC6677071 DOI: 10.4103/ijo.ijo_1341_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the outcome of a nonvalved Aurolab aqueous drainage implant (AADI) in the management of refractory glaucoma. Methods Retrospective case series of patients with refractory glaucoma underwent AADI implantation in posterior segment (PS group) or anterior chamber (AC group) with minimum follow-up of 1 year. Primary outcome criterion was success, defined as intraocular pressure (IOP) <18 or >6 mm Hg or IOP reduced to <20% from baseline, for two consecutive visits after 3 months. Failure was defined as inability to meet IOP criteria, any additional glaucoma surgery, loss of light perception, and implant explantation. Secondary outcome criteria compared groups based on mean IOP, mean glaucoma medication use, best-corrected visual acuity, and complications at each postoperative visit. Results In the AC and PS group of 64 patients, 32 tubes each were placed. Preoperative mean IOP was 37.41 ± 8.6 and 43.38 ± 10.3 mm Hg in AC and PS, respectively. Postoperatively IOP reduced to 14.22 ± 4.9 and 15.21 ± 8.1 mm Hg in AC and PS groups, respectively (P < 0.001). Preoperative mean antiglaucoma medication changed from 2.56 ± 0.9 and 3.44 ± 0.5 to 1.03 ± 0.9 and 1.67 ± 0.5 in AC and PS, respectively, postoperatively (P < 0.001). No significant change in VA was noted in either group. At 12 months, success rate was 84% in AC group and 72% in PS group, with PS group having 2.63 times higher hazard (risk) of failure than AC group. Conclusion AADI implantation in PS or AC is a safe and effective method for IOP control in refractory glaucoma with its low cost being of significance in developing countries.
Collapse
Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shylesh Dabke
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Sindhushree Rajagopal
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohideen A Kadar
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rengappa Ramakrishnan
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| |
Collapse
|
10
|
Suda M, Nakanishi H, Akagi T, Murakami T, Suzuma K, Suda K, Kameda T, Morooka S, Ikeda HO, Tsujikawa A. Baerveldt or Ahmed glaucoma valve implantation with pars plana tube insertion in Japanese eyes with neovascular glaucoma: 1-year outcomes. Clin Ophthalmol 2018; 12:2439-2449. [PMID: 30568422 PMCID: PMC6276639 DOI: 10.2147/opth.s183689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the 1-year surgical outcomes of both Baerveldt glaucoma implant (BGI) and the Ahmed glaucoma valve (AGV) implant with pars plana tube insertion in Japanese eyes with neovascular glaucoma (NVG). Patients and methods This was a retrospective study of 21 eyes of 18 patients who had undergone BGI (10 eyes) or AGV (11 eyes) implantation. The 1-year surgical outcomes in the two groups were compared. Surgical success was defined as an intraocular pressure (IOP) of 6–21 mmHg (criterion A) or 6–18 mmHg (criterion B) with >20% reduction regardless of the use of antiglaucoma medications. Results The mean preoperative IOP was 33.9±6.6 mmHg in the BGI group and 30.9±5.3 mmHg in the AGV group (P=0.31). The IOP at 1-year was lower in the BGI group at 10.3±5.9 mmHg than in the AGV group at 14.8±3.3 mmHg (P=0.044). The mean number of glaucoma medications at 1 year was 1.0±1.3 in the BGI group and 1.4±1.4 in the AGV group (P=0.57). The incidence of postoperative complications during the 1-year follow-up was not statistically different between the two groups; however, one eye in the BGI group lost light perception after additional surgery for Hoffman elbow exposure. The 1-year success rates of the BGI group was 60.0% and that in the AGV group was 90.9% based on criterion A (P=0.095), and 50.0% and 81.8% based on criterion B (P=0.074). Conclusions Significant reductions of the IOP and number of glaucoma medications were achieved at 1 year after both types of implants in Japanese eyes with NVG.
Collapse
Affiliation(s)
- Masayo Suda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Hideo Nakanishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Kenji Suda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Takanori Kameda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Satoshi Morooka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Hanako Ohashi Ikeda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan,
| |
Collapse
|
11
|
Ekşioğlu Ü, Yakın M, Balta Ö, Şingar-Özdemir E, Hüsniye Telek H, Örnek F, Yalvaç I. The Profile and Management of Glaucoma in Adult Aphakic Patients Following Complicated Cataract Surgery. Turk J Ophthalmol 2018; 48:19-22. [PMID: 29576893 PMCID: PMC5854854 DOI: 10.4274/tjo.97957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/28/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives To determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery. Materials and Methods Retrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma. Results Mean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed. Conclusion Prevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.
Collapse
Affiliation(s)
- Ümit Ekşioğlu
- University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Mehmet Yakın
- University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Özgür Balta
- Dr. Nafiz Korez Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Evin Şingar-Özdemir
- University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Hande Hüsniye Telek
- University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Firdevs Örnek
- University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Ilgaz Yalvaç
- Yeditepe University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| |
Collapse
|
12
|
Dirani A, Ciongoli MR, Lesk MR, Rezende F. Small-Gauge Endoscopy-Guided Pneumatic Anterior Hyaloid Detachment: A New Surgical Technique for Combined Pars Plana Vitrectomy and Pars Plana Glaucoma Drainage Implant. Ophthalmic Surg Lasers Imaging Retina 2018; 49:48-50. [DOI: 10.3928/23258160-20171215-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/15/2017] [Indexed: 11/20/2022]
|
13
|
Abstract
Aqueous drainage device tube erosions require prompt intervention to prevent endophthalmitis. As the use of drainage devices in glaucoma surgery continues to increase, recognizing and managing tube erosions is a pertinent issue. This review provides a comprehensive overview of tube erosions, including the rates of erosion with various types of patch grafts, the risk factors associated with erosion, and approaches to repair in order to counsel and treat our patients to prevent endophthalmitis.
Collapse
Affiliation(s)
- Upneet Bains
- a Glaucoma Service, Department of Ophthalmology, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
| | - Ambika Hoguet
- a Glaucoma Service, Department of Ophthalmology, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
| |
Collapse
|
14
|
Abstract
Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and severely elevated intraocular pressure. The pathophysiology of tube obstruction is related to central and anterior displacement of vitreous that is drawn into and condenses within the proximal lumen of the tube. This can occur from days to years following GDI surgery. Successful management of vitreous-tube obstruction generally requires manual removal of the condensed vitreous plug with end-grasping forceps. This technique achieves reversal of tube blockage and restoration of GDI function. Amputation of the incarcerated vitreous alone with vitrectomy or neodymium:yttrium-aluminum-garnet vitreolysis does not consistently restore GDI function and risks persistent intraluminal tube obstruction.
Collapse
|
15
|
Abstract
Aqueous shunts or glaucoma drainage devices are increasingly utilized in the management of refractory glaucoma. The general design of the most commonly-used shunts is based on the principles of the Molteno implant: ie. a permanent sclerostomy (tube), a predetermined bleb area (plate) and diversion of aqueous humour to the equatorial region and away from the limbal subconjunctival space. These three factors make aqueous shunts more resistant to scarring as compared to trabeculectomy. The two most commonly used shunts are the Ahmed Glaucoma Valve, which contains a flow-restrictor, and the non-valved Baervedlt Glaucoma Implant. While the valved implants have a lower tendency to hypotony and related complications, the non-valved implants with larger, more-biocompatible end plate design, achieve lower intraocular pressures with less encapsulation. Non-valved implants require additional suturing techniques to prevent early hypotony and a number of these methods will be described. Although serious shunt-related infection is rare, corneal decompensation and diplopia are small but significant risks.
Collapse
Affiliation(s)
- Jing Wang
- Glaucoma Service, Moorfields Eye Hospital, London, UK
| | - Keith Barton
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, National University Health Service, Singapore
| |
Collapse
|
16
|
Elshatory YM, Gauger EH, Kwon YH, Alward WLM, Boldt HC, Russell SR, Mahajan VB. Management of Pediatric Aphakic Glaucoma With Vitrectomy and Tube Shunts. J Pediatr Ophthalmol Strabismus 2016; 53:339-343. [PMID: 27668871 DOI: 10.3928/01913913-20160818-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To review the impact of vitrectomy and tube shunts on mean intraocular pressure (IOP) and number of glaucoma medications in pediatric aphakic glaucoma. METHODS A retrospective review of pediatric patients who underwent combined vitrectomy and glaucoma tube shunt surgery for aphakic glaucoma was conducted. Inclusion criteria were: age 18 years or younger, diagnosis of aphakic glaucoma, preoperative IOP data, and postoperative IOP data for at least 6 months. Mean IOP lowering at 1 year, number of glaucoma medications at 1 year, and surgical complications, including tube occlusion in the postoperative period, were noted. RESULTS The mean ± standard deviation preoperative IOP was 33.9 ± 10.6 mm Hg (range: 18 to 57 mm Hg) with a mean of three topical IOP-lowering medications. A total of 5 (36%) Ahmed and 9 (64%) Baerveldt tube shunts were placed. One of the Baerveldt tube shunt procedures was combined with revision of a traumatically dislocated tube. The mean IOP at 12 months postoperatively was 16.6 ± 5.8 mm Hg (range: 6 to 28 mm Hg; P < .01, t = 3.74, df = 13) with a mean of 2.3 glaucoma medications. There were no cases of tube occlusion, corneal decompensation, endophthalmitis, or retinal detachment over the 12 months of follow-up. CONCLUSIONS Combined vitrectomy and placement of a glaucoma tube shunt can be safe and effective in lowering IOP based on mean IOP values and number of glaucoma medications at 1 year. [J Pediatr Ophthalmol Strabismus. 2016;53(6):339-343.].
Collapse
|
17
|
Nguyen AH, Dastiridou AI, Chiu GB, Francis BA, Lee OL, Chopra V. Glaucoma surgical considerations for PROSE lens use in patients with ocular surface disease. Cont Lens Anterior Eye 2016; 39:257-61. [DOI: 10.1016/j.clae.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 01/26/2016] [Accepted: 02/02/2016] [Indexed: 11/27/2022]
|
18
|
Parihar JKS, Jain VK, Kaushik J, Mishra A. Pars Plana-Modified versus Conventional Ahmed Glaucoma Valve in Patients Undergoing Penetrating Keratoplasty: A Prospective Comparative Randomized Study. Curr Eye Res 2016; 42:436-442. [PMID: 27348314 DOI: 10.1080/02713683.2016.1185130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the outcome of pars-plana-modified Ahmed glaucoma valve (AGV) versus limbal-based conventional AGV into the anterior chamber, in patients undergoing penetrating keratoplasty (PK) for glaucoma with coexisting corneal diseases. METHOD In this prospective randomized clinical trial, 58 eyes of 58 patients with glaucoma and coexisting corneal disease were divided into two groups. Group 1 (29 eyes of 29 patients) included patients undergoing limbal-based conventional AGV into the anterior chamber (AC) along-with PK and group 2 (29 eyes of 29 patients) included those undergoing pars-plana-modified AGV along-with PK. Outcome measures included corneal graft clarity, intraocular pressure (IOP), number of antiglaucoma medications, and postoperative complications. Patients were followed up for a minimum period of 2 years. RESULTS Out of 58 eyes (58 patients), 50 eyes (50 patients: 25 eyes of 25 patients each in group 1 and group 2) completed the study and were analyzed. Complete success rate for AGV (group 1: 76%; group 2: 72%; p = 0.842) and corneal graft clarity (group 1: 68%; group 2: 76%; p = 0.081) were comparable between the two groups at 2 years. Graft failure was more in conventional AGV (32%) as compared to pars plana-modified AGV (24%) but not statistically significant (p = 0.078) at 2 years. CONCLUSION Though both procedures were comparable in various outcome measures, pars-plana-modified AGV is a viable option for patients undergoing PK, as it provides a relatively better corneal graft survival rate and lesser complications that were associated with conventional AGV.
Collapse
Affiliation(s)
| | - Vaibhav Kumar Jain
- b Department of Ophthalmology , Uttar Pradesh Rural Institute of Medical Sciences & Research , Saifai , Etawah , India
| | - Jaya Kaushik
- c Department of Ophthalmology , Advance Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Avinash Mishra
- d Department of Ophthalmology , Command Hospital (EC) , Kolkata , West Bengal , India
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The surgical management of retinal disorders, including scleral buckling procedures, pars plana vitrectomy, and intravitreal injections of gas or silicone oil, can lead to short-term elevations in intraocular pressure (IOP) and ultimately long-term glaucomatous damage if not treated in a timely manner. Glaucoma in these cases is commonly refractory to conventional therapies. This review highlights the treatment strategies for glaucoma in eyes that have previously undergone vitreoretinal surgery. RECENT FINDINGS Although medical therapy is often used initially to control a temporary rise in IOP, laser and surgical therapy may be required to treat sustained IOP elevation and subsequent glaucomatous damage in eyes that have undergone intraocular surgery for retinal disorders. Glaucoma drainage devices are an important treatment modality, particularly when there is high risk of failure with filtering surgery. SUMMARY Previous vitreoretinal surgery is a known risk factor for the development of glaucoma. Treatment is usually initiated with medical therapy, however, surgical intervention is frequently required to control IOP and prevent progressive glaucomatous damage in patients with refractory glaucoma.
Collapse
|
20
|
Jung YH, Kim YW, Heo JW, Park KH, Jeoung JW. Long-Term Outcome of Ahmed Valve Implantation Combined with 23-Gauge Vitrectomy in Eyes with Neovascular Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.5.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Woo Kim
- Department of Ophthalmology, Armed Forces Busan Hospital, Busan, Korea
| | - Jang Won Heo
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Campagnoli TR, Kim SS, Smiddy WE, Gedde SJ, Budenz DL, Parrish RK, Palmberg PF, Feuer W, Shi W. Combined pars plana vitrectomy and Baerveldt glaucoma implant placement for refractory glaucoma. Int J Ophthalmol 2015; 8:916-21. [PMID: 26558201 DOI: 10.3980/j.issn.2222-3959.2015.05.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/17/2015] [Indexed: 01/08/2023] Open
Abstract
AIM To evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant (PPV-BGI) placement for refractory glaucoma. METHODS The medical records of 92 eyes (89 patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma (NVG) and 49 eyes with other types of glaucoma (non-NVG). RESULTS Outcome measures were visual acuity (VA), intraocular pressure (IOP), glaucoma medical therapy, complications, and success [VA>hand motions (HM), IOP≥6 mm Hg and ≤21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at 1y, respectively (P=0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP (mean±SD) was 30.3±11.7 mm Hg in the Non-NVG group and 40.0±10.6 mm Hg in the NVG group, and IOP was reduced to 15±9.5 mm Hg in the non-NVG group and 15±10.5 mm Hg in the NVG at 1y. Number of glaucoma medications (mean±SD) decreased from 2.7±1.3 in the non-NVG group and 2.8±1.3 in the NVG group preoperatively to 0.76±1.18 in the non-NVG group and 0.51±1.00 in the NVG group at 1y. Improvement in VA of ≥2 Snellen lines was observed in 25 (27%) eyes, although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearing vitreous hemorrhage was the most common postoperative complication occurring in 16 (17%) eyes, and postoperative suprachoroidal hemorrhages developed in 5 (5.4%) eyes. CONCLUSION PPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.
Collapse
Affiliation(s)
- Thalmon R Campagnoli
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sung Soo Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, South Korea
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Steve J Gedde
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Richard K Parrish
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Paul F Palmberg
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - William Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Wei Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| |
Collapse
|
22
|
Combined pars plana vitrectomy and pars plana Baerveldt tube placement in eyes with neovascular glaucoma. Retina 2015; 35:17-28. [PMID: 25046391 DOI: 10.1097/iae.0000000000000235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe characteristics and outcomes of combined pars plana vitrectomy and Baerveldt tube insertion procedure from 2005 to 2010 in eyes with neovascular glaucoma. METHODS Seventy-nine patients (89 eyes) with ≥2 months of follow-up were included. Outcome measures were visual acuity, intraocular pressure (IOP), number of glaucoma medications, and complications. Changes in mean logMAR visual acuity, IOP, and glaucoma medications were compared by a two-tailed t-test. RESULTS Mean patient age was 69.0 years. Forty-three (54%) were male. Mean follow-up time was 19.9 months. Most common causes of neovascular glaucoma was diabetes (n = 63 [71%]) and central retinal vein occlusion (n = 21 [24%]). Eighty-six eyes (97%) underwent a 250 mm Baerveldt drainage device and 3 (3.4%) a 350 mm Baerveldt. Forty-five (51%) 20-gauge, 12 (13%) 23-gauge, and 32 (36%) 25-gauge pars plana vitrectomies were performed. Fifty-two eyes (58%) preoperatively and 23 (33%) postoperatively received intraocular injections for rubeosis and macular edema. Mean ± standard deviation logMAR visual acuity at 18-, 24-, 36-, and 48-month follow-up time points was significantly better than preoperative vision (P < 0.05). Preoperative versus final IOP and number of glaucoma medications were significantly decreased (P < 0.05). Fourteen eyes (16%) had a final visual acuity of no light perception. Most common complications included transient ocular hypertension (n = 82 [92%]), transient hypotony (n = 20 [22%]), hyphema (n = 19 [21%]), corneal edema (n = 17 [19%]), and vitreous hemorrhage (n = 14 [16%]). The frequency of transient hypotony, vitreous hemorrhage, and rubeosis was significantly (P < 0.05) higher in 20-gauge versus 23-/25-gauge pars plana vitrectomy eyes. Nine eyes (10%) required return to the operating room after combined procedure, including 4 eyes (4.5%) for retinal detachment and 3 (3.4%) for high IOP due to tube occlusion. Three eyes (3.4%) developed endophthalmitis and 2 (2.2%) progressed to being pre/phthisical (none were enucleated). CONCLUSION Combined pars plana vitrectomy and Baerveldt glaucoma shunt may be a useful procedure in reducing IOP and number of glaucoma medications in eyes with neovascular glaucoma along with stabilizing visual acuity in a majority of these eyes. Further studies are warranted to verify and expand on these findings.
Collapse
|
23
|
Retrospective review of pars plana versus anterior chamber placement of Baerveldt glaucoma drainage device. J Glaucoma 2015; 24:95-9. [PMID: 23787335 DOI: 10.1097/ijg.0b013e31829d9be2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate outcomes of pars plana (PP) versus anterior chamber (AC) placement of Baerveldt glaucoma drainage device (GDD). METHODS This study is a nonrandomized, retrospective case series evaluating 63 eyes that underwent GDD insertion with Baerveldt 350 device under the supervision of 2 surgeons at 5 centers. The drainage tube was either inserted into the AC or through the PP into the vitreous cavity where eyes had been vitrectomized. Surgery was conducted between 2003 and 2010 with minimum patient follow-up of 6 months. Data on postoperative intraocular pressure (IOP), visual acuity, number of hypotensive medications, and surgical complications were recorded. RESULTS Of the 63 drainage device surgeries, 34 tubes were placed in the AC and 29 were placed into the posterior segment through the PP. Preoperative mean IOP was 32.3±20.3 mm Hg in the AC group and 32.8±18.4 mm Hg in the PP group. Postoperative mean IOP was reduced at all follow-up time points in both the groups. Postoperative mean IOP in the anterior tube group was 14.0, 12.9, and 14.0 mm Hg and in the PP group was 14.2, 14.2, and 14.0 mm Hg, at the 1-, 2-, and 3-year follow-up, respectively. The qualified success rate at 2 years was 94% for the PP group and 91% for the AC group, whereas absolute success was 35% for the PP group and 27% for the AC group at 2-year follow-up. CONCLUSIONS Insertion of the tube of the Baerveldt GDD into the PP is a safe and effective method for IOP control in aphakic, pseudophakic, and vitrectomized eyes where there is a need to avoid anterior tube placement such as coexisting corneal pathology. IOP control results appear comparable to conventional AC placement.
Collapse
|
24
|
Comparison of the changes in corneal endothelial cells after pars plana and anterior chamber ahmed valve implant. J Ophthalmol 2015; 2015:486832. [PMID: 25694824 PMCID: PMC4324977 DOI: 10.1155/2015/486832] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/09/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To compare the changes in corneal endothelial cells after pars plana Ahmed glaucoma valve (AGV) implantation with those after the anterior chamber AGV implantation for refractory glaucoma. Methods. The medical records of 18 eyes with pars plana implantation of AGV (ppAGV) were reviewed retrospectively and were compared with 18 eyes with the anterior chamber AGV (acAGV) implant. The preoperative and postoperative endothelial cells, intraocular pressure (IOP), and postoperative complications during the follow-up in both groups were compared. Results. The average follow-up was 18 months. The postoperative endothelial cells in the ppAGV and acAGV groups were 2044 ± 303 and 1904 ± 324, respectively (P = 0.25). The average percentage decrease in the endothelial cells in the ppAGV and acAGV groups at 18 months was 12.5% and 18.4%, respectively, and showed significant difference between the 2 groups (P = 0.01). No difference in IOP control and the number of postoperative glaucoma medications was observed between the 2 groups. Conclusions. Endothelial cell damage in the ppAGV group for refractory glaucoma appeared to be lower than that in the acAGV group. Therefore, pars plana implantation of AGV may be preferred as it may have lower level of endothelial cell damage while maintaining similar level of IOP control.
Collapse
|
25
|
Parivadhini A, Lingam V. Management of Secondary Angle Closure Glaucoma. J Curr Glaucoma Pract 2014; 8:25-32. [PMID: 26997804 PMCID: PMC4741163 DOI: 10.5005/jp-journals-10008-1157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/19/2013] [Indexed: 11/23/2022] Open
Abstract
Secondary angle closure glaucomas are a distinct entity from primary angle closure glaucoma (PACG). Unlike PACG, secondary angle closure glaucoma's have an identifable contributory factor/s for angle closure and obstruction of aqueous fow which is usually unrelieved by iridotomy. The treatment of each type of secondary angle closure glaucoma is varied, so identification of the primary cause aids in its effective management. How to cite this article: Annadurai P, Vijaya L. Management of Secondary Angle Closure Glaucoma. J Current Glau Prac 2014;8(1):25-32.
Collapse
Affiliation(s)
- Annadurai Parivadhini
- Associate Consultant, Department of Glaucoma, Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu India
| | - Vijaya Lingam
- Director, Department of Glaucoma, Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu India
| |
Collapse
|
26
|
Kim HA, Park KH, Park TK, Ohn YH. Combined Operation Assosciated with Ahmed Glaucoma Valve Implantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.4.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun A Kim
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ka Hee Park
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae Kwann Park
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Hoon Ohn
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
27
|
Gandhi A, Miller DM, Zink JM, Khatana AK, Riemann CD, Petersen MR, Foster RE, Sisk RA. Analysis of long-term outcomes for combined pars plana vitrectomy (PPV) and glaucoma tube shunt surgery in eyes with advanced glaucoma. Eye (Lond) 2013; 28:290-5. [PMID: 24336295 DOI: 10.1038/eye.2013.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/25/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze 12- and 24-month visual acuity, intraocular pressure, and complications associated with combined pars plana vitrectomy (PPV) and glaucoma tube shunt placement in eyes with glaucoma. PATIENTS AND METHODS A retrospective chart review was performed of patients with advanced glaucoma who underwent combined PPV and tube shunt surgery from 2006 to 2010. A minimum of 12 months of follow-up was required for their inclusion in the study. Visual acuity, intraocular pressure, complications, and number of glaucoma medications at 1 and 2 years postoperatively were analyzed. RESULTS Twenty-eight eyes met the inclusion and exclusion criteria. Baseline visual acuity was 20/200 or worse in 14/28 eyes (50.0%) and 20/40 or better in 2/28 eyes (7.1%). Visual acuity remained 20/200 or worse in 50.0% (P=0.921) and 44.4% (P=0.973) of eyes after 1 and 2 years postoperatively, respectively. At baseline, the mean intraocular pressure was 30.4 mm Hg. There was significant improvement in mean IOP at 1 year (14.7 mm Hg, P=0.001) and at 2 years (15.2 mm Hg, P=0.001) postoperatively. Baseline number of glaucoma medications averaged 3.0±1.09 (SD), and improved to 1.8±1.28 (SD) at 1 year (P=0.0002) and to 1.4±1.33 at 2 years (P<0.0001) postoperatively. CONCLUSION In this retrospective interventional case series, surgical management of advanced glaucoma with a combination of PPV and glaucoma tube shunt resulted in significantly reduced IOP and glaucoma medications at 1 and 2 years postoperatively.
Collapse
Affiliation(s)
- A Gandhi
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - D M Miller
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | - J M Zink
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | - A K Khatana
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | - C D Riemann
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | | | - R E Foster
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | - R A Sisk
- Cincinnati Eye Institute, Cincinnati, OH, USA
| |
Collapse
|
28
|
|
29
|
Cheng Y, Liu XH, Shen X, Zhong YS. Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy. Int J Ophthalmol 2013; 6:316-20. [PMID: 23826525 DOI: 10.3980/j.issn.2222-3959.2013.03.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/31/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). METHODS Twelve medically uncontrolled NVG with earlier 23-gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best-corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up. RESULTS The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5±1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow-up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention. CONCLUSION AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.
Collapse
Affiliation(s)
- Yu Cheng
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin No.2 Road, Shanghai 200025, China
| | | | | | | |
Collapse
|
30
|
Abstract
PURPOSE To compare the intermediate-term intraocular pressure (IOP) control and complication profile of the Ahmed Glaucoma Valve (AGV) implanted posteriorly through the pars plana in eyes undergoing concurrent pars plana vitrectomy (PPV) with device implantation in the anterior chamber (AC) in nonvitrectomized eyes. METHODS : We retrospectively reviewed the medical records of 31 case eyes (30 patients) with refractory glaucoma that underwent posterior implantation of AGV after complete PPV and compared them to 31 control eyes (31 patients) with refractory glaucoma that underwent implantation of AGV in the AC. Case-control patients were matched one-to-one on the basis of principal glaucoma diagnosis. All surgeries were performed at 1 institution using a silicone-plate device. Success was defined as intraocular pressure (IOP)≥ 5 mm Hg and ≤ 21 mm Hg with or without glaucoma medications at final follow-up, no additional glaucoma surgery, no removal of the implant, and no loss of light perception. RESULTS The average follow-up was 20.9 months (range, 6 to 54 mo) for the posterior group and 20.5 months (range, 4 to 48 mo) for the anterior group. The reduction in IOP was similar in both groups at all postoperative time points. The number of postoperative glaucoma medications in both groups was not statistically different at final follow-up. Success rates at final follow-up were identical, 83.9% in both groups, and Kaplan-Meier survival curve analysis showed no significant difference between the 2 groups (P=0.96). Postoperative complications were similar between the 2 groups, except there were more instances of early postoperative flat AC in the anterior group than the posterior group (P=0.01). CONCLUSIONS The AGV can similarly control IOP in the majority of cases, whether the tube is placed in the posterior segment after PPV or in the AC of nonvitrectomized eyes.
Collapse
|
31
|
Mangouritsas G, Mourtzoukos S, Portaliou DM, Georgopoulos VI, Dimopoulou A, Feretis E. Glaucoma associated with the management of rhegmatogenous retinal detachment. Clin Ophthalmol 2013; 7:727-34. [PMID: 23620656 PMCID: PMC3633584 DOI: 10.2147/opth.s42792] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Transient or permanent elevation of intraocular pressure (IOP) is a common complication following vitreoretinal surgery. Usually secondary glaucoma, which develops after scleral buckling procedures, or pars plana vitrectomy for repair of rhegmatogenous retinal detachment, is of multifactorial origin. It is essential, for appropriate management, to detect the cause of outflow obstruction. An exacerbation of preexisting open-angle glaucoma or a steroid-induced elevation of IOP should also be considered. Scleral buckling may be complicated by congestion and anterior rotation of the ciliary body resulting in secondary angle closure, which can usually resolve with medical therapy. The use of intravitreal gases may also induce secondary angle-closure with or without pupillary block. Aspiration of a quantity of the intraocular gas may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified silicone oil in the anterior chamber and obstruction of the aqueous outflow pathway. In most eyes medical therapy is successful in controlling IOP; however, silicone oil removal with or without concurrent glaucoma surgery may also be required. Diode laser transscleral cyclophotocoagulation and glaucoma drainage devices constitute useful treatment modalities for long-term IOP control. Cooperation between vitreoretinal and glaucoma specialists is necessary to achieve successful management.
Collapse
|
32
|
Kolomeyer AM, Kim HJ, Khouri AS, Lama PJ, Fechtner RD, Zarbin MA, Bhagat N. Pars plana Baerveldt tube insertion with pars plana vitrectomy for refractory glaucoma. Oman J Ophthalmol 2012; 5:19-27. [PMID: 22557872 PMCID: PMC3339669 DOI: 10.4103/0974-620x.94762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Glaucoma drainage implants (GDIs) are used for managing recalcitrant glaucoma and are usually placed in the anterior chamber. This approach may lead to complications such as corneal decompensation, and so a pars plana approach is used in at risk eyes. Aims: To compare functional outcomes and complications of 250 mm2 and 350 mm2 pars plana Baerveldt tube insertion with pars plana vitrectomy (PPV) (both 20- and 23-gauge) for managing refractory glaucoma. Settings and Design: A retrospective chart review of 38 patients (39 eyes) undergoing combined PPV-Baerveldt procedure for glaucoma recalcitrant to maximal medical treatment or previous filtering procedures with >6 weeks of follow-up. Materials and Methods: Main outcome measures were visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications. Statistical Analysis Used: A paired ‘t’ test was used to evaluate changes in IOP and glaucoma medications, Fisher's exact test was used to compare complication rates, and Kaplan-Meier survival curves were constructed for comparison of overall outcomes. Results: Mean patient age was 62.2 years. Mean follow-up period was 33.7 months, with 36 (92%) eyes followed for ≥6 months. Mean±SD preoperative IOP and number of glaucoma medications were significantly reduced by the combined procedure (P<0.05). Thirty-five (90%) eyes maintained final IOP between 6 and 21 mmHg. Vision improved by ≥2 lines in 10 (26%) eyes, remained stable in 15 (38%) eyes, and decreased in 14 (36%) eyes. Two (5.1%) eyes developed no light perception vision, with one (2.6%) eye becoming phthisical. Twenty-four (62%) eyes developed complications managed with conservative measures. Five (13%) eyes required ≥1 surgeries within a year of the combined procedure. Conclusions: Pars plana Baerveldt tube implantation with PPV can preserve vision, reduce IOP, and decrease the number of glaucoma medications necessary to achieve target IOP in patients with recalcitrant glaucoma.
Collapse
Affiliation(s)
- Anton M Kolomeyer
- The Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | | | | | | | | | | | | |
Collapse
|
33
|
Corneal Graft Survival and Intraocular Pressure Control in Coexisting Penetrating Keratoplasty and Pars Plana Ahmed Glaucoma Valves. Cornea 2012; 31:350-8. [DOI: 10.1097/ico.0b013e31823cbd29] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Jeong HS, Nam DH, Paik HJ, Lee DY. Pars plana Ahmed implantation combined with 23-gauge vitrectomy for refractory neovascular glaucoma in diabetic retinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:92-6. [PMID: 22511834 PMCID: PMC3325627 DOI: 10.3341/kjo.2012.26.2.92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/09/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR). Methods The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up. Results The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 ± 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 ± 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 ± 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 ± 0.61 to 0.96 ± 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases. Conclusions We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.
Collapse
Affiliation(s)
- Hoon Seok Jeong
- Department of Ophthalmology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | | | | | | |
Collapse
|
35
|
23-Gauge pars plana vitrectomy with pars plana Baerveldt tube placement for refractory glaucoma. Eur J Ophthalmol 2012; 22:90-4. [PMID: 22167547 DOI: 10.5301/ejo.5000027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a case series of combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion for intraocular pressure (IOP) control in eyes with glaucoma resistant to maximum tolerated medical therapy and/or having failed previous IOP-lowering procedures. METHODS Eight consecutive patients (8 eyes) undergoing a combined procedure were identified and included in this study. Outcome measures included preoperative and final best-corrected visual acuity (VA), IOP, number of glaucoma medications, and complications. Changes in IOP and glaucoma medications were compared by a paired t test. A Kaplan-Meier survival curve was constructed to evaluate IOP control as a function of time. RESULTS Mean patient age was 70.9 years while the mean follow-up time was 12.1 months. Open angle glaucoma was diagnosed in 5 (68%) eyes. Six (75%) eyes were pseudophakic. All eyes received a 250-mm(2) pars plana Baerveldt tube. Vision remained the same or improved in 6 (75%) eyes. Mean preoperative IOP and number of glaucoma medications were significantly (p<0.05) reduced by the combined procedure. Visual acuity of 5 (63%) eyes improved or remained unchanged. Six (75%) eyes encountered minor complications not requiring a return to the operating room. One (13%) eye underwent drainage of hemorrhagic choroidals on postoperative day 12. CONCLUSIONS A combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion could be considered a useful procedure in reducing IOP and the number of glaucoma medications in eyes with refractory glaucoma.
Collapse
|
36
|
Moon DRC, Choi KS, Lee SJ, Ha SJ. Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.6.801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Da Ru Chi Moon
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sung Jin Lee
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Seung Joo Ha
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea
| |
Collapse
|
37
|
Long-term results of combined endoscope-assisted pars plana vitrectomy and glaucoma tube shunt surgery. Retina 2011; 31:275-83. [PMID: 21102370 DOI: 10.1097/iae.0b013e3181ea48d3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess outcomes after endoscope-assisted pars plana vitrectomy with concurrent pars plana tube shunt placement. METHODS Records of 18 adult patients (19 eyes) with uncontrolled chronic angle-closure glaucoma associated with corneal opacification or fibrosed pupils were retrospectively reviewed. All eyes underwent endoscope-assisted pars plana vitrectomy with Baerveldt tube shunt placement into the vitreous cavity between 1997 and 2005. Intraocular pressure reduction, glaucoma medication reduction, complications, and visual acuity were analyzed. RESULTS Mean follow-up duration was 62 months (range, 10-106 months). Mean preoperative intraocular pressure was 31.3 ± 10.5 mmHg on 3.4 ± 1.0 glaucoma medications. Intraocular pressure was significantly reduced at each postoperative time point examined. In the 17 eyes without phthisis, intraocular pressure was significantly reduced at the final follow-up examination to a mean of 11.4 ± 2.9 mmHg (P < 0.0001) on 1.3 ± 1.2 medications (P < 0.0001). No complications occurred in 14 of 19 eyes. Postoperatively, best-attained visual acuity improved in 14 of 19 eyes, remained unchanged in 4 of 19 eyes, and was reduced in 1 of 19 eyes. CONCLUSION Combined endoscope-assisted pars plana vitrectomy with placement of a Baerveldt tube shunt into the vitreous cavity is a useful intervention in patients with uncontrolled chronic angle-closure glaucoma, media opacities, and limited surgical options.
Collapse
|
38
|
Lim MC, Brandt JD, O'Day DG. Glaucoma after Penetrating Keratoplasty. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
|
40
|
Glaucoma tube shunt implantation through the ciliary sulcus in pseudophakic eyes with high risk of corneal decompensation. J Glaucoma 2010; 19:405-11. [PMID: 19907341 DOI: 10.1097/ijg.0b013e3181bdb52d] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To summarize our clinical experience with implanting Baerveldt glaucoma tube shunts through the ciliary sulcus in eyes with a posterior chamber intraocular lens and shallow anterior chambers, corneal transplants, guttata or edema. PATIENTS AND METHODS A retrospective interventional nonrandomized noncomparative case series. Main outcome measure was postoperative corneal status. Secondary outcome measures included postoperative intraocular pressure (IOP), visual acuity and complications. RESULTS Thirty-six eyes of 32 patients were identified through chart review. Follow-up period was 21.8+/-16.6 months (mean+/-standard deviation, range: 4.0 to 58.5 mo). At final visit, all 23 preoperative clear native corneas and 6 of 7 corneal transplants remained clear. Thus, of the 30 preoperative clear corneas, only 1 decompensated. Preoperative IOP was 27.9+/-11.8 mm Hg (range: 12 to 59 mm Hg), reduced postoperatively to 10.1+/-3.9 mm Hg (range: 2 to 21 mm Hg, P=0.0001), a reduction of 58.2%+/-19.3% (range: 5.0% to 95.4%). Final IOP was >or=5 and <or=21 mm Hg in 33 of 36 eyes (91.7%). It was lowered by 30% or more in 34 of 36 eyes (94.4%). CONCLUSIONS Although previously published studies demonstrated a significant risk of corneal decompensation after angle or pars plana tube implantation, our clinical experience suggests that ciliary sulcus tube implantation in eyes with a posterior chamber intraocular lens is a safe and effective procedure even in eyes with high risk of corneal decompensation.
Collapse
|
41
|
Reichstein D, Kammer J, Recchia F. Combined 25-gauge vitrectomy and posterior tube shunt placement for advanced glaucoma. Ophthalmology 2010; 118:77-81. [PMID: 20709405 DOI: 10.1016/j.ophtha.2010.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/22/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To report the initial clinical outcomes of a combined procedure utilizing 25-gauge vitrectomy and posterior tube shunt placement in eyes with refractory glaucoma not amenable to standard treatment. DESIGN Retrospective chart review. PARTICIPANTS We included 10 eyes (10 consecutive adult patients, mean age 61 years) with advanced glaucoma and anterior segment abnormalities precluding tube placement in the anterior chamber who were treated with combined 25-gauge vitrectomy and posterior tube shunt placement. METHODS Records of consecutive patients were reviewed for demographics, etiology of glaucoma, preoperative clinical data (visual acuity, intraocular pressure, number of ocular antihypertensive medications), and postoperative outcome measures at predetermined time points. MAIN OUTCOME MEASURES (1) Intraocular pressure (IOP) at 1, 2, 6, and 12 months postoperatively; (2) number of ocular antihypertensive medications needed at 12 months postoperatively; (3) visual acuity (VA) at 12 months postoperatively; and (4) incidence of hypotony, retinal detachment, endophthalmitis, and corneal decompensation. RESULTS Preoperatively, mean IOP was 31 mmHg, and patients required a mean of 2.5 ocular antihypertensive medications. Mean IOP at 1, 2, 6, and 12 months postoperatively were 17.0, 16.1, 17.8, and 16.1 mmHg, respectively, and significantly lower than preoperative IOP (P < 0.005 at all time points). At 1 year postoperatively, 90% of patients had an IOP < 20 mmHg, and 50% of patients required ≤ 2 ocular antihypertensive medications. At 1 year postoperatively, VA was the same or improved in 70% of patients, and no worse than 1 Snellen line in any patient. Corneal edema developed in 2 patients. No patient developed hypotony or endophthalmitis. CONCLUSIONS Combined 25-gauge vitrectomy and posterior tube shunt placement can be successful in lowering IOP in eyes with advanced glaucoma not amenable to other therapies.
Collapse
Affiliation(s)
- David Reichstein
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | |
Collapse
|
42
|
|
43
|
Abstract
In the therapeutic approach to complex glaucomas different initial situations were considered: pre-existing glaucoma, induction of glaucoma after vitreoretinal surgery and antiglaucomatous procedures. In pre-existing glaucoma and after filtering surgery maintenance of the filtering bleb requires a vitreoretinal approach for conjunctiva preservation with techniques such as pneumatic retinopexy or small gauge vitrectomy. After vitreoretinal surgery an increase in intraocular pressure (IOP) is common. Secondary glaucoma may occur after scleral buckling and after vitrectomy with or without gas or silicone oil tamponade as well as after application of steroids. Angle closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Vitreous tamponades with expansive or saturated gases may cause angle-closure glaucoma with or without pupillary blockage and may critically shorten ocular perfusion. Postoperative checks, immediate action and a ban on boarding aircraft over the period of intraocular gas tamponade prevent permanent damage to the eye. The majority of secondary glaucomas can effectively be controlled by topical medication and adequate postoperative posture of the patient. Besides the temporary use of systemic antiglaucomatous medication or laser therapy, very rarely in cases of massive swelling or overfill, a direct intervention, such as partial gas or silicone oil removal is required. A prophylactic inferior peripheral iridectomy prevents pupillary blockage in aphakic eyes with intraocular tamponade. In cases of heavy silicone oil use, the peripheral iridectomy is placed in the superior position. Nd:YAG laser application will regulate IOP in cases of occlusion. Secondary glaucoma due to silicone oil emulsification overload is treated by trabecular meshwork aspiration and lavage. In refractory glaucoma repetitive cyclophotocoagulation and drainage implants represent an approved method for long-term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial in nature and may benefit from an exact analysis for an adequate and successful treatment regimen.
Collapse
Affiliation(s)
- M Müller
- Klinik für Augenheilkunde, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | | | | | | |
Collapse
|
44
|
Ang GS, Goh YW, Azuara-Blanco A. Recurrent vitreous occlusion of glaucoma drainage device tube in a patient with glaucoma in aphakia: a case report. CASES JOURNAL 2010; 3:55. [PMID: 20181147 PMCID: PMC2832618 DOI: 10.1186/1757-1626-3-55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 02/10/2010] [Indexed: 11/10/2022]
Abstract
Patients with spontaneous lens dislocation and glaucoma can be challenging to manage. We present a forty-six year old Caucasian lady who was referred with bilateral high intraocular pressure, and was subsequently diagnosed with glaucoma in association with lens dislocation and Marfan syndrome. Baerveldt glaucoma drainage device tubes were inserted in both eyes due to poor response to medical therapy. However, this was complicated by recurrent vitreous occlusion of both glaucoma drainage tubes requiring further multiple surgical interventions. There have not been any further recurrences of vitreous incarceration or posterior segment complications since, but the patient remains under close follow-up.
Collapse
Affiliation(s)
- Ghee Soon Ang
- Department of Ophthalmology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
| | | | | |
Collapse
|
45
|
Anchala AR, Pasquale LR. Neovascular glaucoma: a historical perspective on modulating angiogenesis. Semin Ophthalmol 2009; 24:106-12. [PMID: 19373695 DOI: 10.1080/08820530902800959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anupama R Anchala
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA
| | | |
Collapse
|
46
|
Ritterband DC, Shapiro D, Trubnik V, Marmor M, Meskin S, Seedor J, Liebmann JM, Tello C, Koplin R, Harizman N, Shabto U, Ritch R. Penetrating Keratoplasty With Pars Plana Glaucoma Drainage Devices. Cornea 2007; 26:1060-6. [PMID: 17893534 DOI: 10.1097/ico.0b013e3181342835] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the outcome of penetrating keratoplasty (PK) in eyes undergoing simultaneous insertion or repositioning of a glaucoma drainage device (GDD) through the pars plana. METHODS The medical records of all patients who underwent PK and primary placement or repositioning of a GDD through the pars plana from April 1, 1997, through December 1, 2005, were reviewed. Intraocular pressure (IOP) control was defined as maintenance of IOP > or = 5 and < or = 21 mm Hg (without loss of light perception vision or needing further glaucoma surgery). Kaplan-Meier life table survival analysis was used to estimate the success of graft survival (clarity) and glaucoma control. RESULTS Eighty-three eyes of 80 patients (34 men and 46 women) were identified. Mean follow-up was 16 months (range, 6-96 months). PK and pars plana vitrectomy were performed with primary pars plana GDD insertion (57 eyes) or tube repositioning from the anterior chamber to pars plana (26 eyes). Grafts remained clear in 93% of eyes (76/83) at 6 months, 87% (56/66) at 1 year, and 59% (19/32) at 2 years. IOP was controlled in 87% (72/83) of eyes at 6 months, 95% (57/63) at 1 year, and 83% (20/24) at 2 years. CONCLUSIONS PK with simultaneous pars plana GDD repositioning or placement showed comparable short- and long-term IOP control to that of previous studies with limbal-based GDD. The rate of corneal graft failure and the rate of immunologic rejection were comparable to or lower than those reported in other series with primary limbal-based GDD.
Collapse
Affiliation(s)
- David C Ritterband
- Department of Ophthalmology, New York Eye & Ear Infirmary, New York, NY 10003, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Nagpal M, Wartikar S. Vitrectomy: when things go wrong. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.4.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
48
|
Abstract
The occurrence of hypertonia during a surgically treated retinal disease is frequent because these disorders often involve the same population of patients. The main cause of postoperative hypertonia remains a preoperative unknown glaucoma. Hypertonia occurring before the treatment of a retinal detachment can result from angle recession glaucoma, ghost cell glaucoma, or Schwartz-Matzuo syndrome; all of which are frequently associated with trauma. Hypertonia occurring after the surgery of a retinal detachment can be caused by scleral buckling, a topical postoperative steroid treatment, or an internal tamponade with gas or silicone. The latter is responsible for severe hypertonia that is frequently resistant to treatment. Hypertonia occurring after the use of triamcinolone is usually controlled with medical treatment. Prior filtrating surgery can lead to technical problems during retinal surgery. The knowledge of pre-existing glaucoma may be reason for cautious management of retinal surgery.
Collapse
|
49
|
de Guzman MHP, Valencia A, Farinelli AC. Pars plana insertion of glaucoma drainage devices for refractory glaucoma. Clin Exp Ophthalmol 2006; 34:102-7. [PMID: 16626421 DOI: 10.1111/j.1442-9071.2006.01170.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glaucoma drainage devices are more commonly inserted into the anterior chamber because of the relative ease of this method of insertion. However, in certain cases, posterior placement of the tube may be necessary or may be more desirable. The outcome of a series of patients with glaucoma drainage devices inserted into the pars plana was examined. METHODS Retrospective chart review of patients who underwent pars plana implantation of Molteno and Baerveldt glaucoma drainage devices at the Sydney Eye Hospital. RESULTS There were 33 cases reviewed. The mean follow-up period was 30.2 months. The mean final postoperative intraocular pressure was reduced to 13.4 +/- 4.4 mmHg (SD) from 33.06 +/- 8.47 mmHg preoperatively. The mean number of intraocular pressure-lowering medications in use postoperatively was 0.6 +/- 0.8, reduced from 3.6 +/- 1.27 medications in use preoperatively. Sixteen (48.5%) eyes were classified as complete successes, 14 (42.4%) eyes as qualified successes and three eyes (9%) as failures. Kaplan-Meier survival analysis for cumulative success (absence of failure) predicted 61.1% survival at 60 months. Complications included five cases of decompensation of corneas or corneal grafts, one case each of conjunctival wound dehiscence, large choroidal effusion, epiretinal membrane, Molteno plate extrusion and intraocular pressure unresponsive to medical therapy, and three cases of tube blockage. CONCLUSIONS In this series of patients, pars plana insertion of glaucoma drainage devices has been shown to be an effective alternative for selected cases where anterior chamber tube insertion is not possible or is not ideal.
Collapse
|
50
|
Kono T, Shiga S, Takesue Y, Sakamoto T. Long-Term Results of Pars Plana Vitrectomy Combined With Filtering Surgery for Neovascular Glaucoma. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050501-07] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|