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Sample records for glaucoma drainage implant

  1. Composite fibrous glaucoma drainage implant

    Klapstova, A.; Horakova, J.; Shynkarenko, A.; Lukas, D.

    2017-10-01

    Glaucoma is a frequent reason of loss vision. It is usually caused by increased intraocular pressure leading to damage of optic nerve head. This work deals with the development of fibrous structure suitable for glaucoma drainage implants (GDI). Commercially produced metallic glaucoma implants are very effective in lowering intraocular pressure. However, these implants may cause adverse events such as damage to adjacent tissue, fibrosis, hypotony or many others [1]. The aim of this study is to reduce undesirable properties of currently produced drains and improve their properties by creating of the composite fibrous drain for achieve a normal intraocular pressure. Two types of electrospinning technologies were used for the production of very small tubular implants. First type was focused for production of outer part of tubular drain and the second type of electrospinning method made the inner part of shape follows the connections of both parts. Complete implant had a special properties suitable for drainage of fluid. Morphological parameters, liquid transport tests and in-vitro cell adhesion tests were detected.

  2. Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract.

    Valenzuela, Felipe; Browne, Andrew; Srur, Miguel; Nieme, Carlos; Zanolli, Mario; López-Solís, Remigio; Traipe, Leonidas

    2016-02-01

    To examine the indications, safety, efficacy, and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery. A retrospective case review of 35 eyes (31 patients) subjected to combined phacoemulsification and Ahmed glaucoma drainage implant surgery. Demographic characteristics of the study population, indications for combined surgery, and operative and postoperative complications were recorded. Visual acuity, intraocular pressure (IOP), and number of glaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as IOP ≤ 21 mm Hg without medication, qualified success if IOP ≤ 21 mm Hg with ≥ 1 medications, and failure if IOP>21 mm Hg or ≤ 5 mm Hg on ≥ 2 consecutive visits. Mean follow-up was 29.5 months (range, 6 to 87 mo). The most common indication for combined surgery was a history of prior failed trabeculectomy (60%). Postoperative visual acuity improved in 30 of 35 eyes (85%) (PAhmed glaucoma drainage implant surgery seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP for patients with refractory glaucoma and cataract.

  3. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant.

    Sluch, Ilya; Gudgel, Brett; Dvorak, Justin; Anne Ahluwalia, Mary; Ding, Kai; Vold, Steve; Sarkisian, Steven

    2017-01-01

    To evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study. A retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success. A total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up. The M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time. While the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design. How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

  4. Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient

    Bruno L. B. Esporcatte

    2016-04-01

    Full Text Available ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

  5. Risk factors for tube exposure as a late complication of glaucoma drainage implant surgery

    Chaku M

    2016-03-01

    Full Text Available Meenakshi Chaku,1 Peter A Netland,2 Kyoko Ishida,3 Douglas J Rhee4 1Department of Ophthalmology, Loyola University Chicago, Maywood, IL, 2Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA; 3Department of Ophthalmology, Toho University, Tokyo, Japan; 4Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH, USA Purpose: The purpose of this study was to evaluate the risk factors for tube exposure after glaucoma drainage implant surgery.Patients and methods: This was a retrospective case-controlled observational study of 64 eyes from 64 patients. Thirty-two eyes of 32 patients with tube erosion requiring surgical revision were compared with 32 matched control eyes of 32 patients. Univariate and multivariate risk factor analyses were performed.Results: Mean age was significantly younger in the tube exposure group compared with the control group (48.2±28.1 years versus 67.3±18.0 years, respectively; P=0.003. The proportion of diabetic patients (12.5% in the tube exposure group was significantly less (P=0.041 compared with the control group (37.5%. Comparisons of the type and position of the drainage implant were not significantly different between the two groups. The average time to tube exposure was 17.2±18.0 months after implantation of the drainage device. In both univariate and multivariate analyses, younger age (P=0.005 and P=0.027 and inflammation prior to tube exposure (P≤0.001 and P=0.004 were significant risk factors. Diabetes was a significant risk factor only in the univariate analysis (P=0.027.Conclusion: Younger age and inflammation were significant risk factors for tube exposure after drainage implant surgery. Keywords: glaucoma drainage implant complications, Ahmed Glaucoma Valve, Baerveldt implant, tube erosion, pericardial patch graft

  6. Surgical outcomes of trabeculectomy and glaucoma drainage implant for uveitic glaucoma and relationship with uveitis activity.

    Kwon, Hye Jin; Kong, Yu Xiang George; Tao, Lingwei William; Lim, Lyndell L; Martin, Keith R; Green, Catherine; Ruddle, Jonathan; Crowston, Jonathan G

    2017-07-01

    This study provides ophthalmologists who manage uveitic glaucoma with important information on factors that can affect the success of surgical management of this challenging disease. This study examines surgical outcomes of trabeculectomy and glaucoma device implant (GDI) surgery for uveitic glaucoma, in particular the effect of uveitis activity on surgical outcomes. Retrospective chart review at a tertiary institution. Eighty-two cases with uveitic glaucoma (54 trabeculectomies and 28 (GDI) surgeries) performed between 1 December 2006 and 30 November 2014. Associations of factors with surgical outcomes were examined using univariate and multivariate analysis. Surgical outcomes as defined in Guidelines from World Glaucoma Association. Average follow up was 26.4 ± 21.5 months. Overall qualified success rate of the trabeculectomies was not statistically different from GDI, being 67% and 75%, respectively (P = 0.60). Primary and secondary GDI operations showed similar success rates. The most common postoperative complication was hypotony (~30%). Active uveitis at the time of operation was higher in trabeculectomy compared with GDI group (35% vs. 14%). Active uveitis at the time of surgery did not significantly increase risk of failure for trabeculectomies. Recurrence of uveitis was significantly associated with surgical failure in trabeculectomy group (odds ratio 4.8, P = 0.02) but not in GDI group. Surgical success rate of GDI was not significantly different from trabeculectomy for uveitic glaucoma in this study. Regular monitoring, early and prolonged intensive treatment of ocular inflammation is important for surgical success particularly following trabeculectomy. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  7. Nocardia brasiliensis endophthalmitis in a patient with an exposed Ahmed glaucoma drainage implant.

    Stewart, Michael W; Bolling, James P; Bendel, Rick E

    2013-01-01

    To report a case of endophthalmitis due to Nocardia brasiliensis in an eye with an exposed, infected Ahmed glaucoma drainage implant (GDI). Retrospective case report. A patient with an exposed GDI experienced recurrent episodes of endophthalmitis despite repeated intravitreal injections of antibiotics and steroids. The tube was initially repositioned and finally removed. Whereas repeated cultures from the anterior chamber and vitreous were negative, cultures from the removed tube grew Nocardia brasiliensis. Despite oral trimethoprim-sulfamethoxazole and intravitreal amikacin the eye became phthisical and lost light perception. An exposed GDI may lead to endophthalmitis due to Nocardia brasiliensis and may require explantation to establish a diagnosis.

  8. Glaucoma Drainage Device Erosion Following Ptosis Surgery.

    Bae, Steven S; Campbell, Robert J

    2017-09-01

    To highlight the potential risk of glaucoma drainage device erosion following ptosis surgery. Case report. A 71-year-old man underwent uncomplicated superotemporal Ahmed glaucoma valve implantation in the left eye in 2008. Approximately 8 years later, the patient underwent bilateral ptosis repair, which successfully raised the upper eyelid position. Three months postoperatively, the patient's glaucoma drainage implant tube eroded through the corneal graft tissue and overlying conjunctiva to become exposed. A graft revision surgery was successfully performed with no further complications. Caution and conservative lid elevation may be warranted when performing ptosis repair in patients with a glaucoma drainage implant, and patients with a glaucoma implant undergoing ptosis surgery should be followed closely for signs of tube erosion.

  9. Suprachoroidal drainage with collagen sheet implant- a novel technique for non-penetrating glaucoma surgery.

    Szurman, Peter; Januschowski, Kai; Boden, Karl Thomas; Seuthe, Anna-Maria

    2018-02-01

    Our purpose was both to introduce the new technique of suprachoroidal drainage with collagen sheet implantation as a novel technique of non-penetrating glaucoma surgery and to present first results of a prospective pilot study. A superficial rectangular sclera flap of half-scleral thickness sized 4 × 4.5 mm is dissected anteriorly until clear cornea. Then, a second scleral flap is created underneath the first one sized 3.5x4mm and is cut down full-thickness to the choroid exposing the suprachoroidal space. The flap is then bluntly prepared until the scleral spur is reached. Sharp dissection above the sclera spur exposes Schlemm's canal, which is located directly anteriorly. Schlemm's canal is unroofed, juxtacanalicular meshwork is peeled and the deep flap is cut off at its base. An absorbable collagen sheet (Ologen®, Dahlhausen, Cologne, Germany) is placed into the suprachoroidal space at the level of the ciliary body, and the superficial sclera flap is sutured tightly to prevent leakage. We prospectively analyzed 65 eyes that underwent suprachoroidal drainage with collagen sheet implantation. Mean reduction of intraocular pressure after 3 months was 35.1% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.4 mmHg)(p < 0.01) and after 12 months 35.6% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.0  mmHg)(p < 0.01). The number of topical IOP-reducing medication decreased significantly from 3.5 ± 0.7 to 0.6 ± 0.9 and to 0.9 ± 1.1 after 3 and 12 months, respectively (p < 0.01). No serious complications occurred. Suprachoroidal drainage with collagen sheet implantation seems to be a safe and effective surgical technique for non-penetrating glaucoma surgery that yields the opportunity of a sufficient IOP reduction for eyes unsuitable for canaloplasty.

  10. Simultaneous Implantation of an Ahmed and Baerveldt Glaucoma Drainage Device for Uncontrolled Intraocular Pressure in Advanced Glaucoma.

    Rao, Veena S; Christenbury, Joseph; Lee, Paul; Allingham, Rand; Herndon, Leon; Challa, Pratap

    2017-02-01

    To evaluate efficacy and safety of a novel technique, simultaneous implantation of Ahmed and Baerveldt shunts, for improved control of intraocular pressure (IOP) in advanced glaucoma with visual field defects threatening central fixation. Retrospective case series; all patients receiving simultaneous Ahmed and Baerveldt implantation at a single institution between October 2004 and October 2009 were included. Records were reviewed preoperatively and at postoperative day 1, week 1, month 1, month 3, month 6, year 1, and yearly until year 5. Outcome measures included IOP, best-corrected visual acuity, visual field mean deviation, cup to disc ratio, number of glaucoma medications, and complications. Fifty-nine eyes were identified; mean (±SD) follow-up was 26±23 months. Primary open-angle glaucoma was most common (n=37, 63%). Forty-six eyes (78%) had prior incisional surgery. Mean preoperative IOP was 25.5±9.8 mm Hg. IOP was reduced 50% day 1 (Pglaucoma tube implantation with effects persisting over postoperative year 1 and up to year 5. Complications were higher than that seen in reports of single shunt implantation, which may be explained by patient complexity in this cohort. This technique may prove a promising novel approach for management of uncontrolled IOP in advanced glaucoma.

  11. Ahmed Versus Baerveldt Glaucoma Drainage Implantation in Patients With Markedly Elevated Intraocular Pressure (≥30 mm Hg).

    Resende, Arthur F; Moster, Marlene R; Patel, Neal S; Lee, Daniel; Dhami, Hermandeep; Pro, Michael J; Waisbourd, Michael

    2016-09-01

    Glaucoma patients with markedly elevated intraocular pressure (IOP) are at risk for developing severe hypotony-related complications. The goal of this study was to compare the surgical outcomes of the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI) in this patient population. Patients with preoperative IOP≥30 mm Hg were included. Outcome measures were: (1) surgical failure (IOP>21 mm Hg or glaucoma surgery, or loss of light perception) and (2) surgical complications. A total of 75 patients were included: 37 in the AGV group and 38 in the BGI group. The mean±SD follow-up was 2.3±1.6 years for the AGV group and 2.4±1.7 years for the BGI group (P=0.643). Mean preoperative IOP was 38.7±6.5 mm Hg for the AGV group and 40.8±7.6 mm Hg for the BGI group. At the last follow-up, 10 (27.0%) patients failed in the AGV group compared with 6 (15.8%) patients in the BGI group (P=0.379). The BGI group had higher rate of flat or shallow anterior chamber (n=4, 10%) compared with the AGV group (n=0, 0%) (P=0.043). Failure rates of AGV and BGI in patients with IOP≥30 mm Hg were comparable. There were more early hypotony-related complications in the BGI group; however, none were vision threatening. Both glaucoma drainage implants were effective in treating patients with uncontrolled glaucoma in an emergency setting.

  12. Persistent Hypotony Associated with Immunosuppressive Therapy in Glaucoma Drainage Implant Surgery

    Susana Duch

    2016-09-01

    Full Text Available Purpose: To describe the histopathology of non-valved implant capsules in three cases of persistent postoperative hypotony after the restrictive tube ligature was released in patients receiving immunosuppressive therapy. Observations: The macroscopic appearance of the capsules 3 and 4 months postoperatively was immature and loose. Microscopic examination disclosed extremely irregular thin tissue, with thicknesses ranging from 0.02 to 0.6 mm, depending on the capsular location studied. Withdrawal of immunosuppressive therapy did not facilitate rebuilding of new capsules. Replacement with a valved implant device was necessary in two cases; the third case recovered with tapering of prednisone. Conclusions and Importance: The use of chronic systemic immunosuppressive therapy might interfere with capsular formation around the plates of drainage devices inducing persistent hypotony. In these cases, the use of valved implants might be safer.

  13. Safety and efficacy of a low-cost glaucoma drainage device for refractory childhood glaucoma.

    Kaushik, Sushmita; Kataria, Pankaj; Raj, Srishti; Pandav, Surinder Singh; Ram, Jagat

    2017-12-01

    To evaluate the safety and efficacy of a low-cost glaucoma drainage device (GDD), Aurolab aqueous drainage implant (AADI), similar in design to the Baerveldt glaucoma implant (BGI), in refractory childhood glaucoma. This prospective interventional study was conducted in a tertiary care postgraduate teaching institute. Children aged glaucoma valve implant in children. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Aqueous shunt implantation in glaucoma

    Jing Wang

    2017-01-01

    Full Text Available 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.

  15. Infected Baerveldt Glaucoma Drainage Device by Aspergillus niger

    Nurul-Laila Salim

    2015-01-01

    Full Text Available Fungal endophthalmitis is rare but may complicate glaucoma drainage device surgery. Management is challenging as the symptoms and signs may be subtle at initial presentation and the visual prognosis is usually poor due to its resistant nature to treatment. At present there is lesser experience with intravitreal injection of voriconazole as compared to Amphotericin B. We present a case of successfully treated Aspergillus endophthalmitis following Baerveldt glaucoma drainage device implantation with intravitreal and topical voriconazole.

  16. Late-Onset Endophthalmitis Secondary to Exposed Glaucoma Tube Implant in a Rare Case of Paediatric Glaucoma

    Ranganath, Akshatha; Hashim, Adnan

    2011-01-01

    Glaucoma drainage implants (GDIs) are used to treat paediatric glaucoma resistant to conventional medical and surgical treatment, achieving good intraocular pressure (IOP) control and long-term success. Late endophthalmitis is a rare complication that may develop following GDI surgery. A 17-year-old male presented with acute endophthalmitis 2 years after Ahmed glaucoma valve implantation with pericardial patch graft for management of refractory glaucoma secondary to congenital ectropion uveae...

  17. Conjunctival erosion after glaucoma drainage device surgery: A feasible option

    Suneeta Dubey

    2013-01-01

    Full Text Available Glaucoma drainage devices (GDDs have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.

  18. Conjunctival erosion after glaucoma drainage device surgery: a feasible option.

    Dubey, Suneeta; Prasanth, Baswati; Acharya, Manisha C; Narula, Ritesh

    2013-07-01

    Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.

  19. A Review of the Ahmed Glaucoma Valve Implant and Comparison with Other Surgical Operations.

    Riva, Ivano; Roberti, Gloria; Katsanos, Andreas; Oddone, Francesco; Quaranta, Luciano

    2017-04-01

    The Ahmed glaucoma valve (AGV) is a popular glaucoma drainage implant used for the control of intraocular pressure in patients with glaucoma. While in the past AGV implantation was reserved for glaucoma patients poorly controlled after one or more filtration procedures, mounting evidence has recently encouraged its use as a primary surgery in selected cases. AGV has been demonstrated to be safe and effective in reducing intraocular pressure in patients with primary or secondary refractory glaucoma. Compared to other glaucoma surgeries, AGV implantation has shown favorable efficacy and safety. The aim of this article is to review the results of studies directly comparing AGV with other surgical procedures in patients with glaucoma.

  20. Clinical findings following Ahmed Glaucoma Valve™ implantation in pediatric glaucoma

    Amir Pirouzian

    2008-03-01

    Full Text Available Amir Pirouzian1, Joseph L Demer21Department of Ophthalmology, San Diego Children’s Hospital, San Diego, UCSD, San Diego, CA, USA; 2Department of Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USAPurpose: To describe clinical findings after Ahmed valve drainage implantation in children.Design: All records in one practice were reviewed to identify and describe clinical findings in all children who had undergone Ahmed Glaucoma ValveTM S2 model insertion for uncontrolled primary or secondary glaucoma.Results: A total of 6 patients were identified, ranging in age from 2–15 years. Mean follow-up time averaged from 2–5 years from the time of tube insertion. Three patients exhibited pupillary peaking towards the tube of the valve. All patients required additional surgery or additional medications to control intraocular pressure. Lenticular opacification near the tube site developed in one patient. Gradual tube extrusion was also noted in another two patients.Conclusion: Multiple clinical events follow the Ahmed valve insertion in children. Pupillary irregularity is the most commonly noted event in this series. To avoid or reduce the risk of this complication, additional or modification of surgical procedures could be considered. The mechanism of such occurrence will further be discussed.Keywords: Ahmed Glaucoma Valve, children, pediatric glaucoma

  1. Ahmed glaucoma valve implant: surgical technique and complications

    Riva I

    2017-02-01

    Full Text Available Ivano Riva,1 Gloria Roberti,1 Francesco Oddone,1 Anastasios GP Konstas,2 Luciano Quaranta3 1IRCCS “Fondazione GB Bietti per l’Oftalmologia”, Rome, Italy; 21st University Department of Ophthalmology, Glaucoma Unit, AHEPA Hospital, Thessaloniki, Greece; 3Department of Medical and Surgical Specialties, Section of Ophthalmology, University of Brescia, Brescia, Italy Abstract: Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications. Keywords: glaucoma, surgical technique, glaucoma drainage devices, Ahmed glaucoma valve, complications

  2. Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

    Shen, Christopher C; Salim, Sarwat; Du, Haiming; Netland, Peter A

    2011-01-01

    Purpose: To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation. Patients and methods: This was a retrospective comparative case series. We reviewed 40 eyes of 39 patients with underlying diagnosis of neovascular glaucoma, divided into two groups: Ahmed Glaucoma Valve (N = 20) and trabeculectomy with mitomycin C (N = 20). Surgical success was defined as 6 mm Hg ≤ intraocular pressure ≤21 mm Hg, with or without the use of glaucoma medications, with no further glaucoma surgery, and light perception or better vision. Early postoperative hypotony was defined as intraocular pressure Ahmed Glaucoma Valve group and 25 months (6–77 months) for the trabeculectomy group. Although the mean number of postoperative intraocular pressure-lowering medications was significantly higher in the trabeculectomy group compared with the Ahmed Glaucoma Valve group at 3 and 6 month time points, there was no statistically significant difference at any other time point. There was no statistically significant difference between both groups in postoperative visual acuity and intraocular pressure. Success was 70% and 65% at 1 year and 60% and 55% at 2 years after Ahmed Glaucoma Valve and trabeculectomy, respectively. Kaplan–Meier survival curve analysis showed no significant difference in success between the two groups (P = 0.815). Hyphema was the most common complication in both groups. Conclusion: We found similar results after trabeculectomy with mitomycin C and Ahmed Glaucoma Valve implantation in eyes with neovascular glaucoma. PMID:21468334

  3. Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

    Netland, Peter; Shen,Chris; Salim,Sarwat; Du,Haiming

    2011-01-01

    Christopher C Shen1, Sarwat Salim2, Haiming Du2, Peter A Netland31Glaucoma Consultants Northwest, Seattle, WA, USA; 2University of Tennessee Health Science Center, Memphis, TN, USA; 3University of Virginia School of Medicine, Charlottesville, VA, USAPurpose: To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation. Patients and methods: This was a retrospective comparative case series. We reviewed 40 e...

  4. Clinical outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma.

    Pakravan, Mohammad; Esfandiari, Hamed; Yazdani, Shahin; Doozandeh, Azadeh; Dastborhan, Zahra; Gerami, Ebrahim; Kheiri, Bahareh; Pakravan, Parastou; Yaseri, Mehdi; Hassanpour, Kiana

    2018-03-01

    To evaluate the outcomes of Ahmed glaucoma valve implantation in refractory primary congenital glaucoma as well as primary procedure in aphakic glaucoma. In this retrospective study, medical records of patients who underwent Ahmed glaucoma valve implantation for refractory glaucoma and aphakic glaucoma were reviewed. Primary outcome measures were the surgical success defined as intraocular pressure ≤21 mm Hg and decreased ≥20% and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity, and intraocular pressure. A total of 62 eyes of refractory primary congenital glaucoma patients (group 1) and 33 eyes of aphakic glaucoma patients (group 2) were included in our study. Mean follow-up was 51 ± 33 months in group 1 and 49 ± 41 months in group 2 (p = 0.82). The cumulative probability of success was 90% in both groups at the first year; however, the success rate was 52.5% in group 1 and 71.5% in group 2 at 5 years' follow-up visit. In group 1, the mean intraocular pressure ± standard deviation was 33.1 ± 8.6 mm Hg at the baseline and decreased to 17.1 ± 5.3 mm Hg at 1 year and 18.5 ± 6.4 at 3 years postoperatively (all p's glaucoma medications was 3 ± 0.7 that decreased to 2 ± 0.8 at final follow-up (p = 0.02). Ahmed glaucoma valve implantation has a moderate success rate in the management of refractory primary congenital glaucoma with an increased chance of tube-related complications. The surgical success rate is higher in case of primary Ahmed glaucoma valve implant for aphakic glaucoma with acceptable safety profile.

  5. Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing Ahmed glaucoma valve implantation: 2-year follow-up.

    Arcieri, Enyr S; Paula, Jayter S; Jorge, Rodrigo; Barella, Kleyton A; Arcieri, Rafael S; Secches, Danilo J; Costa, Vital P

    2015-02-01

    To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed glaucoma valve (AGV) implantation. This was a multicentre, prospective, randomized clinical trial that enrolled 40 patients with uncontrolled neovascular glaucoma that had undergone panretinal photocoagulation and required glaucoma drainage device implantation. Patients were randomized to receive IVB (1.25 mg) or not during Ahmed valve implant surgery. Injections were administered intra-operatively, and 4 and 8 weeks after surgery. After a mean follow-up of 2.25 ± 0.67 years (range 1.5-3 years), both groups showed a significant decrease in IOP (p glaucoma undergoing Ahmed glaucoma valve implantation. There is a trend to slightly lower IOPs and number of medications with IVB use during AGV implantation for neovascular glaucoma. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  6. Clinical observation of Ahmed glaucoma valve implantation for refractory glaucoma by directly puncturing the sclerotic tunnel

    Zhi-Ke Xu

    2015-02-01

    Full Text Available AIM: To observe the clinic effects and complication of Ahmed glaucoma valve(AGVimplantation in refractory glaucoma by using the 23G syringe needle direct puncture the sclerotic tunnel.METHODS: Forty-four cases(44 eyesof refractory glaucoma underwent AGV implantation by useing the 23G syringe needle direct puncture the sclerotic tunnel. The intraocular pressure(IOP, visual acuity, and complication of post-operation were contrasted with those of pre-operation. RESULTS:The success rate was 84.1%, the mean preoperative IOP in research group was 52.1±10.1mmHg, and the last follow up mean IOP was 15.6±6.9mmHg. Compared with the preoperative visual acuity, 11 eyes increased, 27 eyes had no changes and 6 eyes decreased. The main post-operative complications included shallow anterior chamber(4 eyes, choroidal detachment(3 eyes, drainage tube shift(1 eye, hyphema(6 eyes, drainage tube blockage(1 eye, expulsive choroidal hemorrhage(1 eye, and fiber wrap of drainage tray(5 eyes.CONCLUSION: AGV implantation by direct puncture the sclerotic tunnel is feasible and easy. It avoids of making sclerotic petal and the xenogenic sclera transplanting, simplified the operation technique, prevent the leakage of around tube. The shallow anterior chamber rate is lower. It is an effective procedure for refractory glaucoma.

  7. Late-onset endophthalmitis secondary to exposed glaucoma tube implant in a rare case of paediatric glaucoma.

    Ranganath, Akshatha; Hashim, Adnan

    2011-01-01

    Glaucoma drainage implants (GDIs) are used to treat paediatric glaucoma resistant to conventional medical and surgical treatment, achieving good intraocular pressure (IOP) control and long-term success. Late endophthalmitis is a rare complication that may develop following GDI surgery. A 17-year-old male presented with acute endophthalmitis 2 years after Ahmed glaucoma valve implantation with pericardial patch graft for management of refractory glaucoma secondary to congenital ectropion uveae. The glaucoma tube was exposed due to erosion of the overlying conjunctiva with no visible pericardial graft. After control of active infection, he underwent tube revision surgery whereby the exposed tube was retained and repatched with a double-thickness pericardial patch graft. He did well following surgery with good control of IOP and restoration of vision. Conjunctival dehiscence with graft melting over the GDI tube presented a major risk factor for endophthalmitis. Prompt surgical revision of an exposed tube is highly recommended to avoid ocular morbidity.

  8. Late-Onset Endophthalmitis Secondary to Exposed Glaucoma Tube Implant in a Rare Case of Paediatric Glaucoma

    Akshatha Ranganath

    2011-01-01

    Full Text Available Glaucoma drainage implants (GDIs are used to treat paediatric glaucoma resistant to conventional medical and surgical treatment, achieving good intraocular pressure (IOP control and long-term success. Late endophthalmitis is a rare complication that may develop following GDI surgery. A 17-year-old male presented with acute endophthalmitis 2 years after Ahmed glaucoma valve implantation with pericardial patch graft for management of refractory glaucoma secondary to congenital ectropion uveae. The glaucoma tube was exposed due to erosion of the overlying conjunctiva with no visible pericardial graft. After control of active infection, he underwent tube revision surgery whereby the exposed tube was retained and repatched with a double-thickness pericardial patch graft. He did well following surgery with good control of IOP and restoration of vision. Conjunctival dehiscence with graft melting over the GDI tube presented a major risk factor for endophthalmitis. Prompt surgical revision of an exposed tube is highly recommended to avoid ocular morbidity.

  9. Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

    Erçalık, Nimet Yeşim; İmamoğlu, Serhat

    2018-01-01

    Purpose. To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. Materials and Methods. The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical...

  10. Expanded polytetrafluoroethylene membrane alters tissue response to implanted Ahmed glaucoma valve.

    DeCroos, Francis Char; Ahmad, Sameer; Kondo, Yuji; Chow, Jessica; Mordes, Daniel; Lee, Maria Regina; Asrani, Sanjay; Allingham, R Rand; Olbrich, Kevin C; Klitzman, Bruce

    2009-07-01

    Long-term intraocular pressure control by glaucoma drainage implants is compromised by the formation of an avascular fibrous capsule that surrounds the glaucoma implant and increases aqueous outflow resistance. It is possible to alter this fibrotic tissue reaction and produce a more vascularized and potentially more permeable capsule around implanted devices by enclosing them in a porous membrane. Ahmed glaucoma implants modified with an outer 5-microm pore size membrane (termed porous retrofitted implant with modified enclosure or PRIME-Ahmed) and unmodified glaucoma implants were implanted into paired rabbit eyes. After 6 weeks, the devices were explanted and subject to histological analysis. A tissue response containing minimal vascularization, negligible immune response, and a thick fibrous capsule surrounded the unmodified Ahmed glaucoma implant. In comparison, the tissue response around the PRIME-Ahmed demonstrated a thinner fibrous capsule (46.4 +/- 10.8 microm for PRIME-Ahmed versus 94.9 +/- 21.2 microm for control, p vascularized near the tissue-material interface. A prominent chronic inflammatory response was noted as well. Encapsulating the aqueous outflow pathway with a porous membrane produces a more vascular tissue response and thinner fibrous capsule compared with a standard glaucoma implant plate. Enhanced vascularity and a thinner fibrous capsule may reduce aqueous outflow resistance and improve long-term glaucoma implant performance.

  11. A case of WAGR syndrome in association with developmental glaucoma requiring bilateral Baerveldt glaucoma implants and subsequent tube repositioning

    Akagi T

    2015-06-01

    Full Text Available Tadamichi Akagi, Munemitsu Yoshikawa, Hideo Nakanishi, Nagahisa Yoshimura Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan Abstract: Glaucoma drainage device implantation is efficacious for the treatment of pediatric glaucoma patients when multiple angle surgeries fail. However, tube touching of the corneal endothelium is one of the major postoperative complications to deal with. A 15-month-old male patient with Wilms’ tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR syndrome was diagnosed with bilateral developmental glaucoma. He underwent Baerveldt glaucoma implant (BGI surgeries in both eyes after multiple failed trabeculotomies. The tube in his right eye was touching the cornea 15 months after BGI surgery. To avoid corneal endothelium damage, BGI tube repositioning with scleral fixation was performed without serious complications. The bilateral BGI surgeries achieved successful intraocular pressure reduction for over 2 years and tube repositioning with scleral fixation of BGI tube was successful for BGI tube malposition. Although careful attention to intraocular pressure and tube malposition is essential after glaucoma drainage device implantation, especially in pediatric cases, BGI surgery is effective in the management of developmental glaucoma following unsuccessful angle surgeries. Keywords: Baerveldt glaucoma implant, developmental glaucoma, WAGR syndrome, tube repositioning, glaucoma drainage device

  12. Follow-up of the original cohort with the Ahmed glaucoma valve implant.

    Topouzis, F; Coleman, A L; Choplin, N; Bethlem, M M; Hill, R; Yu, F; Panek, W C; Wilson, M R

    1999-08-01

    To study the long-term results of the Ahmed glaucoma valve implant in patients with complicated glaucoma in whom short-term results have been reported. In this multicenter study, we analyzed the long-term outcome of a cohort of 60 eyes from 60 patients in whom the Ahmed glaucoma valve was implanted. Failure was characterized by at least one of the following: intraocular pressure greater than 21 mm Hg at both of the last two visits less than 6 mm Hg at both of the last two visits, loss of light perception, additional glaucoma surgery, devastating complications, and removal or replacement of the Ahmed glaucoma valve implant. Devastating complications included chronic hypotony, retinal detachment, malignant glaucoma, endophthalmitis, and phthisis bulbi; we also report results that add corneal complications (corneal decompensation or edema, corneal graft failure) as defining a devastating complication. The mean follow-up time for the 60 eyes was 30.5 months (range, 2.1 to 63.5). When corneal complications were included in the definition of failure, 26 eyes (43%) were considered failures. Cumulative probabilities of success at 1, 2, 3, and 4 years were 76%, 68%, 54%, and 45%, respectively. When corneal complications were excluded from the definition of failure, 13 eyes (21.5%) were considered failures. Cumulative probabilities of success at 1, 2, 3, and 4 years were 87%, 82%, 76%, and 76%, respectively. Most of the failures after 12 months of postoperative follow-up were because of corneal complications. The long-term performance of the Ahmed glaucoma valve implant is comparable to other drainage devices. More than 12 months after the implantation of the Ahmed glaucoma valve implant, the most frequent adverse outcome was corneal decompensation or corneal graft failure. These corneal problems may be secondary to the type of eyes that have drainage devices or to the drainage device itself. Further investigation is needed to identify the reasons that corneal problems

  13. Conjunctival erosion after glaucoma drainage device surgery: A feasible option

    Dubey, Suneeta; Prasanth, Baswati; Acharya, Manisha C; Narula, Ritesh

    2013-01-01

    Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evid...

  14. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case.

    Berezina, Tamara L; Fechtner, Robert D; Cohen, Amir; Kim, Eliott E; Chu, David S

    2015-01-01

    We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency. How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64.

  15. Superior versus inferior Ahmed glaucoma valve implantation.

    Pakravan, Mohammad; Yazdani, Shahin; Shahabi, Camelia; Yaseri, Mehdi

    2009-02-01

    To compare the efficacy and safety of Ahmed glaucoma valve (AGV) (New World Medical Inc., Rancho Cucamonga, CA) implantation in the superior versus inferior quadrants. Prospective parallel cohort study. A total of 106 eyes of 106 patients with refractory glaucoma. Consecutive patients with refractory glaucoma underwent AGV implantation in the superior or inferior quadrants. Main outcome measures included intraocular pressure (IOP) and rate of complications. Other outcome measures included best corrected visual acuity (BCVA), number of glaucoma medications, and success rate (defined as at least 30% IOP reduction and 5glaucoma surgery, phthisis bulbi, or loss of light perception. Of a total of 106 eyes, 58 and 48 eyes underwent AGV implantation in the superior and inferior quadrants, respectively. Baseline characteristics were comparable in the study groups, except for preoperative IOP, which was higher in the superior group (P = 0.01). Patients were followed for a mean period of 10.6+/-8.49 months and 10.58+/-6.75 months in the superior and inferior groups, respectively (P = 0.477). BCVA was comparable between the groups at all postoperative visits (P>0.122). After 1 year, statistically significant but comparable IOP reduction from baseline (Pglaucoma medications was comparable after 1 year (1.3+/-1.2 vs. 1.9+/-0.8 for superior and inferior implants, respectively, P = 0.256). Success rates were also similar at 1 year: 27 eyes (81.8%) versus 20 eyes (95.2%) for superior and inferior implants, respectively (P = 0.227). However, the overall rate of complications, such as implant exposure necessitating removal, cosmetically unappealing appearance, and endophthalmitis, was higher in the inferior group: 12 eyes (25%) versus 3 eyes (5.2%) for superior and inferior groups, respectively, (P = 0.004). Superior and inferior AGV implants have similar intermediate efficacy in terms of IOP reduction, decrease in number of glaucoma medications, and preservation of vision. However

  16. Update on Minimally Invasive Glaucoma Surgery (MIGS and New Implants

    Lívia M. Brandão

    2013-01-01

    Full Text Available Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes and are collectively termed “minimally invasive glaucoma surgery (MIGS.” The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt. The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.

  17. Early Ahmed glaucoma valve implantation after penetrating keratoplasty leads to better outcomes in an Asian population with preexisting glaucoma.

    Ming-Cheng Tai

    Full Text Available BACKGROUND: To evaluate the efficacy of Ahmed Glaucoma Valve (AGV surgery and the optimal interval between penetrating keratoplasty (PKP and AGV implantation in a population of Asian patients with preexisting glaucoma who underwent PKP. METHODOLOGY/PRINCIPAL FINDINGS: In total, 45 eyes of 45 patients were included in this retrospective chart review. The final intraocular pressures (IOPs, graft survival rate, and changes in visual acuity were assessed to evaluate the outcomes of AGV implantations in eyes in which AGV implantation occurred within 1 month of post-PKP IOP elevation (Group 1 and in eyes in which AGV implantation took place more than 1 month after the post-PKP IOP evaluation (Group 2. Factors that were associated with graft failure were analyzed, and the overall patterns of complications were reviewed. By their final follow-up visits, 58% of the patients had been successfully treated for glaucoma. After the operation, there were no statistically significant differences between the groups with respect to graft survival (p = 0.98, but significant differences for IOP control (p = 0.049 and the maintenance of visual acuity (VA (p21 mm Hg. The most common surgical complication, aside from graft failure, was hyphema. CONCLUSIONS/SIGNIFICANCE: Early AGV implantation results in a higher probability of AGV survival and a better VA outcome without increasing the risk of corneal graft failure as a result of post-PKP glaucoma drainage tube implantation.

  18. Early Ahmed Glaucoma Valve Implantation after Penetrating Keratoplasty Leads to Better Outcomes in an Asian Population with Preexisting Glaucoma

    Tai, Ming-Cheng; Chen, Yi-Hao; Cheng, Jen-Hao; Liang, Chang-Min; Chen, Jiann-Torng; Chen, Ching-Long; Lu, Da-Wen

    2012-01-01

    Background To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) surgery and the optimal interval between penetrating keratoplasty (PKP) and AGV implantation in a population of Asian patients with preexisting glaucoma who underwent PKP. Methodology/Principal Findings In total, 45 eyes of 45 patients were included in this retrospective chart review. The final intraocular pressures (IOPs), graft survival rate, and changes in visual acuity were assessed to evaluate the outcomes of AGV implantations in eyes in which AGV implantation occurred within 1 month of post-PKP IOP elevation (Group 1) and in eyes in which AGV implantation took place more than 1 month after the post-PKP IOP evaluation (Group 2). Factors that were associated with graft failure were analyzed, and the overall patterns of complications were reviewed. By their final follow-up visits, 58% of the patients had been successfully treated for glaucoma. After the operation, there were no statistically significant differences between the groups with respect to graft survival (p = 0.98), but significant differences for IOP control (p = 0.049) and the maintenance of visual acuity (VA) (pglaucoma, a history of previous PKP, and a preoperative IOP that was >21 mm Hg. The most common surgical complication, aside from graft failure, was hyphema. Conclusions/Significance Early AGV implantation results in a higher probability of AGV survival and a better VA outcome without increasing the risk of corneal graft failure as a result of post-PKP glaucoma drainage tube implantation. PMID:22629464

  19. Molteno3 Implantation as Primary Glaucoma Surgery

    Juha O. Välimäki

    2014-01-01

    Full Text Available Purpose. To determine the outcome of Molteno3 implantation as primary glaucoma surgery and to analyze the factors influencing the surgical outcome. Methods. This is a retrospective clinical study of 106 consecutive eyes (97 patients with no previous glaucoma surgery. Surgical failure was defined as an IOP > 21 mmHg or less than a 20% reduction below baseline, or IOP ≤ 5 mmHg, on two consecutive visits after 3 months follow-up, or reoperation for glaucoma or loss of light perception. Results. At the end of the follow-up (mean, 35 months; range, 12–71 months, the mean postoperative IOP (14.2 ± 4.4 mmHg was statistically significantly lower than the preoperative IOP (35.2 ± 9.7 mmHg (P<0.001. Life-table success rates were 97%, 94%, and 91% after follow-up of 12, 24, and 36 months, respectively. Success rate for an IOP ≤ 18 mmHg was 77% at the last visit. Success was not influenced by previous cataract surgery, sex, age, laser trabeculoplasty (LTP, preoperative IOP, or number of antiglaucoma medications. Forty-seven eyes had 66 postoperative complications. Conclusions. The primary Molteno3 implant provided significant IOP lowering with minimal and manageable complications in uncontrolled glaucoma. Neither previous cataract surgery nor LTP had any detrimental effect on surgical success.

  20. Evaluation of success after second Ahmed glaucoma valve implantation.

    Nilforushan, Naveed; Yadgari, Maryam; Jazayeri, Anis Alsadat; Karimi, Nasser

    2016-03-01

    To evaluate the outcome of the second Ahmed glaucoma valve (AGV) surgery in eyes with failed previous AGV surgery. Retrospective case series. Following chart review, 36 eyes of 34 patients with second AGV implantation were enrolled in this study. The primary outcome measure was surgical success defined in terms of intraocular pressure (IOP) control using two criteria: Success was defined as IOP ≤21 mmHg (criterion 1) and IOP ≤16 mmHg (criterion 2), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than two medications (qualified success). Kaplan-Meier survival analysis was used to determine the probability of surgical success. The average age of the patients was 32.7 years (range 4-65), and the mean duration of follow-up was 21.4 months (range 6-96). Preoperatively, the mean IOP was 26.94 mmHg (standard deviation [SD] 7.03), and the patients were using 2.8 glaucoma medications on average (SD 0.9). The mean IOP decreased significantly to 13.28 mmHg (SD 3.59) at the last postoperative visit (P = 0.00) while the patients needed even fewer glaucoma medications on average (1.4 ± 1.1, P = 0.00). Surgical success of second glaucoma drainage devices (Kaplan-Meier analysis), according to criterion 1, at 6, 12, 18, and 42 months was 94%, 85%, 80%, and 53% respectively, and according to criterion 2, was 94%, 85%, 75%, and 45%, respectively. Repeated AGV implantation seems to be a safe modality of treatment with acceptable success rate in cases with failed previous AGV surgery.

  1. Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

    Nimet Yeşim Erçalık

    2018-01-01

    Full Text Available Purpose. To evaluate the outcomes of Ahmed glaucoma valve (AGV implantation in vitrectomized eyes. Materials and Methods. The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP, best-corrected visual acuity (BCVA, number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. Results. The mean follow-up duration was 11.7 ± 5.5 (range, 6–23 months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001 and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021. At the last visit, 11 eyes (84.4% had stable or improved VA and one eye (7.7% had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%. Postoperative complications were bleb encapsulation (69.2%, early hypotony (38.5%, hyphema (23.1%, decompression retinopathy (23.1%, choroidal detachment (15.4%, intraocular hemorrhage (7.7%, and late endophthalmitis (7.7%. One eye (7.7% was enucleated because of late endophthalmitis. Conclusions. Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

  2. Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes.

    Erçalık, Nimet Yeşim; İmamoğlu, Serhat

    2018-01-01

    To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. The mean follow-up duration was 11.7 ± 5.5 (range, 6-23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg ( p =0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 ( p =0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis. Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

  3. The effect of an Ahmed glaucoma valve implant on corneal endothelial cell density in children with glaucoma secondary to uveitis.

    Kalinina Ayuso, Viera; Scheerlinck, Laura M; de Boer, Joke H

    2013-03-01

    To assess the effect of Ahmed glaucoma valve implants on corneal endothelial cell density (ECD) in children with uveitic glaucoma. Cross-sectional study. setting: Institutional. patientpopulation: Eighty eyes from 42 patients diagnosed with uveitis before the age of 16. Twenty-eight eyes had an Ahmed glaucoma valve implant because of secondary glaucoma. Fifty-two eyes without an implant served as controls. intervention orobservationprocedure(s): Corneal ECD was examined cross-sectionally using a noncontact specular microscope. Univariate and multivariate generalized estimating equations analyses with correction for paired eyes were performed. mainoutcomemeasure(s): Correlation of ECD with the presence of an Ahmed glaucoma valve implant and with the time following implantation. ECD was significantly lower in the Ahmed glaucoma valve group than in controls (2359 and 3088 cells/mm(2), respectively; P Ahmed glaucoma valve implantation. Presence of an Ahmed glaucoma valve implant, previous intraocular surgery, age, duration of uveitis, and history of corneal touch by the implant tube were all significantly associated with decreased ECD. Following a multivariate analysis, presence of an Ahmed glaucoma valve implant (B = -340; adjusted P Ahmed glaucoma valve implantation was highly correlated with decreased ECD (B = -558, P Ahmed glaucoma valve implants in children with uveitic glaucoma are independently associated with decreased ECD, and this effect is associated with the time interval following Ahmed glaucoma valve implantation. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Endophthalmitis associated with the Ahmed glaucoma valve implant.

    Al-Torbak, A A; Al-Shahwan, S; Al-Jadaan, I; Al-Hommadi, A; Edward, D P

    2005-04-01

    To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended.

  5. Endophthalmitis associated with the Ahmed glaucoma valve implant

    Al-Torbak, A A; Al-Shahwan, S; Al-Jadaan, I; Al-Hommadi, A; Edward, D P

    2005-01-01

    Aim: To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. Methods: A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. Results: 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Conclusion: Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended. PMID:15774923

  6. Glaucoma in modified osteo-odonto-keratoprosthesis eyes: role of additional stage 1A and Ahmed glaucoma drainage device-technique and timing.

    Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Shetty, Roshni; Krishnamoorthy, Sripriya; Balekudaru, Shantha; Vijaya, Lingam

    2015-03-01

    To report the technique, timing, and outcomes of the Ahmed glaucoma drainage device in eyes with the modified osteo-odonto-keratoprosthesis (MOOKP) and the role of an additional stage 1A to the Rome-Vienna protocol. Retrospective interventional case series. Case records of 22 eyes of 20 patients with high intraocular pressure at various stages of the MOOKP procedure performed in 85 eyes of 82 patients were studied. Stage 1A, which includes total iridodialysis, intracapsular cataract extraction, and anterior vitrectomy, was done in all eyes as the primary stage. Seventeen Ahmed glaucoma drainage devices were implanted in 15 eyes of 14 patients (chemical injury in 9 [10 eyes] and Stevens-Johnson syndrome in 5 patients). Implantation was performed during and after stage 1A in 2 and 7 eyes, respectively, after stage 1B+1C in 1 eye, and after stage 2 in 6 eyes. Eleven of 15 eyes (73.3%) remained stable with adequate control of intraocular pressure over a mean follow-up period of 33.68 months (1-90 months). Complications related to the drainage device were hypotony in 1 eye and vitreous block of the tube in 1 eye. It is ideal to place the Ahmed glaucoma drainage device prior to the mucosal graft when the anatomy of the ocular surface is least altered with best outcomes. The technique of placement of the drainage device during the various stages of the MOOKP procedure has been described. The intraocular pressure stabilized in three quarters of the eyes with pre-existing glaucoma. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Case Series: Keratolimbal Allograft as a Patch Graft for Glaucoma Drainage Devices.

    Ahmed, Sarah F; Schmutz, Mason; Mosaed, Sameh

    2017-09-01

    Tube exposure remains one of the most common complications after glaucoma drainage device (GDD) implantation, despite various types of patch grafts available today. We present a 4 patient case series following the effectivity of the keratolimbal allograft (KLAL) as a patch graft for cases of tube exposure. Given its inherent population of stem cells, our hypothesis was that this highly replicative, biological tissue would provide an adequate means of glaucoma tube coverage. The subset of patients chosen for the KLAL patch graft all had a history of abnormally scarred conjunctiva or thin sclera. The aim of utilizing the KLAL patch with its associated donor conjunctival and scleral ring was also to provide additional reinforcement and adequate tube coverage in the setting of compromised native tissue. Four patients comprised of 2 males and 2 females with a minimum postoperative period of 12 months. All GDDs were initially implanted with a limbal-based incision using either Ahmed glaucoma valve or Baerveldt drainage implant. Three of the 4 patients received the KLAL patch graft after tube exposure with scleral patch graft and 1 patient received KLAL as the primary graft during initial tube placement. Two of the 4 eyes experienced tube re-exposure postoperatively at 2 and 3 months, respectively. Both of these cases had a history of prior tube exposure after scleral patch graft and both were tubes placed in the pars plana. Interestingly, the patients with failed grafts were younger with a history of more ocular surgeries as compared with the patients with graft viable eyes. Through our case series, we found that the KLAL utilized as a patch graft over GDD tubes has the potential for favorable outcomes in certain subtypes of eyes. Although further large scale investigation will be necessary to better define the risk factors associated with graft failure, proving the graft's viability is a crucial first step.

  8. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma.

    Tang, Min; Fu, Yang; Wang, Ying; Zheng, Zhi; Fan, Ying; Sun, Xiaodong; Xu, Xun

    2016-01-09

    Neovascular glaucoma is a refractive glaucoma. Recently, anti-VEGF factors have been used alone or in combination for the treatment of neovascular glaucoma. However, the medium- and long-term efficacy of such drugs remains to be evaluated. This study was to determine the efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma. In this prospective non-randomized study, 43 neovascular glaucoma patients (43 eyes) were assigned to receive either 0.5 mg intravitreal ranibizumab for three to 14 days before Ahmed glaucoma valve implantation (injection group, n = 21) or Ahmed glaucoma valve implantation alone (control group, n = 22). The patients were followed up for six to 12 months. Differences in surgical success rate, intraocular pressure, best corrected visual acuity, anti-glaucoma medications and postoperative complications were compared between the two groups. Surgical success was defined as IOP > = 6 mm Hg and glaucoma medications, and without severe complications or reoperation. Of the 43 patients, 40 completed the 6-month follow-up and 37 completed the 1-year follow-up. Success rate was 73.7% vs. 71.4% at six months and 72.2% vs. 68.4% at 12 months in the injection group and the control group respectively. No significant difference was noted between the two groups (six months: P = 0.87, 12 months: P = 1.00). There were no significant differences in the two groups with respect to intraocular pressure, best corrected visual acuity, anti-glaucoma medications or postoperative complications at six months or 12 months. Single intravitreal ranibizumab (0.5 mg) before surgery has no significant effect on the medium- or long-term outcomes of neovascular glaucoma treated with Ahmed glaucoma valve implantation. Chinese Clinical Trial Registry ( ChiCTR-OOC-14005709, Trial registration date: 2014-12-01).

  9. Intracameral air injection during Ahmed glaucoma valve implantation in neovascular glaucoma for the prevention of tube obstruction with blood clot: Case Report.

    Hwang, Sung Ha; Yoo, Chungkwon; Kim, Yong Yeon; Lee, Dae Young; Nam, Dong Heun; Lee, Jong Yeon

    2017-12-01

    Glaucoma drainage implant surgery is a treatment option for the management of neovascular glaucoma. However, tube obstruction by blood clot after Ahmed glaucoma valve (AGV) implantation is an unpredictable clinically challenging situation. We report 4 cases using intracameral air injection for the prevention of the tube obstruction of AGV by blood clot. The first case was a 57-year-old female suffering from ocular pain because of a tube obstruction with blood clot after AGV implantation in neovascular glaucoma. Surgical blood clot removal was performed. However, intractable bleeding was noted during the removal of the blood clot, and so intracameral air injection was performed to prevent a recurrent tube obstruction. After the procedure, although blood clots formed around the tube, the tube opening where air could touch remained patent. In 3 cases of neovascular glaucoma with preoperative severe intraocular hemorrhages, intracameral air injection and AGV implantation were performed simultaneously. In all 3 cases, tube openings were patent. It appears that air impeded the blood clots formation in front of the tube opening. Intracameral air injection could be a feasible option to prevent tube obstruction of AGV implant with a blood clot in neovascular glaucoma with high risk of tube obstruction. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  10. A novel implantable glaucoma valve using ferrofluid.

    Eleftherios I Paschalis

    Full Text Available PURPOSE: To present a novel design of an implantable glaucoma valve based on ferrofluidic nanoparticles and to compare it with a well-established FDA approved valve. SETTING: Massachusetts Eye & Ear Infirmary, Boston, USA. METHODS: A glaucoma valve was designed using soft lithography techniques utilizing a water-immiscible magnetic fluid (ferrofluid as a pressure-sensitive barrier to aqueous flow. Two rare earth micro magnets were used to calibrate the opening and closing pressure. In-vitro flow measurements were performed to characterize the valve and to compare it to Ahmed™ glaucoma valve. The reliability and predictability of the new valve was verified by pressure/flow measurements over a period of three months and X-ray diffraction (XRD analysis over a period of eight weeks. In vivo assessment was performed in three rabbits. RESULTS: In the in vitro experiments, the opening and closing pressures of the valve were 10 and 7 mmHg, respectively. The measured flow/pressure response was linearly proportional and reproducible over a period of three months (1.8 µl/min at 12 mmHg; 4.3 µl/min at 16 mmHg; 7.6 µl/min at 21 mmHg. X-ray diffraction analysis did not show oxidization of the ferrofluid when exposed to water or air. Preliminary in vivo results suggest that the valve is biocompatible and can control the intraocular pressure in rabbits. CONCLUSIONS: The proposed valve utilizes ferrofluid as passive, tunable constriction element to provide highly predictable opening and closing pressures while maintaining ocular tone. The ferrofluid maintained its magnetic properties in the aqueous environment and provided linear flow to pressure response. Our in-vitro tests showed reliable and reproducible results over a study period of three months. Preliminary in-vivo results were very promising and currently more thorough investigation of this device is underway.

  11. Vitreous occlusion of tube implant in a phakic patient with traumatic glaucoma

    Suneeta Dubey

    2014-01-01

    Full Text Available Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management.

  12. [Long-term outcomes of Ahmed glaucoma valve implantation for treating refractory glaucoma].

    Xu, Yumei; Hong, Tao; Li, Wanming

    2015-02-10

    To explore the efficacies and complications of Ahmed glaucoma valve implantation for treating refractory glaucoma. A retrospective study of case series was conducted for 24 patients (26 eyes) with refractory glaucoma from February 2001 to July 2008 at our hospital. Ahmed glaucoma valve implantation was performed. Pre- and post-operative best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), number of medications and complications were recorded and analyzed. The follow-up period was 58-159 months. The post-operative values of IOP were 13.02+/-6.79, 11.43+/-5.24 and 18.56+/-6.43 mmHg at 1 day, 1 month and the last follow-up respectively. There were significant difference when compared with pre-operative IOP (37.59+/-10.76 mmHg, P glaucoma drugs after glaucoma valve implantation and the average number of medication was 1.72+/-0.98. There was significant difference with the pre-operative medication number 2.7 ± 0.7 (P = 0.001). The surgical success rate was 73.1%. And the causes of failure were endophthalmitis, corneal endothelial decompensation, persistent conjunctival wound non-healing, glaucoma valve exposure and loss of light perception.Early postoperative complications were ocular hypotony, shallow anterior chamber, hyphema, transient high IOP and tube occlusion. And long-term complications included encapsulated cyst formation, tube exposure, corneal endothelial decompensation and endophthalmitis. Ahmed glaucoma valve implantation is efficacious for refractory glaucoma.However, clinicians should pay attention to the prevention and treatment of complications.

  13. Clinical observation on Ahmed glaucoma valve implantation for teenagers with refractory glaucoma

    Dong-Dao Song

    2016-06-01

    Full Text Available AIM:To observe the clinical effect of Ahmed glaucoma valve(AGVimplantation for teenagers with refractory glaucoma. METHODS: Twenty-seven patients(27 eyeswith refractory glaucoma were treated with AGV implantation in our hospital from October 2012 to October 2014. The patients were followed up for 12mo. The success rate of the operation, postoperative intraocular pressure, the best corrected visual acuity, as well as complications were recorded. RESULTS: The success rate of the operation was 85%. The intraocular pressure of the 27 patients decreased from 48.3±8.3mmHg before operations to 21.4±8.1mmHg(PPCONCLUSION: AGV implantation is characterized by a high success rate, simple operation, less complications and is an effective treatment for refractory glaucoma in adolescents.

  14. Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

    Satana, Banu; Yalvac, Ilgaz S; Sungur, Gulten; Eksioglu, Umit; Basarir, Berna; Altan, Cigdem; Duman, Sunay

    2015-01-01

    To evaluate outcomes of patients with uveitic glaucoma secondary to Behçet disease (BD) who underwent Ahmed glaucoma valve (AGV) implantation. A retrospective chart review of 14 eyes of 10 patients with uveitic glaucoma associated with BD who underwent AGV implantation at a tertiary referral center. Treatment success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with or without antiglaucoma medication, without further additional glaucoma surgery or loss of light perception. The main outcome measures were IOP, best-corrected visual acuity measured with Snellen charts, and number of glaucoma medications. Mean duration of postoperative follow-up was 18.2±6.6 months (range, 6 to 31 mo). Of the 14 eyes, 10 (71.4%) were pseudophakic and 5 (35.7%) had primary AGV implantation without a history of previous glaucoma surgery. At the most recent follow-up visit, 13 of the 14 eyes had an IOP between 6 and 21 mm Hg. Mean IOP was significantly reduced during follow-up, as compared with preoperative values (P≤0.005). The cumulative probability of surgical success rate was 90.9% at 18 months based on Kaplan-Meier survival analysis. The mean number of antiglaucoma medications required to achieve the desired IOP decreased from 3.4±0.5 preoperatively to 1.0±1.1 postoperatively (P≤0.05). Visual acuity loss of >2 lines occurred in 4 eyes (28.5%) due to optic atrophy associated with retinal vasculitis. Temporary hypotony developed during follow-up in 4 eyes (28.5%) at first postoperative week. For the management of uveitic glaucoma associated with BD, AGV implantation is a successful method for glaucoma control but requires additional surgical interventions for high early hypotony rates.

  15. Ahmed glaucoma valve implant: surgical technique and complications.

    Riva, Ivano; Roberti, Gloria; Oddone, Francesco; Konstas, Anastasios Gp; Quaranta, Luciano

    2017-01-01

    Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications.

  16. Biodegradable microfabricated plug-filters for glaucoma drainage devices.

    Maleki, Teimour; Chitnis, Girish; Park, Jun Hyeong; Cantor, Louis B; Ziaie, Babak

    2012-06-01

    We report on the development of a batch fabricated biodegradable truncated-cone-shaped plug filter to overcome the postoperative hypotony in nonvalved glaucoma drainage devices. Plug filters are composed of biodegradable polymers that disappear once wound healing and bleb formation has progressed past the stage where hypotony from overfiltration may cause complications in the human eye. The biodegradable nature of device eliminates the risks associated with permanent valves that may become blocked or influence the aqueous fluid flow rate in the long term. The plug-filter geometry simplifies its integration with commercial shunts. Aqueous humor outflow regulation is achieved by controlling the diameter of a laser-drilled through-hole. The batch compatible fabrication involves a modified SU-8 molding to achieve truncated-cone-shaped pillars, polydimethylsiloxane micromolding, and hot embossing of biodegradable polymers. The developed plug filter is 500 μm long with base and apex plane diameters of 500 and 300 μm, respectively, and incorporates a laser-drilled through-hole with 44-μm effective diameter in the center.

  17. Critical Assessment of Implantable Drug Delivery Devices in Glaucoma Management

    Dharani Manickavasagam

    2013-01-01

    Full Text Available Glaucoma is a group of heterogeneous disorders involving progressive optic neuropathy that can culminate into visual impairment and irreversible blindness. Effective therapeutic interventions must address underlying vulnerability of retinal ganglion cells (RGCs to degeneration in conjunction with correcting other associated risk factors (such as elevated intraocular pressure. However, realization of therapeutic outcomes is heavily dependent on suitable delivery system that can overcome myriads of anatomical and physiological barriers to intraocular drug delivery. Development of clinically viable sustained release systems in glaucoma is a widely recognized unmet need. In this regard, implantable delivery systems may relieve the burden of chronic drug administration while potentially ensuring high intraocular drug bioavailability. Presently there are no FDA-approved implantable drug delivery devices for glaucoma even though there are several ongoing clinical studies. The paper critically assessed the prospects of polymeric implantable delivery systems in glaucoma while identifying factors that can dictate (a patient tolerability and acceptance, (b drug stability and drug release profiles, (c therapeutic efficacy, and (d toxicity and biocompatibility. The information gathered could be useful in future research and development efforts on implantable delivery systems in glaucoma.

  18. XEN Gel Implant: a new surgical approach in glaucoma.

    Chaudhary, Ankita; Salinas, Lauriane; Guidotti, Jacopo; Mermoud, André; Mansouri, Kaweh

    2018-01-01

    Glaucoma is a leading cause of blindness worldwide. Intraocular pressure (IOP) lowering is the only effective treatment strategy. Traditional glaucoma surgeries are generally considered to be unpredictable and associated with a high rate of complications. This has led to the development of a novel XEN Gel Implant, a type of minimally invasive glaucoma surgery (MIGS), lowering the IOP without extensive surgical dissection. Areas covered: A literature search was undertaken on PubMed using the terms XEN glaucoma, gelatin microstent, and MIGS. All the articles and case reports on XEN Gel Implant and selected articles on MIGS were studied and reviewed. We have discussed the results of most studies on XEN Gel Implant related to its efficacy, safety and success. Expert commentary: The XEN Gel Implant effectively lowers IOP and medication use, with a favorable safety profile. Long-term data on its success and cost-effectiveness are lacking. The studies have shown it to be without any serious adverse events and to have good safety profile encouraging future research on this novel implant. There is a need to correctly identify selection criteria for patients, who would benefit the most from the XEN Gel Implant.

  19. Long-term clinical outcomes of Ahmed valve implantation in patients with refractory glaucoma.

    Chang Kyu Lee

    Full Text Available To evaluate the long-term efficacy of intraocular pressure (IOP reduction and complications of Ahmed Glaucoma Valve (AGV implantation in patients with refractory glaucoma.Retrospective study.The study involved 302 refractory glaucoma patients who underwent AGV implantation and had a minimum follow-up of 6 months between March 1995 and December 2013.An operation was defined as successful when (1 the postoperative IOP remained between 5 and 21 mmHg and was reduced 30% compared to the baseline IOP with or without medication, (2 there was no loss of light perception or vision-threatening severe complications, and (3 no additional filtering or aqueous drainage surgery was required. Clinical records were reviewed.IOP, anti-glaucoma medications, and complications.The mean follow-up period was 62.25 months (range, 6 to 190 months. The cumulative probability of success was 89% at 6 months, 81% at 1 year, 66% at 3 years, 44% at 10 years, and 26% at 15 years. IOP was reduced from a mean of 32.2 ± 10.5 mmHg to 18.6 ± 9.1 mmHg at 1 month, 15.2 ± 7.0 mmHg at 6 months, and 14.2 ± 3.5 mmHg at 15 years. Surgical failures were significantly increased when preoperative IOP was high, and when severe complications occurred after AGV implantation (P < 0.05.AGV implantation was successful for IOP control in patients with refractive glaucoma in the long term. However, the success rate of surgery decreased over time. Preoperative high IOP and severe complications related to the operation were significant risk factors for failure.

  20. Surgical Outcomes of Additional Ahmed Glaucoma Valve Implantation in Refractory Glaucoma.

    Ko, Sung Ju; Hwang, Young Hoon; Ahn, Sang Il; Kim, Hwang Ki

    2016-06-01

    To evaluate the surgical outcomes of the implantation of an additional Ahmed glaucoma valve (AGV) into the eyes of patients with refractory glaucoma following previous AGV implantation. This study is a retrospective review of the clinical histories of 23 patients who had undergone a second AGV implantation after a failed initial implantation. Age, sex, prior surgery, glaucoma type, number of medications, intraocular pressure (IOP), visual acuity, and surgical complications were analyzed. Surgical success was defined as IOP maintained below 21 mm Hg, with at least a 20% overall reduction in IOP, regardless of the use of IOP-lowering medications. Following the implantation of a second AGV, the mean IOP decreased from 39.3 to 18.5 mm Hg (52.9% reduction, P<0.001). The mean number of postoperative IOP-lowering medications administered decreased from 2.8 to 1.7 after the second AGV implantation (P<0.001). The cumulative probability of success for the procedure was 87% after 1 year and 52% after 3 years. Three patients (13.0%) experienced bullous keratopathy after the second AGV implantation. None of the patients showed any evidence of diplopia or ocular movement limitation as a result of the presence of 2 AGVs in the same eye. Prior trabeculectomy was found to be a significant risk factor for failure (P=0.027). A second AGV implantation can be a good choice of surgical treatment when the first AGV has failed to control IOP.

  1. Intraocular pressure control of a novel glaucoma drainage device - in vitro and in vivo studies

    Li-Jun Cui

    2017-09-01

    Full Text Available AIM: To evaluate the intraocular pressure (IOP control of an artificial trabeculum drainage system (ATDS, a newly designed glaucoma drainage device, and postoperative complications in normal rabbit eyes. METHODS: Pressure drops in air and fluid of 30 ATDS were measured after being connected to a closed manometric system. Twenty of them were then chosen and implanted randomly into the eyes of 20 rabbits. Postoperative slit-lamp, gonioscopic examination and IOP measurements were recorded periodically. Ultrasound biomicroscopy and B-scan ultrasonography were also used to observe the complications. Eyes were enucleated on day 60. RESULTS: Pressure drops of 4.6-9.4 mm Hg were obtained at physiological aqueous flow rates in the tests in vitro. The average postoperative IOP of the experimental eyes (11.6-12.8 mm Hg was lower than the controls significantly (P<0.05 at each time point. Complications of hemorrhage (n=1, cellulosic exudation (two cases and local iris congestion (two cases were observed. The lumina of the devices were devoid of obstructions in all specimens examined and a thin fibrous capsule was found around the endplate. CONCLUSION: ATDS reduce IOP effectively. However, further studies on the structure are needed to reduce complications.

  2. Long-term clinical outcomes of Ahmed valve implantation in patients with refractory glaucoma.

    Lee, Chang Kyu; Ma, Kyoung Tak; Hong, Young Jae; Kim, Chan Yun

    2017-01-01

    To evaluate the long-term efficacy of intraocular pressure (IOP) reduction and complications of Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma. Retrospective study. The study involved 302 refractory glaucoma patients who underwent AGV implantation and had a minimum follow-up of 6 months between March 1995 and December 2013. An operation was defined as successful when (1) the postoperative IOP remained between 5 and 21 mmHg and was reduced 30% compared to the baseline IOP with or without medication, (2) there was no loss of light perception or vision-threatening severe complications, and (3) no additional filtering or aqueous drainage surgery was required. Clinical records were reviewed. IOP, anti-glaucoma medications, and complications. The mean follow-up period was 62.25 months (range, 6 to 190 months). The cumulative probability of success was 89% at 6 months, 81% at 1 year, 66% at 3 years, 44% at 10 years, and 26% at 15 years. IOP was reduced from a mean of 32.2 ± 10.5 mmHg to 18.6 ± 9.1 mmHg at 1 month, 15.2 ± 7.0 mmHg at 6 months, and 14.2 ± 3.5 mmHg at 15 years. Surgical failures were significantly increased when preoperative IOP was high, and when severe complications occurred after AGV implantation (P glaucoma in the long term. However, the success rate of surgery decreased over time. Preoperative high IOP and severe complications related to the operation were significant risk factors for failure.

  3. Effect of Ahmed valve implantation on late neovascular glaucoma

    Ping-An Mao

    2013-09-01

    Full Text Available AIM: To discuss the effect and safety of Ahmed valve implantation in late neovascular glaucoma. METHODS: The Ahmed glaucoma valve were implanted in 41 eyes(41 caseswith late neovascular glaucoma, the follow-up was 12 months on average, intraocular pressure was recorded at 1 day, 1 week, 1 month, 3, 6, 12 months respectively after operation and compared with that before operation, at the same time, the complications and treatment were analyzed.RESULTS: The mean intraocular pressure before operation, 1 day, 1 week, 1 month, 3, 6, 12 months after operation was 59.83±5.53, 19.27±8.19, 19.69±6.86, 20.67±6.73, 21.05±6.93, 21.49±7.42, 22.14±8.08mmHg, the mean intraocular pressure before operation was higher than that after operation and the difference was obvious in statistics. Major complications included hyphema, low intraocular pressure early postoperation, shallow anterior chamber, obstruction of the tube, the plate wrapped or exposed.CONCLUSION: Ahmed valve implantation is an effective method to treatlate neovascular glaucoma.

  4. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    Huang J

    2015-06-01

    Full Text Available Jingjing Huang,1 Jialiu Lin,1 Ziqiang Wu,2 Hongzhi Xu,3 Chengguo Zuo,1 Jian Ge1 1State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Center for Advanced Eye Care, Carson City, NV, USA; 3Institute of Child Health Policy, University of Florida, Gainesville, FL, USA Purpose: The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries.Patients and methods: Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1 intraocular pressure (IOP ≥6 and ≤21 mmHg; 2 IOP reduction of at least 30% relative to preoperative values; and 3 without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications.Results: Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80 mm, corneal diameter was 14.71±1.07 (13.0–16.0 mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0, and IOP was 39.5±5.7 (30–55 mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18 months. There were significant reductions in IOPs and the number of glaucoma medications (P<0.001 postoperatively. The IOPs after operation were 11.3±3.4, 13.6±5.1, 16.3±2.7, and 16.1±2.6 mmHg at 1 month, 6 months, 12 months, and 18 months, respectively. Kaplan–Meier estimates of the cumulative probability of valve success were 85.7%, 71.4%, and 71.4% at 6, 12, and 18 months, respectively. Severe surgical complications, including erosion of tube, endophthalmitis, retinal detachment, choroidal detachment, and delayed suprachoroidal hemorrhage, occurred in 28

  5. Supra-Tenon Capsule Implantation of the Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma.

    Elhefney, Eman M; Al-Sharkawy, Hossam T; Kishk, Hanem M

    2016-09-01

    To evaluate the efficacy of supra-Tenon capsule implantation of an Ahmed glaucoma valve (AGV) as a measure to decrease the fibrotic potential of the Tenon capsule on bleb formation and its subsequent effect on intraocular pressure (IOP) control in children with refractory glaucoma. Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. A prospective interventional study. Twenty-two eyes of 12 children with refractory glaucoma underwent supra-Tenon capsule implantation of AGV. Ophthalmic examinations under general anesthesia including measurement of the corneal diameter and the IOP with Perkin's tonometer were performed preoperatively, on the first postoperative day, the first postoperative week, weekly for the first month, 2-weekly for the following 3 months, and monthly for at least 18 months. Postoperative complications and the number of glaucoma medications used preoperatively and postoperatively were recorded. The paired Student t test was used to compare preoperative and postoperative data. There were 12 eyes (54.6%) with refractory congenital glaucoma, 7 eyes (31.8%) with refractory pseudophakic glaucoma, and 3 eyes (13.6%) with refractory aphakic glaucoma. Patients included 10 male (83.3%) and 2 female (16.7%) children with a mean age of 16.3±9.7 months. The mean follow-up duration was 24.1±4.3 months. There was a statistically significant difference between the mean preoperative IOP (30.7±2.88 mm Hg) and the mean postoperative IOP (16.1±3.60 mm Hg) (t=16.22 and P=0.000, with a mean decrease in the IOP by 47.6%). The difference between the mean number of antiglaucoma medications before surgery (1.86±0.4) and after surgery (1.0±0.9) was also statistically significant (t=4.31 and P=0.000). Total success was achieved in 18 eyes (81.9%). Postoperative complications included tube exposure and slippage (10%), hypotony (10%), and hyphema (5%). Supra-Tenon capsule implantation of the AGV was successful in controlling the IOP with few

  6. Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman

    Shah, Manali R.; Khandekar, Rajiv B.; Zutshi, Rajiv; Mahrooqi, Rahima

    2013-01-01

    Background: We present outcomes of Ahmed Glaucoma Valve (AGV) implantation in treating refractory glaucoma in a tertiary hospital in Oman. Refractory glaucoma was defined as previously failed conventional glaucoma surgery and an uncontrolled intraocular pressure (IOP) of more than 21 mm Hg despite treatment with three topical and/or oral therapy. Materials and Methods: This historical cohort study was conducted in 2010. Details of medical and surgical treatment were recorded. Ophthalmologists examined eyes and performed glaucoma surgeries using AGV. The best corrected distant vision, IOP, and glaucoma medications were prospectively reviewed on 1st day, 1st, 6th, 12th week postoperatively, and at the last follow up. Result: Glaucoma specialists examined and treated 40 eyes with refractory glaucoma of 39 patients (20 males + 19 females). Neo-vascular glaucoma was present in 23 eyes. Vision before surgery was glaucoma medications (2.38; SD 1.1) was reduced compared to the mean number of postoperative medications (1.92; SD 0.9) at 12 weeks. Conclusion: We succeeded in reducing visual disabilities and the number of anti-glaucoma medications used to treat refractory glaucoma by AGV surgery. PMID:23772122

  7. Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy

    Zhi-Qin Wu

    2016-07-01

    Full Text Available AIM: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy. METHODS: Thirty-six patients(36 eyeswith prior failed sequential trabeculectomy who underwent Ahmed glaucoma valve implantation were included. The intraocular pressure(IOP, best corrected visual acuity(BCVAand complications were ovserved and all the patients were followed up at least for 12mo. RESULTS: Mean preoperative IOP was 35.20±7.28mmHg and reduced to 10.15±3.34, 11.23±3.56, 15.63±5.72, 17.17±5.47, 17.73±6.23,19.76±5.43mmHg at 1, 2wk, 1, 3, 6 and 12mo after surgery, which was significant different from the preoperative level(t=12.643, 11.837, 10.324, 8.839, 8.462, 8.046, all PZ=-0.420, P>0.05. At 12mo after operation, the complete success rate reached 78% and the conditional success rate reached 92%. There were 5 eyes complicated with shallow anterior chamber, 3 eye complicated with anterior chamber hemorrhage, which all recovered after additional treatments. Late complications included valve exposure and encapsulated cystic blebs around the plate. Severe corneal endothelium loss occurred in 1 patient. CONCLUSION: Ahmed glaucoma valve implantation is effective in reducing IOP at 1-year follow-up in refractory glaucoma patients with prior sequential failed trabeculectomy, but we should fully understand and attach great importance to all kinds of complications that may occur.

  8. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure.

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56-30.80) mm, corneal diameter was 14.71±1.07 (13.0-16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9-1.0), and IOP was 39.5±5.7 (30-55) mmHg. The mean follow-up time was 18.29±10.96 (5-44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (Pvalve success were 85.7%, 71.4%, and 71.4% at 6, 12, and 18 months, respectively. Severe surgical complications, including erosion of tube, endophthalmitis, retinal detachment, choroidal detachment, and delayed suprachoroidal hemorrhage, occurred in 28.6% cases. AGV implantation remains a viable option for patients with advanced primary congenital glaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications.

  9. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    Purpose The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Patients and methods Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Results Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80) mm, corneal diameter was 14.71±1.07 (13.0–16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0), and IOP was 39.5±5.7 (30–55) mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (Pglaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications. PMID:26082610

  10. A prospective comparative study on neovascular glaucoma and non-neovascular refractory glaucoma following Ahmed glaucoma valve implantation.

    Li, Zheng; Zhou, Minwen; Wang, Wei; Huang, Wenbin; Chen, Shida; Li, Xingyi; Gao, Xinbo; Zhang, Xiulan

    2014-01-01

    Neovascular glaucoma is a refractory disease, and difficult to manage. The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) and non-NVG patients. This prospective, non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG (NVG group) and 28 had non-NVG (non-NVG group). All of the patients underwent AGVI. The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab (IVR/IVB) before AGVI. Intraocular pressure (IOP) was the primary outcome measure in this study. Surgical success rate, number of antiglaucoma medications used, best corrected visual acuity (BCVA), and postoperative complications were analyzed between the groups. All of the patients completed the study (follow-up of 12 months). Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5% and 92.9%, respectively; this difference was significant (P = 0.036). The complete success rates in the NVG and non-NVG groups at 12 months were 66.7% and 89.3%, respectively (P = 0.049). Compared with preoperative examinations, the postoperative mean IOP and use of medications were significantly lower at all follow-up time points in both groups (all P glaucoma, but the success rate of surgery was related to the type of refractory glaucoma. The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients.

  11. Intermediate-term and long-term outcome of piggyback drainage: connecting glaucoma drainage device to a device in-situ for improved intraocular pressure control.

    Dervan, Edward; Lee, Edward; Giubilato, Antonio; Khanam, Tina; Maghsoudlou, Panayiotis; Morgan, William H

    2017-11-01

    This study provides results of a treatment option for patients with failed primary glaucoma drainage device. The study aimed to describe and evaluate the long-term intraocular pressure control and complications of a new technique joining a second glaucoma drainage device directly to an existing glaucoma drainage device termed 'piggyback drainage'. This is a retrospective, interventional cohort study. Eighteen eyes of 17 patients who underwent piggyback drainage between 2004 and 2013 inclusive have been studied. All patients had prior glaucoma drainage device with uncontrolled intraocular pressure. The piggyback technique involved suturing a Baerveldt (250 or 350 mm) or Molteno3 glaucoma drainage device to an unused scleral quadrant and connecting the silicone tube to the primary plate bleb. Failure of intraocular pressure control defined as an intraocular pressure greater than 21 mmHg on maximal therapy on two separate occasions or further intervention to control intraocular pressure. The intraocular pressure was controlled in seven eyes (39%) at last follow-up with a mean follow-up time of 74.2 months. The mean preoperative intraocular pressure was 27.1 mmHg (95% confidence interval 23.8-30.3) compared with 18.4 mmHg (95% confidence interval 13.9-22.8) at last follow-up. The mean time to failure was 57.1 months (95% confidence interval 32.2-82), and the mean time to further surgery was 72.3 months (95% confidence interval 49.9-94.7). Lower preoperative intraocular pressure was associated with longer duration of intraocular pressure control (P = 0.048). If the intraocular pressure was controlled over 2 years, it continued to be controlled over the long term. Two eyes (11%) experienced corneal decompensation. Piggyback drainage represents a viable surgical alternative for the treatment of patients with severe glaucoma with failing primary glaucoma drainage device, particularly in those at high risk of corneal decompensation. © 2017 Royal Australian and New Zealand

  12. Evaluation of two different operations to implant the Ahmed glaucoma valve in patients with refractory glaucoma

    Yue Wu

    2016-04-01

    Full Text Available AIM:To evaluate the efficacy and safety of Ahmed glaucoma valve(AGVimplantation surgery using different methods. METHODS:This was a retrospective study of patients with refractory glaucoma in whom AGV implantation was performed between June 2011 and September 2014. According to the method of tube insertion into the anterior chamber, the sample was divided into two groups, needle-generated scleral tunnel and scleral flap. The surgical success rate, intraocular pressure(IOP, number of antiglaucoma medications used, best correct visual acuity, postoperative complications, and operation duration were analyzed between the two groups. RESULTS:Compared with preoperative data, the two groups showed statistically significant decrease on IOP and the number of antiglaucoma medication used at all follow-up points(PP=0.932; however, statistically significant differences were detected when flat anterior chamber complications between the needle-generated scleral tunnel group(6%and the scleral flap group(24%were compared(P=0.032. CONCLUSION:AGV implantation may be an effective method in managing refractory glaucoma, since the two methods have similar efficacy. However, the needle-generated scleral tunnel technique application could greatly decrease the incidence of flat anterior chamber complications and decrease the duration of the operation.

  13. Initial clinical experience with Ahmed Valve implantation in refractory pediatric glaucoma

    Novak-Lauš, Katia; Škunca Herman, Jelena; Šimić Prskalo, Marija; Jurišić, Darija; Mandić, Zdravko

    2016-01-01

    The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of I...

  14. Biodegradable radioactive implants for glaucoma filtering surgery produced by ion implantation

    Assmann, W. [Department fuer Physik, Ludwig-Maximilians-Universitaet Muenchen, 85748 Garching (Germany)]. E-mail: walter.assmann@lmu.de; Schubert, M. [Department fuer Physik, Ludwig-Maximilians-Universitaet Muenchen, 85748 Garching (Germany); Held, A. [Augenklinik, Technische Universitaet Muenchen, 81675 Munich (Germany); Pichler, A. [Augenklinik, Technische Universitaet Muenchen, 81675 Muenchen (Germany); Chill, A. [Zentralinstitut fuer Medizintechnik, Technische Universitaet Muenchen, 85748 Garching (Germany); Kiermaier, S. [Zentralinstitut fuer Medizintechnik, Technische Universitaet Muenchen, 85748 Garching (Germany); Schloesser, K. [Forschungszentrum Karlsruhe, 76021 Karlsruhe (Germany); Busch, H. [NTTF GmbH, 53619 Rheinbreitbach (Germany); Schenk, K. [NTTF GmbH, 53619 Rheinbreitbach (Germany); Streufert, D. [Acri.Tec GmbH, 16761 Hennigsdorf (Germany); Lanzl, I. [Augenklinik, Technische Universitaet Muenchen, 81675 Munich (Germany)

    2007-04-15

    A biodegradable, {beta}-emitting implant has been developed and successfully tested which prevents fresh intraocular pressure increase after glaucoma filtering surgery. Ion implantation has been used to load the polymeric implants with the {beta}-emitter {sup 32}P. The influence of ion implantation and gamma sterilisation on degradation and {sup 32}P-fixation behavior has been studied by ion beam and chemical analysis. Irradiation effects due to the applied ion fluence (10{sup 15} ions/cm{sup 2}) and gamma dose (25 kGy) are found to be tolerable.

  15. Combined Glaucoma Tube Shunt (Ahmed) and Fluocinolone Acetonide (Retisert™) Implantation Compared to Ahmed Alone in Uveitic Glaucoma.

    Zivney, Mark; Lin, Phoebe; Edmunds, Beth; Parikh, Mansi; Takusagawa, Hana; Tehrani, Shandiz

    2016-12-01

    Glaucoma is a known complication of uveitis, and may require glaucoma tube shunt implantation for intraocular pressure (IOP) control. The success of glaucoma tube shunt implantation in the setting of a local ocular steroid depot in uveitic glaucoma remains unknown. The purpose of this study was to determine whether patients who underwent combined glaucoma tube shunt (Ahmed) and fluocinolone acetonide (Retisert™, Bausch + Lomb, Bridgewater, NJ, USA) implantation have superior outcomes compared to patients with Ahmed implants only in the setting of uveitic glaucoma. All participants were studied retrospectively and underwent Ahmed implantation alone or with existing/concurrent Retisert implantation (combined group) at a single academic institution. The main outcome measures were IOP, visual acuity (VA), number of IOP-lowering medications, and adverse events at 6 months after Ahmed implantation. Secondary outcome measures included adverse events and surgical success at 6 months after Ahmed implantation. Mean IOP at 6 months after Ahmed implantation was 15.3 ± 4.8 and 15.1 ± 4.9 mm Hg in the Ahmed only group (n = 17) and the combined group (n = 17), respectively (p = 0.89). The mean number of IOP-lowering medications at 6 months after Ahmed implantation was 1.7 ± 1.0 and 1.8 ± 1.0 in the Ahmed only group and the combined group, respectively (p = 0.86). Mean VA at 6 months after Ahmed implantation was 0.35 ± 0.29 and 0.42 ± 0.33 log mean angle of resolution in the Ahmed only group and the combined group, respectively (p = 0.50). No significant differences in surgical success or adverse events were noted between the two groups. At 6 months, no significant differences in mean IOP, mean number of IOP-lowering medications, VA, surgical success, or adverse events were noted between Ahmed implantation alone or combined Ahmed and Retisert implantation in patients with uveitic glaucoma.

  16. Angle closure glaucoma in congenital ectropion uvea

    Grace M. Wang

    2018-06-01

    Full Text Available Purpose: Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Observations: Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months and required additional surgery (cycloablation or trabeculectomy. Conclusions and importance: Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control. Keywords: Congenital ectropion uvea, Juvenile glaucoma, Angle-closure glaucoma, Glaucoma drainage device

  17. Development of a micro-mechanical valve in a novel glaucoma implant.

    Siewert, Stefan; Schultze, Christine; Schmidt, Wolfram; Hinze, Ulf; Chichkov, Boris; Wree, Andreas; Sternberg, Katrin; Allemann, Reto; Guthoff, Rudolf; Schmitz, Klaus-Peter

    2012-10-01

    This paper describes methods for design, manufacturing and characterization of a micro-mechanical valve for a novel glaucoma implant. The implant is designed to drain aqueous humour from the anterior chamber of the eye into the suprachoroidal space in case of an elevated intraocular pressure (IOP). In contrast to any existing glaucoma drainage device (GDD), the valve mechanism is located in the anterior chamber and there, surrounded by aqueous humour, immune to fibrosis induced failure. For the prevention of hypotony the micro-mechanical valve is designed to open if the physiological pressure difference between the anterior chamber and the suprachoroidal space in the range of 0.8 mmHg to 3.7 mmHg is exceeded. In particular the work includes: (i) manufacturing and morphological characterization of polymer tubing, (ii) mechanical material testing as basis for (iii) the design of micro-mechanical valves using finite element analysis (FEA), (iv) manufacturing of microstent prototypes including micro-mechanical valves by femtosecond laser micromachining and (v) the experimental fluid-mechanical characterization of the manufactured microstent prototypes with regard to valve opening pressure. The considered materials polyurethane (PUR) and silicone (SIL) exhibit low elastic modulus and high extensibility. The unique valve design enables a low opening pressure of micro-mechanical valves. An ideal valve design for PUR and SIL with an experimentally determined opening pressure of 2 mmHg and 3.7 mmHg is identified. The presented valve approach is suitable for the inhibition of hypotony as a major limitation of today's GDD and will potentially improve the minimally invasive treatment of glaucoma.

  18. Comparison of the Ahmed glaucoma valve with the Baerveldt glaucoma implant: a meta-analysis.

    Wang, Yi-Wen; Wang, Ping-Bao; Zeng, Chao; Xia, Xiao-Bo

    2015-10-13

    This study aims to compare the efficacy and safety of the Ahmed glaucoma valve (AGV) with the Baerveldt glaucoma implant (BGI) in glaucoma patients. Databases were searched to identify studies that met pre-stated inclusion criteria, involving randomized controlled clinical trials (RCTs) and non-randomized controlled clinical trials. Treatment effect was analyzed using a random-effect model. Ten controlled clinical trials (1048 eyes) were analyzed, involving two RCTs and eight retrospective comparative studies. Short-term results (6-18 months) and long-term results (>18 months) were analyzed separately. There was no significant difference in the success rate for short-term follow-up between the AGV and BGI groups (5 studies, 714 eyes, odds ratio [OR]: 0.97; 95 % confidence interval [CI]: 0.56, 1.66; P = 0.90). For long-term pooled results (7 studies, 835 eyes), the success rate of AGVs was lower than that of BGIs (OR: 0.73; 95 % CI: 0.54, 0.99, P = 0.04), However, subgroup and sensitivity analyses did not show a significant difference in the success rate between the two groups (P ≥0.05). The AGV group had a higher mean intraocular pressure than the BGI group in short-term (6 studies, 685 eyes, weighted mean difference [WMD]: 2.12 mmHg; 95 % CI: 0.72-3.52; P glaucoma medications after implantation than the AGV group in two follow-up periods (all P <0.05). The AGV was found to be associated with a significantly lower frequency of total complications (8 studies, 971 eyes, OR: 0.67; 95 % CI: 0.50-0.90; P = 0.007) and severe complications (8 studies, 971 eyes, OR: 0.57; 95 % CI: 0.36-0.91; P = 0.02) than the BGI. The study showed no significant difference in success rate between the two groups. The BGI was more effective for control of intraocular pressure and required fewer medications than the AGV, but the AGV had lower incidence of total and severe complications than the BGI.

  19. Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors

    He, Ye; Tian, Ying; Song, Weitao; Su, Ting; Jiang, Haibo; Xia, Xiaobo

    2017-01-01

    Abstract This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating neovascular glaucoma (NVG) and to analyze the factors influencing the surgical success rate. This is a retrospective review of 40 eyes of 40 NVG patients who underwent AGV implantation at Xiangya Hospital of Central South University, China, between January 2014 and December 2016. Pre- and postoperative intraocular pressure (IOP), visual acuity, surgical success rate, medications, and complications were observed. Surgical success criteria were defined as IOP ≤21 and >6 mm Hg with or without additional medications. Kaplan–Meier survival curves and Multivariate cox regression analysis were used to examine success rates and risk factors for surgical outcomes. The mean follow-up period was 8.88 ± 3.12 months (range: 3–17). IOP declined at each visit postoperatively and it was statistically significant (P < .001). An average of 3.55 ± 0.86 drugs was applied preoperatively, while an average of 0.64 ± 0.90 drugs was used postoperatively, with the difference being of statistical significance (P < .05). The complete surgical success rate of 3, 6, and 12 months after the operation was 85%, 75%, and 65%, respectively. Meanwhile, the qualified success rate of 3, 6, and 12 months after the operation was 85%, 80%, and 77.5%, respectively. The multivariate cox regression analysis showed that age (hazard ratio: 3.717, 7.246; 95% confidence interval: 1.149–12.048, 1.349–38.461; P = .028, .021) was influencing factors for complete success rate and qualified success rate among all NVG patients. Gender, previous operation history, primary disease, and preoperative IOP were found to be not significant. AGV implantation is an effective and safe surgical method to treat NVG. Age is an important factor influencing the surgical success rate. PMID:29049253

  20. Glaucoma

    ... glaucoma Images Eye Slit-lamp exam Visual field test Glaucoma References Anderson DR. The optic nerve in glaucoma. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 . Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 3, chap 48. Giaconi JA, ...

  1. Glaucoma

    Full Text Available ... Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Glaucoma Embedded video for NEI YouTube Videos: Glaucoma Embedded video for NEI YouTube Videos: Glaucoma NEI ...

  2. Long-term Outcomes of Ahmed Glaucoma Valve Implantation in Refractory Glaucoma at Farabi Eye Hospital, Tehran, Iran.

    Zarei, Reza; Amini, Heidar; Daneshvar, Ramin; Nabi, Fahimeh Naderi; Moghimi, Sasan; Fakhraee, Ghasem; Eslami, Yadollah; Mohammadi, Masoud; Amini, Nima

    2016-01-01

    To describe long-term outcomes and complications of Ahmed glaucoma valve (AGV) implantation in subjects with refractory glaucoma at Farabi Eye Hospital, Tehran, Iran. This retrospective cohort study evaluated patient records of all subjects with refractory glaucoma who had undergone AGV implantation up to January 2013. The main outcome measure was the surgical success rate. Complete success was defined as intraocular pressure (IOP) glaucoma medications or additional surgery. Qualified success was IOP glaucoma medications. In all cases, loss of vision (no light perception) was considered an independent indicator of failure. Data were also collected on intraoperative and postoperative complications. Twenty-eight eyes were included in the study. With a mean follow-up of 48.2 ± 31.7 months (median: 40.50 months; range: 3-124 months), the IOP decreased from a mean preoperative value of 30.8 ± 5.6 mmHg to 20.0 ± 6.4 mmHg at last visit. The number of medications decreased from 3.7 ± 0.4 preoperatively to 2.5 ± 1.1 postoperatively. Cumulative qualified success was achieved in 69% of eyes. Mean time to failure according to qualified success criteria was 92.3 ± 9.4 months. Postoperative complications were recorded in 16 (57.1%) eyes. The most common complication was focal endothelial corneal decompensation at the site of tube-cornea touch. AGV implantation with adjunctive topical anti-glaucoma drops controlled IOP in approximately 70% of eyes with refractory glaucoma with a median of 40.5 months of follow-up. However, complication rates were higher.

  3. Mitomycin-C Trabeculectomy versus Ahmed Glaucoma Implant in Pediatric Aphakic Glaucoma

    Mohammad Pakravan

    2008-12-01

    Full Text Available

    PURPOSE: To compare the outcomes and complications of mitomycin-C trabeculectomy (MMC-T versus the Ahmed glaucoma implant (AGI for treatment of pediatric aphakic glaucoma. METHODS: In a randomized clinical trial, 30 eyes of 28 children < 16 years of age who had undergone anterior lensectomy-vitrectomy for congenital cataract were assigned to MMC-T (15 eyes of 13 children or AGI (15 eyes of 15 children. Surgical success was classified as complete (IOP 6-21 mmHg without any antiglaucoma medication and partial (IOP 6-21 mmHg with < 2 topical antiglaucoma agents in the absence of any sight-threatening complication or need for further glaucoma surgery, stable cup/disc ratios and visual loss < 2 Snellen lines. Overall success was defined as the sum of complete and partial success. RESULTS: Mean patient age was 9.1±4.1 and 10.9±5.1 years in the MMC-T and AGI groups, respectively (P=0.29. After a mean follow up of 14.8±11 and 13.1±9.7 months; complete, partial and overall success rates were 33.3%, 40% and 73.3% in the MMC-T vs 20%, 66.7% and 86.7% in the AGI groups, respectively (P= 0.361. Complication and failure rates were 40% and 26.7% in the MMC-T group vs 26.7% and 13.3% in the AGI group, respectively (P= 0.439. CONCLUSION: MMC-T and AGI seem to be comparable in terms of success and complications as the initial surgical

  4. Wound dehiscence and device migration after subconjunctival bevacizumab injection with Ahmed glaucoma valve implantation

    Arezoo Miraftabi; Naveed Nilforushan

    2016-01-01

    Purpose: To report a complication pertaining to subconjunctival bevacizumab injection as an adjunct to Ahmed Glaucoma Valve (AGV) implantation. Case Report: A 54-year-old woman with history of complicated cataract surgery was referred for advanced intractable glaucoma. AGV implantation with adjunctive subconjunctival bevacizumab (1.25 mg) was performed with satisfactory results during the first postoperative week. However, 10 days after surgery, she developed wound dehiscence and tube exposur...

  5. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

    Turalba, Angela; Pasquale,Louis

    2014-01-01

    Angela V Turalba,1,2 Louis R Pasquale1,2 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA Objective: To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Design: Retrospective comparative case series. Participants: Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receivi...

  6. Comparison of Six Different Silicones In Vitro for Application as Glaucoma Drainage Device

    Claudia Windhövel

    2018-02-01

    Full Text Available Silicones are widely used in medical applications. In ophthalmology, glaucoma drainage devices are utilized if conservative therapies are not applicable or have failed. Long-term success of these devices is limited by failure to control intraocular pressure due to fibrous encapsulation. Therefore, different medical approved silicones were tested in vitro for cell adhesion, cell proliferation and viability of human Sclera (hSF and human Tenon fibroblasts (hTF. The silicones were analysed also depending on the sample preparation according to the manufacturer’s instructions. The surface quality was characterized with environmental scanning electron microscope (ESEM and water contact angle measurements. All silicones showed homogeneous smooth and hydrophobic surfaces. Cell adhesion was significantly reduced on all silicones compared to the negative control. Proliferation index and cell viability were not influenced much. For development of a new glaucoma drainage device, the silicones Silbione LSR 4330 and Silbione LSR 4350, in this study, with low cell counts for hTF and low proliferation indices for hSF, and silicone Silastic MDX4-4210, with low cell counts for hSF and low proliferation indices for hTF, have shown the best results in vitro. Due to the high cell adhesion shown on Silicone LSR 40, 40,026, this material is unsuitable.

  7. Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

    Waisbourd, Michael; Fischer, Naomi; Shalev, Hadas; Spierer, Oriel; Ben Artsi, Elad; Rachmiel, Rony; Shemesh, Gabi; Kurtz, Shimon

    2016-01-01

    AIM To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (Pglaucoma surgeries. Therefore, the results are limited to the cohort included in this study. PMID:27803857

  8. Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up

    Kubaisi B

    2018-05-01

    Full Text Available Buraa Kubaisi,1,2 Arash Maleki,1,2 Aseef Ahmed,1,2 Neel Lamba,1,2 Haitham Sahawneh,1,2 Andrew Stephenson,1,2 Alyssa Montieth,1,2 Shobha Topgi,3 C Stephen Foster1,2,4 1Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; 2Ocular Immunology & Uveitis Foundation, Waltham, MA, USA; 3The State University of New York Downstate, Brooklyn, NY, USA; 4Harvard Medical School, Boston, MA, USA Purpose: To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™-induced glaucoma. Methods: This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015. Results: Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg. Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found. Conclusion: AGV is an effective and safe method of

  9. Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up.

    Kubaisi, Buraa; Maleki, Arash; Ahmed, Aseef; Lamba, Neel; Sahawneh, Haitham; Stephenson, Andrew; Montieth, Alyssa; Topgi, Shobha; Foster, C Stephen

    2018-01-01

    To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma. This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015. Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found. AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years.

  10. Propionibacterium acnes endophthalmitis in Ahmed glaucoma valve.

    Gutiérrez-Díaz, E; Montero-Rodríguez, M; Mencía-Gutiérrez, E; Fernández-González, M C; Pérez-Blázquez, E

    2001-01-01

    To report a case of Propionibacterium acnes endophthalmitis in a patient with an Ahmed glaucoma valve. A nine-year-old boy with bilateral congenital glaucoma, with an Ahmed glaucoma valve implanted in the left eye, had recurrent conjunctival dehiscence and endophthalmitis. Vitreous cultures demonstrated the presence of Propionibacterium acnes. This is the first reported case of Propionibacterium acnes endophthalmitis in an Ahmed glaucoma valve and the second one in a glaucoma drainage device. We strongly recommend using a patch graft to prevent and treat tube exposure. Conjunctival grafts may be useful to close the conjunctiva when there is marked scarring to prevent patch exposure and melting or extrusion.

  11. Development of a novel CsA-PLGA drug delivery system based on a glaucoma drainage device for the prevention of postoperative fibrosis

    Dai, Zhaoxing; Yu, Xiaobo; Hong, Jiaxu; Liu, Xi [Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031 (China); Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031 (China); Sun, Jianguo, E-mail: sjgsun@126.com [Research Center, Eye & ENT Hospital, Fudan University, Shanghai 200031 (China); Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031 (China); State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 200031 (China); Sun, Xinghuai, E-mail: xhsun@shmu.edu.cn [Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031 (China); Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031 (China)

    2016-09-01

    The formation of a scar after glaucoma surgery often leads to unsuccessful control of intraocular pressure, and should be prevented by using a variety of methods. We designed and developed a novel drug delivery system (DDS) comprising cyclosporine A (CsA) and poly(lactic-co-glycolic acid) (PLGA) based on a glaucoma drainage device (GDD) that can continuously release CsA to prevent postoperative fibrosis following glaucoma surgery. The CsA@PLGA@GDD DDS was observed by field emission scanning electron microscopy and revealed an asymmetric pore structure. Thermogravimetric analysis was performed to measure the weight loss and evaluate the thermal stability of the CsA@PLGA@GDD DDS. The in vitro drug release profile of the DDS was studied using high performance liquid chromatography, which confirmed that the DDS released CsA at a stable rate and maintained adequate CsA concentrations for a relatively long time. The biocompatibility of the DDS and the inhibitory effects on the postoperative fibrosis were investigated in vitro using rabbit Tenon's fibroblasts. The in vivo safety and efficacy of the DDS were examined by implanting the DDS into Tenon's capsules in New Zealand rabbits. Bleb morphology, intraocular pressure, anterior chamber reactions, and anterior chamber angiography were studied at a series of set times. The DDS kept the filtration pathway unblocked for a longer time compared with the control GDD. The results indicate that the CsA@PLGA@GDD DDS represents a safe and effective strategy for preventing scar formation after glaucoma surgery. - Highlights: • CsA@PLGA@GDD drug delivery system (DDS) was designed and prepared successfully. • The DDS released CsA at a stable rate for > 3 months. • The DDS kept filtration pathway unblocked for a longer time than control. • CsA@PLGA@GDD DDS prevented glaucoma scar formation as a safe and effective strategy.

  12. Development of a novel CsA-PLGA drug delivery system based on a glaucoma drainage device for the prevention of postoperative fibrosis

    Dai, Zhaoxing; Yu, Xiaobo; Hong, Jiaxu; Liu, Xi; Sun, Jianguo; Sun, Xinghuai

    2016-01-01

    The formation of a scar after glaucoma surgery often leads to unsuccessful control of intraocular pressure, and should be prevented by using a variety of methods. We designed and developed a novel drug delivery system (DDS) comprising cyclosporine A (CsA) and poly(lactic-co-glycolic acid) (PLGA) based on a glaucoma drainage device (GDD) that can continuously release CsA to prevent postoperative fibrosis following glaucoma surgery. The CsA@PLGA@GDD DDS was observed by field emission scanning electron microscopy and revealed an asymmetric pore structure. Thermogravimetric analysis was performed to measure the weight loss and evaluate the thermal stability of the CsA@PLGA@GDD DDS. The in vitro drug release profile of the DDS was studied using high performance liquid chromatography, which confirmed that the DDS released CsA at a stable rate and maintained adequate CsA concentrations for a relatively long time. The biocompatibility of the DDS and the inhibitory effects on the postoperative fibrosis were investigated in vitro using rabbit Tenon's fibroblasts. The in vivo safety and efficacy of the DDS were examined by implanting the DDS into Tenon's capsules in New Zealand rabbits. Bleb morphology, intraocular pressure, anterior chamber reactions, and anterior chamber angiography were studied at a series of set times. The DDS kept the filtration pathway unblocked for a longer time compared with the control GDD. The results indicate that the CsA@PLGA@GDD DDS represents a safe and effective strategy for preventing scar formation after glaucoma surgery. - Highlights: • CsA@PLGA@GDD drug delivery system (DDS) was designed and prepared successfully. • The DDS released CsA at a stable rate for > 3 months. • The DDS kept filtration pathway unblocked for a longer time than control. • CsA@PLGA@GDD DDS prevented glaucoma scar formation as a safe and effective strategy.

  13. Glaucoma

    Full Text Available ... Diabetic Eye Disease Education Program Glaucoma Education Program Low Vision Education Program Hispanic/Latino Program Vision and ... Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish ...

  14. Glaucoma

    Full Text Available ... Diabetic Eye Disease Education Program Glaucoma Education Program Low Vision Education Program Hispanic/Latino Program Vision and Aging ... Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos ...

  15. Glaucoma

    Full Text Available ... Eye Disease Dilated Eye Exam Dry Eye For Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Glaucoma Embedded ...

  16. Glaucoma

    Full Text Available ... YouTube Videos: Glaucoma Embedded video for NEI YouTube Videos: Glaucoma ... *PDF files require the free Adobe® Reader® software for viewing. This website is maintained by the ...

  17. Glaucoma

    Glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading ... no symptoms at first. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. ...

  18. A new design and application of bioelastomers for better control of intraocular pressure in a glaucoma drainage device.

    Luong, Quang Minh; Shang, Lei; Ang, Marcus; Kong, Jen Fong; Peng, Yan; Wong, Tina T; Venkatraman, Subbu S

    2014-02-01

    Glaucoma drainage device (GDD) implantation is an effective method of lowering the intraocular pressure (IOP). Commonly used GDDs can be classified into nonvalved and valved. Although a stable IOP is critical, currently available devices often cause extreme IOP fluctuations: nonvalved GDDs suffer from a risk of hypotony (IOP22 mmHg). It is hypothesized that a GDD with a valve designed to open around the time of onset of the hypertensive phase, would minimize IOP fluctuation. Accordingly, a valve fabricated from a biodegradable polymer poly(L-lactide-co-ϵ-caprolactone) (PLC 70/30) is evaluated in vitro and in vivo. The pressure response is compared with its non-degradable counterpart in in vitro studies of IOP. It is also established that in vitro, the biodegradability of the valve is programmed to occur over 12 weeks. In vivo, a steady and low IOP is achieved with the biodegradable valve and the hypertensive phase is significantly attenuated compared with the commercial device. Fibrotic encapsulation of the device is also minimized with the biodegradable valve in vivo. Copyright © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Use of a 350-mm2 Baerveldt glaucoma drainage device to maintain vision and control intraocular pressure in dogs with glaucoma: a retrospective study (2013-2016).

    Graham, Kathleen L; Donaldson, David; Billson, Francis A; Billson, F Mark

    2017-09-01

    To evaluate the 350-mm 2 Baerveldt glaucoma drainage device (GDD) in dogs with refractory glaucoma when modifications to address postoperative hypotony (extraluminal ligature; intraluminal stent) and the fibroproliferative response (intraoperative Mitomycin-C; postoperative oral colchicine and prednisolone) are implemented as reported in human ophthalmology. Retrospective case series. Twenty-eight client-owned dogs (32 eyes) including seven dogs (nine eyes) with primary glaucoma and 21 dogs (23 eyes) with secondary glaucoma. The medical records of all dogs undergoing placement of a 350-mm 2 Baerveldt GDD at a veterinary ophthalmology referral service between 2013 and 2016 were reviewed. Signalment, diagnosis, duration and previous treatment of glaucoma, previous intraocular surgery, IOP, visual, and surgical outcomes were recorded. IOP was maintained glaucoma medication were required following surgery. Vision was retained in 18 of 27 (66.7%) eyes with vision at the time of surgery. No eyes that were blind at the time of surgery (n = 5) had restoration of functional vision. Complications following surgery included hypotony (26/32; 81.3%), intraocular hypertension (24/32; 75.0%), and fibrin formation within the anterior chamber (20/32; 62.5%). The average follow-up after placement of the GDD was 361.1 days (median 395.6 days). Efforts to minimize postoperative hypotony and address the fibroproliferative response following placement of a 350-mm 2 Baerveldt GDD showed an increased success rate to other reports of this device in dogs and offers an alternative surgical treatment for controlling intraocular pressure in dogs with glaucoma. © 2016 American College of Veterinary Ophthalmologists.

  20. Evaluation of the tightness of contact between 
limbal sclera tunnel and tube following Ahmed 
glaucoma valve implantation.

    Holló, Gábor; Naghizadeh, Farzaneh

    2013-01-01

    To investigate whether the tightness of contact between the tube and the limbal sclera tunnel can be evaluated with high-magnification anterior segment optical coherence tomography (OCT) imaging following Ahmed glaucoma valve implantation. Tightness between the tube and the limbal sclera tunnel was investigated with the CAM-L cornea lens adapter of the Optovue Fourier-domain OCT (RTVue-OCT) for 21 uncomplicated Ahmed glaucoma valves implanted in 20 eyes of 19 patients with glaucoma. Nineteen valves were implanted 4 to 124 months earlier (late postoperative cases) and 2 valves 1 day prior to the imaging (early postoperative cases). All valves were introduced into the anterior chamber via a limbal sclera tunnel. The limbal intratunnel part of the tube was successfully imaged in all but 2 cases where an additional full-thickness sclera patch was used. In 14 cases, the contact was tight without tube compression. In 
5 cases, the tube was partially compressed but remained open in the limbal sclera tunnel, and redilated behind the limbus. No case with loose contact or peritubular filtration was seen. The posterior run of the tube was successfully imaged in all 19 cases without a full-thickness sclera patch. High-magnification imaging with the CAM- L anterior segment adapter of the RTVue-OCT allows detailed examination of the limbal insertion area of tubes in both the early and late postoperative periods. Therefore this method may potentially be applied for detection of complications related to tube insertion after glaucoma drainage device surgery.

  1. Application of 5-Fluorouracil-Polycaprolactone Sustained-Release Film in Ahmed Glaucoma Valve Implantation Inhibits Postoperative Bleb Scarring in Rabbit Eyes.

    Bi, Xiu-Zeng; Pan, Wei-Hua; Yu, Xin-Ping; Song, Zong-Ming; Ren, Zeng-Jin; Sun, Min; Li, Cong-Hui; Nan, Kai-Hui

    2015-01-01

    This study was designed to investigate whether 5-fluorouracil (5-Fu)-polycaprolactone sustained-release film in Ahmed glaucoma valve implantation inhibits postoperative bleb scarring in rabbit eyes. Eighteen New Zealand white rabbits were randomly divided into three groups (A, B and C; n = 6 per group). Group A received combined 5-Fu-polycaprolactone sustained-release film application and Ahmed glaucoma valve implantation, group B received local infiltration of 5-Fu and Ahmed glaucoma valve implantation, and group C received Ahmed glaucoma valve implantation. Postoperative observations were made of the anterior segment, intraocular pressure, central anterior chamber depth, blebs, drainage tube, and accompanying ciliary body detachment. The pathology of the blebs and surrounding tissues were observed at month 3 postoperatively. We revealed that the 5-Fu-polycaprolactone sustained-release film maintained a release concentration range of 13.7 ± 0.12 to 37.41 ± 0.47 μg/ml over three months in vitro. Postoperatively, diffuse blebs with ridges were found in all eyes in group A, two blebs were observed in group B, and no bleb formation was present in group C. The postoperative central anterior chamber depth in group A was significantly less than that of the other two groups. The postoperative intraocular pressure of group A stabilized at 6.33-8.67 mmHg, whereas that of group C gradually remained at 7.55-10.02 mmHg. The histopathology showed that the fibrous tissue thickness of the blebs in group A was significantly thinner than that of the other groups. We conclude that the 5-Fu-polycaprolactone sustained-release film had a sustained drug release effect, which promoted the inhibition of bleb scarring after Ahmed glaucoma valve implantation.

  2. The use of irradiated corneal patch grafts in pediatric Ahmed drainage implant surgery.

    Nolan, Kaitlyn Wallace; Lucas, Jordyn; Abbasian, Javaneh

    2015-10-01

    To describe the use of irradiated cornea for scleral reinforcement in Ahmed glaucoma valve drainage implant (AGV) devices in children. The medical records of patients endophthalmitis, and tube/plate self-explantation. A total of 25 procedures (20 patients) met inclusion criteria. Average patient age was 70 months (range, 2 months to 17 years). Mean follow-up was 24.8 months (range, 6 months to 6.2 years). One tube experienced conjunctival exposure through two separate corneal grafts (2/25 cases [8%]), sequentially in the same eye. The first event occurred at month 3.5 after primary implantation of the tube shunt; the second erosion occurred following revision of the existing implant at month 1.5 postoperatively. There were 2 cases of auto-explantation, 2 cases of wound dehiscence, and 1 case of persistent inflammation. There were no cases of endophthalmitis or other infections. To our knowledge, this is the first report describing the use of corneal patch grafts in children. Irradiated cornea improves cosmesis and enhances visualization of the tube. The risk of tube exposure was found to be low and comparable to other materials used as a patch graft. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  3. Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

    Jea H. Yu

    2016-01-01

    Full Text Available Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions. Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement. Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG. On average, intraocular pressure was reduced from 39±14 mmHg to 15±2 mmHg and the number of glaucoma medications was reduced from 4±1 to 0. Preoperative and most recent visual acuities were hand-motion (HM and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively. Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

  4. Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery.

    Yu, Jea H; Nguyen, Chuck; Gallemore, Esmeralda; Gallemore, Ron P

    2016-01-01

    Purpose . To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions. Methods . Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement. Results . In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from 39 ± 14 mmHg to 15 ± 2 mmHg and the number of glaucoma medications was reduced from 4 ± 1 to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively. Conclusion . The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

  5. Bilateral Ocular Decompression Retinopathy after Ahmed Valve Implantation for Uveitic Glaucoma

    Javier Flores-Preciado

    2016-11-01

    Full Text Available Case Report: We report the case of a 29-year-old man who underwent Ahmed valve implantation in both eyes as treatment for uveitic glaucoma, subsequently presenting with bilateral ocular decompression retinopathy in the postoperative period. Discussion: Ocular decompression retinopathy is a rare complication of filtering surgery in patients with glaucoma; however, the course is benign in most cases, with spontaneous resolution of bleedings and improvement of visual acuity.

  6. Surgical Results of Trabeculectomy and Ahmed Valve Implantation Following a Previous Failed Trabeculectomy in Primary Congenital Glaucoma Patients

    Lee, Naeun; Ma, Kyoung Tak; Bae, Hyoung Won; Hong, Samin; Seong, Gong Je; Hong, Young Jae; Kim, Chan Yun

    2015-01-01

    Purpose To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. Methods A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. Results The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9...

  7. Delayed-onset streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation.

    Bayraktar, Zerrin; Kapran, Ziya; Bayraktar, Sükrü; Acar, Nur; Unver, Yaprak Banu; Gök, Kemran

    2005-01-01

    To report a case of delayed-onset Streptococcus pyogenes endophthalmitis following implantation of an Ahmed glaucoma valve. A 10-year-old patient presented with acute endophthalmitis 1 year after Ahmed glaucoma valve implantation. The conjunctiva and Tenon's capsule over the valve plate had been penetrated by one of the polypropylene fixation sutures. The valve was removed, and pars plana vitrectomy was performed. Vitreous specimens and removal of the discharge over the plate revealed Streptococcus pyogenes. This is the first documented case of Streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation. We think the conjunctival buttonhole caused by the polypropylene suture provided an entry site for the infection. (c) Japanese Ophthalmological Society 2005.

  8. Glaucoma

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  9. Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma.

    Yadgarov, Arkadiy; Liu, Dan; Crane, Elliot S; Khouri, Albert S

    2017-01-01

    To describe postoperative surgical success of either Ahmed or Baerveldt tube shunt implantation for eyes with medically uncontrolled traumatic glaucoma. A review was carried out to identify patients with traumatic glaucoma that required tube shunt implantation between 2009 and 2015 at Rutgers University in Newark, New Jersey, USA. Seventeen eyes from 17 patients met inclusion criteria, including at least 3-month postoperative follow-up. The main outcome measure was surgical success at 1-year follow-up after tube implantation. Mean preoperative intraocular pressure (IOP) was 34.1 ± 8.2 mm Hg on 3.1 ± 1.6 ocular hypotensive medications. Nine eyes (53%) sustained closed globe injury. Ten eyes (59%) received an Ahmed valve shunt and seven eyes (41%) received a Baerveldt tube shunt. Surgical success rate at 1 year postoperatively was 83%. Compared to preoperative, the mean postoperative IOP was significantly lower (16.1 ± 3.5 mm Hg, p Ahmed or Baerveldt tube shunt provided successful control of IOP in patients with medically uncontrollable traumatic glaucoma. Yadgarov A, Liu D, Crane ES, Khouri AS. Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma. J Curr Glaucoma Pract 2017;11(1):16-21.

  10. Glaucoma

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  11. Angle closure glaucoma in congenital ectropion uvea.

    Wang, Grace M; Thuente, Daniel; Bohnsack, Brenda L

    2018-06-01

    Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months) and required additional surgery (cycloablation or trabeculectomy). Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control.

  12. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    Jingjing Huang,1 Jialiu Lin,1 Ziqiang Wu,2 Hongzhi Xu,3 Chengguo Zuo,1 Jian Ge1 1State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Center for Advanced Eye Care, Carson City, NV, USA; 3Institute of Child Health Policy, University of Florida, Gainesville, FL, USA Purpose: The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve...

  13. Clinical outcomes after combined Ahmed glaucoma valve implantation and penetrating keratoplasty or pars plana vitrectomy.

    Lee, Jin Young; Sung, Kyung Rim; Tchah, Hung Won; Yoon, Young Hee; Kim, June Gone; Kim, Myoung Joon; Kim, Jae Yong; Yun, Sung-Cheol; Lee, Joo Yong

    2012-12-01

    To evaluate whether a combination of penetrating keratoplasty (PKP) or pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation affords a level of success similar to that of AGV implantation alone. Eighteen eyes underwent simultaneous PPV and AGV, 14 eyes with PKP and AGV and 30 eyes with AGV implantation alone were evaluated. Success was defined as attainment of an intraocular pressure (IOP) >5 and glaucoma medication. Kaplan-Meier survival analysis was performed to compare cumulative survival between the combined surgery groups and the AGV implantation-alone group. Cox proportional hazard regression analysis was conducted to identify factors predictive of success in each of the three groups. Mean (±standard deviation) preoperative IOP was 30.2 ± 10.2 mmHg in the PKP + AGV, 35.2 ± 9.8 mmHg in the PPV + AGV, and 36.2 ± 10.1 mmHg in the AGV implantation-alone group. The cumulative success rate at 18 months was 66.9%, 73.2%, and 70.8% in the three groups, respectively. Neither combined surgery group differed significantly in terms of cumulative success rate compared with the AGV implantation-alone group (p = 0.556, p = 0.487, respectively). The mean number of preoperative anti-glaucoma medications prescribed was significantly associated with success in the PKP + AGV implantation group (hazard ratio, 2.942; p = 0.024). Either PKP or PPV performed in conjunction with AGV implantation afforded similar success rates compared to patients treated with AGV implantation alone. Therefore, in patients with refractory glaucoma who have underlying corneal or retinal pathology requiring treatment with PKP or PPV, AGV implantation can be performed simultaneously.

  14. Comparison of Ahmed glaucoma valve implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis.

    Tan HaiBo

    Full Text Available To compare the efficacy and safety of Ahmed glaucoma valve implantation (AGV with trabeculectomy in the management of glaucoma patients.A comprehensive literature search (PubMed, Embase, Google, and the Cochrane library was performed, including a systematic review with meta-analysis of controlled clinical trials comparing AGV versus trabeculectomy. Efficacy estimates were the weighted mean differences (WMDs for the percentage intraocular pressure reduction (IOPR % from baseline to end-point, the reduction in glaucoma medications, and the odds ratios (ORs for complete and qualified success rates. Safety estimates were the relative risks (RRs for adverse events. All outcomes were reported with a 95% confidence interval (CI. Statistical analysis was performed using the RevMan 5.0 software.Six controlled clinical trials were included in this meta-analysis. There was no significant difference between the AGV and trabeculectomy in the IOPR% (WMD = -3.04, 95% CI: -8.36- 2.26; P = 0.26. The pooled ORs comparing AGV with trabeculectomy were 0.46 (0.22, 0.99 for the complete success rate (P = 0.05 and 0.97 (0.78-1.20 for the quantified success rate (P = 0.76. No significant difference in the reduction in glaucoma medicines was observed (WMD = 0.24; 95% CI: -0.27-0.76; P = 0.35. AGV was found to be associated with a significantly lower frequency of all adverse events (RR = 0.71; 95%CI: 1.14-0.97; p = 0.001 than trabeculectomy, while the most common complications did not differ significantly (all p> 0.05.AGV was equivalent to trabeculectomy in reducing the IOP, the number of glaucoma medications, success rates, and rates of the most common complications. However, AGV was associated with a significantly lower frequency of overall adverse events.

  15. Comparison of Ahmed glaucoma valve implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis.

    HaiBo, Tan; Xin, Kang; ShiHeng, Lu; Lin, Liu

    2015-01-01

    To compare the efficacy and safety of Ahmed glaucoma valve implantation (AGV) with trabeculectomy in the management of glaucoma patients. A comprehensive literature search (PubMed, Embase, Google, and the Cochrane library) was performed, including a systematic review with meta-analysis of controlled clinical trials comparing AGV versus trabeculectomy. Efficacy estimates were the weighted mean differences (WMDs) for the percentage intraocular pressure reduction (IOPR %) from baseline to end-point, the reduction in glaucoma medications, and the odds ratios (ORs) for complete and qualified success rates. Safety estimates were the relative risks (RRs) for adverse events. All outcomes were reported with a 95% confidence interval (CI). Statistical analysis was performed using the RevMan 5.0 software. Six controlled clinical trials were included in this meta-analysis. There was no significant difference between the AGV and trabeculectomy in the IOPR% (WMD = -3.04, 95% CI: -8.36- 2.26; P = 0.26). The pooled ORs comparing AGV with trabeculectomy were 0.46 (0.22, 0.99) for the complete success rate (P = 0.05) and 0.97 (0.78-1.20) for the quantified success rate (P = 0.76). No significant difference in the reduction in glaucoma medicines was observed (WMD = 0.24; 95% CI: -0.27-0.76; P = 0.35). AGV was found to be associated with a significantly lower frequency of all adverse events (RR = 0.71; 95%CI: 1.14-0.97; p = 0.001) than trabeculectomy, while the most common complications did not differ significantly (all p> 0.05). AGV was equivalent to trabeculectomy in reducing the IOP, the number of glaucoma medications, success rates, and rates of the most common complications. However, AGV was associated with a significantly lower frequency of overall adverse events.

  16. Surgical results of trabeculectomy and Ahmed valve implantation following a previous failed trabeculectomy in primary congenital glaucoma patients.

    Lee, Naeun; Ma, Kyoung Tak; Bae, Hyoung Won; Hong, Samin; Seong, Gong Je; Hong, Young Jae; Kim, Chan Yun

    2015-04-01

    To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38). There was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.

  17. Heterologous, Fresh, Human Donor Sclera as Patch Graft Material in Glaucoma Drainage Device Surgery.

    Tsoukanas, Dimitrios; Xanthopoulou, Paraskevi; Charonis, Alexandros C; Theodossiadis, Panagiotis; Kopsinis, Gerasimos; Filippopoulos, Theodoros

    2016-07-01

    To determine the safety and efficacy of fresh, human sclera allografts as a patch graft material in glaucoma drainage device (GDD) surgery. Retrospective, noncomparative, interventional, consecutive case series. All GDD cases operated between 2008 and 2013 in which fresh human corneoscleral rims were used immediately after the central corneal button was used for penetrating or endothelial keratoplasty. Surgery was performed by 2 surgeons at 2 facilities. The Ahmed Glaucoma Valve (FP-7) was used exclusively in this cohort. Sixty-four eyes of 60 patients were identified; demographic data were recorded along with intraocular pressure (IOP), medication requirements, visual acuity, complications, and subsequent interventions. Incidence of complications. IOP and medication requirements at the last follow-up. Quilified success utilizing Tube Versus Trabeculectomy study criteria. The mean age of the cohort was 66.2±19.1 years; the average preoperative IOP was 33.2±11.1 mm Hg on 4.2±1.3 IOP-lowering agents before GDD surgery. IOP decreased significantly to 14.1±4.7 mm Hg (Pendophthalmitis, and there was 1 case of conjunctival erosion and tube/plate exposure (1.6%) occurring 30 days after surgery. Qualified success was estimated as 90.5% and 81% at 1 and 2 years, respectively, using Tube Versus Trabeculectomy study criteria. Heterologous, fresh, human donor sclera appears to be a safe material for GDD tube coverage. It provides a cost-efficient alternative compared with traditional patch graft materials associated with a low risk of pathogen transmission.

  18. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma.

    Hernandez-Oteyza, Alejandra; Lazcano-Gomez, Gabriel; Jimenez-Roman, Jesus; Hernandez-Garciadiego, Carlos

    2014-01-01

    To describe clinical results of Ahmed glaucoma valve implantation in Mexican patients with neovascular glaucoma (NVG). We reviewed records of 60 eyes of 60 patients with NVG who underwent Ahmed valve implantation, with a follow-up period of 1 year. We identified successful and failed cases and compared baseline and follow-up characteristics to identify possible differences between both groups. We classified 36 eyes (60%) as successful and 24 (40%) as failed cases. We found a significant difference in success rate in patients who had a hypertensive phase at any time during the follow-up period (OR = 5.15, CI = 1.49-20.15, p = 0.004). Patients in the success group showed a statistically significant decrease in the number of glaucoma medications 1 year after surgery (p Ahmed valve surgical failure in patients with NVG. How to cite this article: Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez-Roman J, Hernandez-Garciadiego C. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma. J Curr Glaucoma Pract 2014;8(3):86-90.

  19. Wound Dehiscence and Device Migration after Subconjunctival Bevacizumab Injection with Ahmed Glaucoma Valve Implantation.

    Miraftabi, Arezoo; Nilforushan, Naveed

    2016-01-01

    To report a complication pertaining to subconjunctival bevacizumab injection as an adjunct to Ahmed Glaucoma Valve (AGV) implantation. A 54-year-old woman with history of complicated cataract surgery was referred for advanced intractable glaucoma. AGV implantation with adjunctive subconjunctival bevacizumab (1.25 mg) was performed with satisfactory results during the first postoperative week. However, 10 days after surgery, she developed wound dehiscence and tube exposure. The second case was a 33-year-old man with history of congenital glaucoma and uncontrolled IOP who developed AGV exposure and wound dehiscence after surgery. In both cases, for prevention of endophthalmitis and corneal damage by the unstable tube, the shunt was removed and the conjunctiva was re-sutured. The potential adverse effect of subconjunctival bevacizumab injection on wound healing should be considered in AGV surgery.

  20. Initial Clinical Experience with Ahmed Valve Implantation in Refractory Pediatric Glaucoma

    Novak-Lauš, Katia; Škunca Herman, Jelena; Šimić Prskalo, Marija; Jurišić, Darija; Mandić, Zdravko

    2016-12-01

    The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate.

  1. Bilateral Sturge-Weber Syndrome and glaucoma controlled with Ahmed valve implant

    Marcelo Jarczun Kac

    2015-02-01

    Full Text Available Sturge-Weber Syndrome is a rare neuro-oculocutaneous disorder. The authors describe the case of a 13 years old boy, presented with bilateral Sturge-Weber Syndrome and glaucoma. Surgical treatment with Ahmed valve implantation in both eyes was carried out achieving lower levels of intraocular pressure.

  2. Glaucoma

    Full Text Available ... Education Programs National Eye Health Education Program (NEHEP) Diabetic Eye Disease Education Program Glaucoma Education Program Low ... Macular Degeneration Amblyopia Animations Blindness Cataract Convergence Insufficiency Diabetic Eye Disease Dilated Eye Exam Dry Eye For ...

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  4. Glaucoma

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  6. Glaucoma

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  7. Glaucoma

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  8. Using optical coherence tomography to evaluate glaucoma implant healing response in rabbit eyes

    Gossage, Kirk W.; Tkaczyk, Tomasz S.; Barton, Jennifer K.

    2002-06-01

    Glaucoma is a set of diseases that cause optic nerve damage and visual field loss. The most important risk factor for the development of glaucoma is elevated intraocular pressure. One approach used to alleviate the pressure increase is to surgically install glaucoma implants. Two standard Ahmed and ten experimental ePTFE implants were evaluated in this study in rabbit eyes. The implants were imaged with optical coherence tomography (OCT) at 0, 7, 15, 30, and 90 days after implantation. Histology was collected at days 7, 15, 30, and 90 and compared to the OCT images. Preliminary analysis of images indicates that OCT can visualize the development of fibrous encapsulation of the implant, tissue erosion, fibrin accumulation in the implant tube, and tube position in the anterior chamber. A new OCT handheld probe was developed to facilitate in vivo imaging in rabbit eye studies. The OCT probe consists of a mechanical scaffold designed to allow the imaging fiber to be held in a fixed position with respect to the rabbit eye, with minimal anesthesia. A piezo electric lateral scanning device allows the imaging fiber to be scanned across the tissue so that 2D images may be acquired.

  9. Comparative study of encapsulated blebs following Ahmed glaucoma valve implantation and trabeculectomy with mitomycin-C.

    Bae, Kunho; Suh, Wool; Kee, Changwon

    2012-08-01

    To compare the histopathologic and morphologic findings of encapsulated blebs following Ahmed glaucoma valve implantation and primary standard trabeculectomy with mitomycin-C. We reviewed the records of patients with otherwise uncontrollable glaucoma who had undergone Ahmed glaucoma valve implantation or trabeculectomy with mitomycin-C. Five eyes that underwent Ahmed valve implantation and three eyes that underwent trabeculectomy needed surgical revision of the initial surgery due to encapsulated bleb development with total loss of function. The surgically removed encapsulated blebs were analyzed macroscopically and microscopically. Removal of the encapsulated bleb was performed at a mean follow-up time of 26.6 ± 19.4 weeks in the Ahmed valve implantation group and 12.0 ± 11.4 weeks in the trabeculectomy group. The fibrotic wall of the encapsulated blebs had an overall thickness of 2.48 ± 0.42 mm in the Ahmed valve implantation group and 1.62 ± 0.37 mm in the trabeculectomy group. Macroscopically, the coconut flesh-like smooth surface was split into two layers, and the wall of the capsule was thicker in the Ahmed valve implantation group than in the trabeculectomy group. Histopathologically, the fibrotic capsule was composed of an inner fibrodegenerative layer and an outer fibrovascular layer, and there were no histopathological differences between the two groups. The fibrotic capsule wall was thicker in the Ahmed valve group, but there were no differences in histological findings between the two groups.

  10. Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience.

    Rotsos, Tryfon; Tsioga, Anastasia; Andreanos, Konstantinos; Diagourtas, Andreas; Petrou, Petros; Georgalas, Ilias; Papaconstantinou, Dimitrios

    2018-01-01

    To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference ( P glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.

  11. Graft failure: III. Glaucoma escalation after penetrating keratoplasty.

    Greenlee, Emily C; Kwon, Young H

    2008-06-01

    Glaucoma after penetrating keratoplasty is a frequently observed post-operative complication and is a risk factor for graft failure. Penetrating keratoplasty performed for aphakic and pseudophakic bullous keratopathy and inflammatory conditions are more likely to cause postoperative glaucoma compared with keratoconus and Fuchs' endothelial dystrophy. The intraocular pressure elevation may occur immediately after surgery or in the early to late postoperative period. Early postoperative causes of glaucoma include pre-existing glaucoma, retained viscoelastic, hyphema, inflammation, pupillary block, aqueous misdirection, or suprachoroidal hemorrhage. Late causes include pre-existing glaucoma, angle-closure glaucoma, ghost cell glaucoma, suprachoroidal hemorrhage, and steroid-induced glaucoma. Determining the cause of IOP elevation can help guide therapeutic intervention. Treatments for refractory glaucoma include topical anti-glaucoma medications such as beta-adrenergic blockers. Topical carbonic anhydrase inhibitors, miotic agents, adrenergic agonists, and prostaglandin analogs should be used with caution in the post-keratoplasty patient, because of the possibility of corneal decompensation, cystoid macular edema, or persistent inflammation. Various glaucoma surgical treatments have reported success in post-keratoplasty glaucoma. Trabeculectomy with mitomycin C can be successful in controlling IOP without the corneal toxicity noted with 5-fluorouracil. Glaucoma drainage devices have successfully controlled intraocular pressure in postkeratoplasty glaucoma; this is, however, associated with increased risk of graft failure. Placement of the tube through the pars plana may improve graft success compared with implantation within the anterior chamber. In addition, cyclophotocoagulation remains a useful procedure for eyes that have refractory glaucoma despite multiple surgical interventions.

  12. Assessment of conditions affecting surgical success of Ahmed glaucoma valve implants in glaucoma secondary to different uveitis etiologies in adults.

    Sungur, G; Yakin, M; Eksioglu, U; Satana, B; Ornek, F

    2017-10-01

    PurposeThere is little known about the long-term efficacy and safety of Ahmed glaucoma valve (AGV) implant and about the conditions affecting surgical success in uveitic glaucoma (UG).Patients and methodsThe charts of adult patients with UG who underwent AGV implantation from 2006 to 2015 were reviewed retrospectively.ResultsData of 46 eyes of 39 patients were evaluated. Mean follow-up was 51.93±23.08 months. Mean preoperative IOP was 37.05±9.62 mm Hg and mean number of preoperative topical anti-glaucomatous medications was 2.98±0.27. One eye (2%) was defined as failure because of implant extraction surgery. In the rest of the eyes, intraocular pressure (IOP) was under control with or without anti-glaucomatous medications during follow-up. The cumulative probability of complete success (IOP control without medications) was 78% at 6 months, 76% at 1 year, 71% at 2 years, 66% at 3 years, and 63% at 4 years (95% confidence interval, 61.24-87.81). The cumulative probability of eyes without complication was 64% at 6 months, 48% at 12 months, 44% at 24 months, 41% at 36 months, and 38% at 48 months (95% confidence interval, 34.64-62.85). Complete success was lower in eyes with previous ocular surgery than the eyes without (P=0.061) and it was lower in eyes with active inflammation at the time of surgery than the eyes without (P=0.011).ConclusionAGV implantation is an effective and safe alternative method in the management of UG, especially when it is performed as a primary surgical option and when no inflammation is present preoperatively.

  13. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide.

    Turalba, Angela V; Pasquale, Louis R

    2014-01-01

    To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Retrospective comparative case series. Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA. A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery. Primary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Five out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.2±4.6 in TA cases versus [vs] 14.7±5.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.8±1.3 in TA cases vs 1.6±1.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group. Subtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery.

  14. The effect of intravitreal bevacizumab injection before Ahmed valve implantation in patients with neovascular glaucoma.

    Kang, Jung Youb; Nam, Ki Yup; Lee, Sang Joon; Lee, Seung Uk

    2014-08-01

    To evaluate the effect of intravitreal bevacizumab (IVB) before Ahmed valve implantation for treatment of neovascular glaucoma (NVG). This study is a retrospective, comparative, consecutive case series. The study group consisted of 27 eyes of 26 patients with NVG who underwent an Ahmed valve implantation. Thirteen eyes were treated with Ahmed valve implantation alone (control group), and 14 eyes were treated with a combination of preoperative IVB injection and Ahmed valve implantation (IVB group). Visual acuity, intraocular pressure (IOP), number of anti-glaucoma medications, surgical complications, and success rate were compared between the two groups. There were no significant differences in preoperative characteristics between the two groups. Visual acuity at 1, 2 weeks, and 1 month after surgery were significantly better in the IVB group (p = 0.038, 0.034, and 0.032, respectively). Hyphema associated with Ahmed valve implantation occurred significantly less in the IVB group (p = 0.016). On the other hand, the mean IOP and number of anti-glaucoma medications at all follow-up periods were similar between the two groups. Kaplan-Meier survival analysis showed the probability of success 6 months after surgery as 71.4 % in the IVB group and 84.6 % in the control group. No significant difference in success rate was found between the groups (p = 0.422). IVB before Ahmed valve implantation for treatment of NVG reduced the incidence of hyphema. In this retrospective study, IVB provided better visual outcome in the early postoperative periods but did not significantly improve mean IOP, number of anti-glaucoma medications, or success rate.

  15. Outcomes of severe uveitic glaucoma treated with Baerveldt implant: can blindness be prevented?

    Tan, Annelie N; Cornelissen, Michiel F; Webers, Carroll A B; Erckens, Roel J; Berendschot, Tos T J M; Beckers, Henny J M

    2018-02-01

    To evaluate long-term outcomes on efficacy and safety of severe uveitic glaucoma treated with a Baerveldt glaucoma implant (BGI). A retrospective study of 47 eyes of 47 patients with uveitic glaucoma treated by a BGI between September 2002 and September 2015. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, course of the uveitis, visual acuity (VA) and complications. Mean IOP dropped from 30.6 ± 8.1 mmHg with 3.6 ± 1.1 glaucoma medications at baseline to 10.6 ± 4.3 mmHg with 1.0 ± 1.3 glaucoma medications after a mean follow-up of 63.6 ± 43.1 months. In the majority of cases, IOP remained stable during follow-up. However, especially in several patients with viral uveitis, episodes with IOP peaks were observed during a flare-up despite a functioning implant. These peaks remained below preoperative levels. During follow-up, 16 patients (34%) experienced a clinically significant VA loss, mainly because of late-stage glaucoma or hypotony maculopathy. Early postoperative complications were transient choroidal effusion (n = 5), shallow/flat anterior chamber (n = 4), hyphaema (n = 2) and suprachoroidal haemorrhage (n = 1). The most important late postoperative complication was hypotony maculopathy (n = 5), three of these in juvenile idiopathic arthritis (JIA) patients. The BGI is an effective and safe treatment for patients with refractive secondary glaucoma due to uveitis. In a majority of patients, VA remains stable and a low and stable IOP is maintained over time with an acceptable number of complications. In particular, patients with viral uveitis and glaucoma should be closely monitored for IOP peaks that may occur during episodes of a flare-up of uveitis, whereas at the other end of the spectrum, patients with JIA seem much more prone to hypotony maculopathy. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  16. Long-term results of Ahmed glaucoma valve implantation in Egyptian population.

    Elhefney, Eman; Mokbel, Tharwat; Abou Samra, Waleed; Kishk, Hanem; Mohsen, Tarek; El-Kannishy, Amr

    2018-01-01

    To evaluate the long-term results and complications of Ahmed glaucoma valve (AGV) implantation in a cohort of Egyptian patients. A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure (IOP) measurement before surgery and at 1d, weekly for the 1 st month, 3, 6mo, and 1y after surgery and yearly afterward for 5y. IOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as IOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery. IOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes (41.1%), complicated cataract in 9 eyes (7.25%), recessed tube in 8 eyes (6.45%), tube exposure in 6 eyes (4.8%) and corneal touch in 6 eyes (4.8%). Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes (1.6%). Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful IOP control after AGV implantation. However, effective complications management can improve the rate of success.

  17. Long-term results of Ahmed glaucoma valve implantation in Egyptian population

    Eman Elhefney

    2018-03-01

    Full Text Available AIM: To evaluate the long-term results and complications of Ahmed glaucoma valve (AGV implantation in a cohort of Egyptian patients. METHODS: A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure (IOP measurement before surgery and at 1d, weekly for the 1st month, 3, 6mo, and 1y after surgery and yearly afterward for 5y. IOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as IOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS: Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery. IOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes (41.1%, complicated cataract in 9 eyes (7.25%, recessed tube in 8 eyes (6.45%, tube exposure in 6 eyes (4.8% and corneal touch in 6 eyes (4.8%. Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes (1.6%. CONCLUSION: Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful IOP control after AGV implantation. However, effective complications management can improve the rate of success.

  18. Fluid Dynamics of a Novel Micro-Fistula Implant for the Surgical Treatment of Glaucoma.

    Sheybani, Arsham; Reitsamer, Herbert; Ahmed, Iqbal Ike K

    2015-07-01

    The purpose of this study was to describe the fluidics of a novel non-valved glaucoma implant designed to prevent hypotony and compare the fluidics of this device with two commonly used non-valved glaucoma devices. The XEN 45 micro-fistula implant was designed to limit hypotony by virtue of its length and width according to the Hagen-Poiseuille equation. Flow testing was performed using a syringe pump and pressure transducer at multiple flow rates. The pressure differentials across the XEN implant, the Ex-Press implant, and 10 mm of silicone tubing from a Baerveldt implant at a physiologic flow rate (2.5 μL/min) were extrapolated. The XEN 45 achieved a steady-state pressure calculated at 7.56 mm Hg at 2.5 μL/min. At the same flow rate, the Ex-Press device and Baerveldt tubing reached steady-state pressures of 0.09 and 0.01 mm Hg, respectively. Under flow testing, the XEN micro-fistula implant was able to maintain backpressure above numerical hypotony levels without the use of complex valve systems. This is due to the XEN implant's design, derived from the principles that dictate Newtonian fluids.

  19. Glaucoma

    Full Text Available ... search for current job openings visit HHS USAJobs Home >> NEI YouTube Videos >> NEI YouTube Videos: Glaucoma Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia Animations Blindness Cataract ...

  20. Glaucoma

    Full Text Available ... Glaucoma Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia Animations Blindness Cataract Convergence ... is maintained by the NEI Office of Science Communications, Public Liaison, and Education. Technical questions about this ...

  1. Glaucoma

    Full Text Available ... Macular Degeneration Amblyopia Animations Blindness Cataract Convergence Insufficiency Diabetic Eye Disease Dilated Eye Exam Dry Eye For Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube ...

  2. Glaucoma

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  3. Glaucoma

    ... considerably, providing more precise visual assessment tests and biologic markers for the disease. NIH-sponsored research led to the development of prostaglandins, a new class of drugs that offers excellent IOP control with fewer side effects. The Early Manifest Glaucoma ...

  4. Intraocular pressure control after the implantation of a second Ahmed glaucoma valve.

    Jiménez-Román, Jesús; Gil-Carrasco, Félix; Costa, Vital Paulino; Schimiti, Rui Barroso; Lerner, Fabián; Santana, Priscila Rezende; Vascocellos, Jose Paulo Cabral; Castillejos-Chévez, Armando; Turati, Mauricio; Fabre-Miranda, Karina

    2016-06-01

    The objective of this study is to evaluate the efficacy and safety of a second Ahmed glaucoma valve (AGV) in eyes with refractory glaucoma that had undergone prior Ahmed device implantation. This multicenter, retrospective study evaluated 58 eyes (58 patients) that underwent a second AGV (model S2-n = 50, model FP7-n = 8) due to uncontrolled IOP under maximal medical therapy. Outcome measures included IOP, visual acuity, number of glaucoma medications, and postoperative complications. Success was defined as IOP glaucoma medications preoperatively at 12 and 30 months were 3.17 ± 0.16 (n = 58), 1.81 ± 0.2 (n = 42), and 1.83 ± 0.35 (n = 18), respectively. The reductions in mean IOP and number of medications were statistically significant at all time intervals (P glaucoma, and is associated with relatively few complications.

  5. Clinical research of phacoemulsification with posterior chamber intraocular lens implantation for glaucoma with different goniosynechia ranges

    Qing-Yu Li

    2016-02-01

    Full Text Available AIM:To study the effect of phacoemulsification with posterior chamber intraocular lens implantation to treat glaucoma with different angle-closure range, which may provide a better way to treat the angle-closure glaucoma.METHODS:There were 47 cases(54 eyeswith angle-closure glaucoma, and all of them underwent phacoemulsification and posterior chamber intraocular lens implantation. According to the range of goniosynechia, these patients were divided into three groups:the eyes with the range of goniosynechia≤1/2 were group A(13 eyes; the eyes with 1/23/4 were group C(23 eyes. We observed the status of anterior chamber angle and the intraocular pressure(IOPof the three groups at 2wk after operations. RESULTS:Compared to the preoperative condition, the IOP of the three groups at 2wk after operations decreased significantly. The IOP reductions of group B and C were more significant than that of group A, and the differences were significant(PPP3/4 appeared in group B; in group C, there were 5 eyes with goniosynechia>3/4, 1 eye with disappeared anterior chamber, 3 eyes with corneal edema, 1 eye with choroidal hemorrhage. The differences of postoperative complication rate among the three groups was statistically significant(PPCONCLUSION:For patients with angle closure glaucoma who have mild to moderate goniosynechia, phacoemulsification with posterior chamber intraocular lens implantation is an effective way. After operations, their closed anterior angle reopened. But to the patients with severe adhesions, there are more complications after operations, especially the glaucoma may reoccur.

  6. Pathological studies on lachrymal dilated drainage tube implantation in rabbits

    Yun Peng

    2014-06-01

    Full Text Available AIM: To observe the pathological changes of the lower segment of nasolacrimal duct mucosa in rabbits at different stages after retrograde lachrymal dilated drainage tube implantation. METHODS: Totally 14 New Zealand rabbits were used in the present study. One side of nasolacrimal duct was obstructed to produce an experimental model and operated the reverse implantation of nasolacrimal duct intubation. Histological changes of the lower segment of nasolacrimal duct mucosa were observed by routine light microscope at 2, 4, 6, 8, 10, 12 and 14wk after the operation. RESULTS: Compared with the control side, the group of 2 and 4wk after surgery presented the inflammatory cytokine. The group of 12wk after the operation presented isolated granuloma. Group 12 and 14wk presented scattered granuloma. The size of the granulomas was smaller and the density of epithelioid cell and fibroblast were lower in group 12wk than those in group 14wk by HE and Masson trichrome stain.CONCLUSION: Recurrent Silicone Tube is used to treat nasolacrymal duct obstruction. Nasolacrimal duct can be narrowed and blocked again by granuloma, progressive fibrosis and adhesion of surrounding tissues when tube is in the duct more than 12wk.

  7. Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant

    Clara Ye

    2018-06-01

    Full Text Available Purpose: We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL (Visian ICL™, Staar Inc., Monrovia, CA implant that resulted in advanced visual field loss. Observations: A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Conclusions and importance: Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss. Keywords: Phakic intraocular lens, Intraocular collamer lens, Pigment dispersion, Glaucoma

  8. Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience

    Tryfon Rotsos

    2018-02-01

    Full Text Available AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (P<0.001. The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation. Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes, shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.

  9. Comparison of graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with a glaucoma drainage device.

    Iverson, Shawn M; Spierer, Oriel; Papachristou, George C; Feuer, William J; Shi, Wei; Greenfield, David S; O'Brien, Terrence P

    2018-02-01

    To compare corneal graft survival rates after penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSEK) in patients with a glaucoma drainage device (GDD) or medically managed glaucoma. A retrospective chart review was conducted on consecutive patients who underwent primary PK or primary DSEK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and a minimum of 6 months of follow-up. Graft failure was defined as an edematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularization and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: GDD-PK, GDD-DSEK, medical-PK and medical-DSEK. Fifty-six eyes of 56 patients were identified as meeting inclusion criteria. Among eyes with a GDD, there was no difference in the proportion of failures between PK grafts (48%) and DSEK grafts (50%) (p = 0.90). Failure occurred earlier in DSEK recipients compared to PK recipients, 5.82 ± 6.77 months versus 14.40 ± 7.70 months, respectively (p = 0.04). A Kaplan-Meier analysis did not identify a difference between the four groups with respect to graft failure (p = 0.52). There is no significant difference in graft survival rates between medically and surgically treated glaucoma patients for either PK or DSEK grafts. In patients with GDD, graft failure occurs earlier in DSEK compared to PK.

  10. Trabeculectomy With Mitomycin C or Ahmed Valve Implantation in Eyes With Uveitic Glaucoma.

    Bettis, Daniel I; Morshedi, Richard G; Chaya, Craig; Goldsmith, Jason; Crandall, Alan; Zabriskie, Norm

    2015-01-01

    To report and compare the results of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation in the management of uveitic glaucoma. The records of 41 eyes of 29 patients who underwent trabeculectomy with MMC or Ahmed valve implantation for uveitic glaucoma were retrospectively reviewed. Seventeen eyes underwent trabeculectomy with MMC, and 24 eyes underwent Ahmed valve implantation. Outcomes included postoperative intraocular pressure (IOP), percent reduction from preoperative IOP, postoperative number of medications, time to failure, and complications. Mean follow-up was 21.2 months in the trabeculectomy group and 23.8 months in the valve group (P=0.06). Mean IOP was reduced from 29.2 to 18.4 mm Hg in the trabeculectomy group (31.3%), compared with a reduction from 33.4 to 15.5 mm Hg in the Ahmed valve group (42.7%, P=0.53). Postoperatively, 1.76 medications were used in the trabeculectomy group, compared with 1.83 medications in the Ahmed valve group (P=0.89). Cumulative success at 1 year was 66.7% in the trabeculectomy group, compared with 100% in the Ahmed valve group (P=0.02). Mean time to failure was 8.36 months with trabeculectomy, and 21.8 months with Ahmed valve (P=0.02). Complications in both groups were typically rare and self-limited, with recurrent inflammation being most common. Although both trabeculectomy with MMC and Ahmed valve implantation are reasonable surgical options in the management of uncontrolled uveitic glaucoma, Ahmed valve implantation was associated with higher cumulative success rate at 1 year and a longer mean time to failure.

  11. Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant.

    Ye, Clara; Patel, Cajal K; Momont, Anna C; Liu, Yao

    2018-06-01

    We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc., Monrovia, CA) implant that resulted in advanced visual field loss. A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL) placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP) in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss.

  12. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

    Turalba AV

    2014-07-01

    Full Text Available Angela V Turalba,1,2 Louis R Pasquale1,2 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA Objective: To evaluate intraoperative subtenon triamcinolone acetonide (TA as an adjunct to Ahmed glaucoma valve (AGV implantation. Design: Retrospective comparative case series. Participants: Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA.Methods: A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery.Main outcome measures: Primary outcomes included intraocular pressure (IOP and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP was defined as an IOP measurement of greater than 21 mmHg (with or without medications during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Results: Five out of 19 (26% TA cases and 12 out of 23 (52% non-TA cases developed the HP (P=0.027. Mean IOP (14.2±4.6 in TA cases versus [vs] 14.7±5.0 mmHg in non-TA cases; P=0.78, and number of glaucoma medications needed (1.8±1.3 in TA cases vs 1.6±1.1 in the comparison group; P=0.65 were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group, early tube erosion (n=1 and bacterial endophthalmitis (n=1 were noted with TA but not in the non-TA group.Conclusions: Subtenon TA injection during AGV implantation may decrease the

  13. Combined Ahmed Glaucoma Valve Placement, Intravitreal Fluocinolone Acetonide Implantation and Cataract Extraction for Chronic Uveitis.

    Chang, Ingrid T; Gupta, Divakar; Slabaugh, Mark A; Vemulakonda, Gurunadh A; Chen, Philip P

    2016-10-01

    To report the outcomes of combined Ahmed glaucoma valve (AGV) placement, intravitreal fluocinolone acetonide implant, and cataract extraction procedure in the treatment of chronic noninfectious uveitis. Retrospective case series of patients with chronic noninfectious uveitis who underwent AGV placement, intravitreal fluocinolone acetonide implantation, and cataract extraction in a single surgical session performed at 1 institution from January 2009 to November 2014. Outcome measures included intraocular pressure (IOP) and glaucoma medication use. Secondary outcome measures included visual acuity, systemic anti-inflammatory medications, number of uveitis flares, and complications. Fifteen eyes of 10 patients were studied, with a mean age of 40.3±15.7 and mean follow-up duration of 26 months (range, 13 to 39 mo). Before surgery, the IOP was 18.5±7.3 mm Hg and patients were using 1.5±1.5 topical glaucoma medications. At the 12-month follow-up, IOP was 12.8±3.2 mm Hg (P=0.01) and patients were using 0.5±0.8 (P=0.03) topical glaucoma medications. At 36 months of follow-up, late, nonsustained hypotony had occurred in 3 eyes (20%), and 1 eye (6%) had received a second AGV for IOP control. Before treatment, patients had 2.7±1.5 uveitis flares in the year before surgery while on an average of 2.1±0.6 systemic anti-inflammatory medications, which decreased to an average of 0.1±0.3 (Pglaucoma medications at 12 months after treatment in patients with chronic uveitis.

  14. Intraocular pressure control with Ahmed glaucoma drainage device in patients with cicatricial ocular surface disease-associated or aniridia-related glaucoma.

    Almousa, Radwan; Lake, Damian B

    2014-08-01

    To analyze the control of intraocular pressure (IOP) with an Ahmed glaucoma drainage device (AGDD) in two groups of glaucoma patients--one with cicatricial ocular surface disease (COSD) and one with aniridia. This is a retrospective comparative case series of nine patients (11 eyes) with COSD and six patients (8 eyes) with aniridia who underwent AGDD surgery to control IOP. The main outcome measure in both groups was stability of IOP between 6 and 21 mmHg. Mean IOP decreased significantly in both groups after AGDD surgery (29.6 ± 8.7 vs 14.7 ± 2.5, p = 0.008 in the COSD group; 26.3 ± 8.2 vs 15.3 ± 5.8, p = 0.008 in the aniridia group). Over a mean post-surgery follow-up of 37.1 months in the COSD group, we managed to control IOP in nine eyes; IOP control was successful in 87 % of eyes at 12 months and 58 % of eyes at 26 months. Over a mean post-surgery follow-up of 37.4 months in the aniridia group, we managed to control the IOP in seven eyes; IOP control was successful in 87 % of eyes at 12 months. AGDD surgery had no significant deleterious effect on visual acuity in either group. A severe complication occurred in one eye (1/8) in the aniridia group (lost vision due to retinal detachment) and in one eye (1/11) in the COSD group (tube exposure). AGDD surgery is effective in controlling IOP and has a low complication rate in COSD and aniridia patients; however, some of the complications are severe and prompt management is needed to prevent deleterious results.

  15. OLOGEN® implant in the management of glaucoma in an unusual case of Axenfeld-Rieger syndrome

    O K Radhakrishnan

    2014-01-01

    Full Text Available We report an unusual case of Axenfeld-Rieger Syndrome with secondary glaucoma managed with Ologen® implant. A 35-year-old male presented with complaints of decreased vision in both eyes of 22 years duration. His best corrected visual acuity (BCVA was no perception of light in right eye and 20/30 in left eye. Gonioscopy revealed anterior insertion of iris into trabecular meshwork, prominent iris processes and broad-based synechiae with prominent Schwalbe′s line along the angle circumference with cord-like structures taking its origin at the level of Schwalbe′s line in both eyes. Fundus examination revealed total glaucomatous optic atrophy in right eye with 0.9:1 cup disc ratio with bipolar notch in left eye. Humphrey visual field analysis showed superior and inferior arcuate scotoma in left eye. Intraocular pressure measured by Goldman applanation tonometry was 30 mmHg and 26 mmHg in right and left eye, respectively. After an unsuccessful medical management, he underwent trabeculectomy with Ologen® implant under local anesthesia in his left eye. Postoperatively, at the end of one year, intraocular pressure (IOP in his left eye was controlled without medication. This case highlights the management of secondary angle closure glaucoma in Axenfeld-Rieger syndrome with Ologen® implant.

  16. Outcomes of using a sutureless bovine pericardial patch graft for Ahmed glaucoma valve implantation.

    Quaranta, Luciano; Riva, Ivano; Floriani, Irene C

    2013-01-01

    To evaluate the long-term outcomes of a surgical technique using a sutureless bovine pericardial patch graft for the implantation of an Ahmed glaucoma valve (AGV). 
 This was a pilot study on patients with primary open-angle glaucoma refractory to repeated surgical filtering procedures. All patients underwent AGV implant technique using a sutureless bovine pericardial patch graft. The pericardial membrane was cut using an ordinary corneal trephine with a diameter of 9.0 or 10.0 mm. The anterior part of the tube was covered with the graft and kept in place with fibrin glue. Subsequently, the cap was stitched all around the tube and the dissected conjunctiva was laid over it. Intraocular pressure (IOP) and complications were evaluated 1 week and 1, 3, 6, 12, and 24 months after surgery.
 The procedure was used to treat 20 eyes of 20 consecutive patients (12 men and 8 women: mean age [SD] 64.8 [7.8] years). Mean IOP was 28.1 mm Hg (SD 4.9) at baseline and decreased to 14.9 mm Hg (SD 1.5) 24 months after surgery (pendophthalmitis were recorded.
 The results suggest that the sutureless technique using a bovine pericardial graft patch is a safe and rapid procedure for AGV implantation.

  17. [A new operation in the treatment of refractory glaucoma: limbo-sclerectomy with valvular drainage of supraciliary space].

    Lapochkin, V I; Svirin, A V; Korchuganova, E A

    2001-01-01

    A new antiglaucoma operation has been developed: limbosclerectomy with valvular drainage of the supraciliary space. The operation was performed on 82 eyes with artiphakia, pseudophakia, and previously operated primary open-angle glaucoma. The patients were observed for 1.3 +/- 0.6 years after the intervention. Compensation of intraocular pressure and a significant increase in the coefficient of liquid discharge facility were observed in remote periods in all patients: in 95.1% patients without hypotensive therapy and in 4.9% cases instillations of 0.5% thimolol maleate twice a day were needed. Visual acuity and visual field borders did not appreciably change after the intervention. The operation is recommended for practice.

  18. Comparison of 1-year outcomes after Ahmed glaucoma valve implantation with and without Ologen adjuvant.

    Kim, Tai Jun; Kang, Sohyun; Jeoung, Jin Wook; Kim, Young Kook; Park, Ki Ho

    2018-02-14

    Many studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively. The aim of this study was to compare the 1-year outcomes of AGV implantation with and without Ologen adjuvant for the treatment of refractory glaucoma. This retrospective study included a total of 20 eyes of 20 glaucoma patients, who were followed for at least 1-year after undergoing AGV implantation. In 12 eyes of 12 patients, conventional AGV (CAGV) surgery was performed, while in 8 eyes of 8 patients, Ologen-augmented AGV (OAGV) implantation was performed. The outcomes were evaluated according to intraocular pressure (IOP) and the number of IOP-lowering medications. Complete success was defined as IOP ≤ 21 mmHg without medications throughout the 1-year follow-up period, and qualified success was defined as IOP ≤ 21 mmHg with or without medications throughout the 1-year follow-up period. The rate of complete success was significantly higher in the OAGV group (50.0%) than in the CAGV group (8.3%) (p = 0.035). There were no significant differences between the two groups in terms of qualified success or incidence of the early hypertensive phase. The IOP changes were similar between the groups within 1-year postoperatively, though the number of IOP-lowering medications was significantly lower in the OAGV group during the early hypertensive phase (p = 0.031, 0.031, and 0.025 at postoperative months 1, 2, and 3, respectively). When subjects were divided into groups according to the occurrence of the early hypertensive phase, the group with early hypertensive phase was more likely to use IOP-lowering medications at postoperative 6 months and 1 year (p = 0.002 and 0.005, respectively). OAGV surgery shows encouraging results for patients with refractory glaucoma, specifically with respect to the achievement of complete success and the reduction of the

  19. [Coupled Analysis of Fluid-Structure Interaction of a Micro-Mechanical Valve for Glaucoma Drainage Devices].

    Siewert, S; Sämann, M; Schmidt, W; Stiehm, M; Falke, K; Grabow, N; Guthoff, R; Schmitz, K-P

    2015-12-01

    Glaucoma is the leading cause of irreversible blindness worldwide. In therapeutically refractory cases, alloplastic glaucoma drainage devices (GDD) are being increasingly used to decrease intraocular pressure. Current devices are mainly limited by fibrotic encapsulation and postoperative hypotension. Preliminary studies have described the development of a glaucoma microstent to control aqueous humour drainage from the anterior chamber into the suprachoroidal space. One focus of these studies was on the design of a micro-mechanical valve placed in the anterior chamber to inhibit postoperative hypotension. The present report describes the coupled analysis of fluid-structure interaction (FSI) as basis for future improvements in the design micro-mechanical valves. FSI analysis was carried out with ANSYS 14.5 software. Solid and fluid geometry were combined in a model, and the corresponding material properties of silicone (Silastic Rx-50) and water at room temperature were assigned. The meshing of the solid and fluid domains was carried out in accordance with the results of a convergence study with tetrahedron elements. Structural and fluid mechanical boundary conditions completed the model. The FSI analysis takes into account geometric non-linearity and adaptive remeshing to consider changing geometry. A valve opening pressure of 3.26 mmHg was derived from the FSI analysis and correlates well with the results of preliminary experimental fluid mechanical studies. Flow resistance was calculated from non-linear pressure-flow characteristics as 8.5 × 10(-3) mmHg/µl  · min(-1) and 2.7 × 10(-3) mmHg/µl  · min(-1), respectively before and after valve opening pressure is exceeded. FSI analysis indicated leakage flow before valve opening, which is due to the simplified model geometry. The presented bidirectional coupled FSI analysis is a powerful tool for the development of new designs of micro-mechanical valves for GDD and may help to minimise the time and cost

  20. A retrospective study on the outcomes of Ahmed valve versus Ahmed valve combined with fluocinolone implant in uveitic glaucoma.

    Sevgi, Duriye D; Davoudi, Samaneh; Talcott, Katherine E; Cho, Heeyoon; Guo, Rong; Lobo, Ann-Marie; Papaliodis, George N; Turalba, Angela; Sobrin, Lucia; Shen, Lucy Q

    2017-01-01

    To compare the intraocular pressure (IOP) outcomes of Ahmed glaucoma valve (AGV) surgery alone versus AGV with fluocinolone implant in uveitic glaucoma patients. We identified uveitic glaucoma patients with AGV surgery alone and AGV surgery combined with fluocinolone implant from the Massachusetts Eye and Ear Ocular Inflammation Database. Demographic information, visual acuity, and IOP were recorded at preoperative visits and 1, 6, and 12 months after surgery. Incidence of hypertensive phase, defined as an IOP of >21 mm Hg or use of additional treatment to lower IOP occurring any time between 7 days to 6 months postoperatively, was investigated. Multilevel mixed effects models were performed to compare the outcomes between groups. Eighteen eyes of 13 uveitic glaucoma patients with 1-year follow-up data were included. There were 11 eyes of 9 patients (mean age, 56.5 years; 63.6% male) in the AGV group and 7 eyes of 4 patients (mean age, 61.3 years; 71.4% male) in the AGV + fluocinolone group. There was no significant difference in visual acuity change at 1 year after surgery between groups ( P = 0.25), although visual acuity improvement was significant in the AGV group ( P = 0.01). The hypertensive phase occurred in 91% of AGV patients and 43% of AGV + fluocinolone patients ( P = 0.30), with onset of 8-40 days (mean, 18 days) after surgery. IOP and number of glaucoma medications decreased at the 1-year postoperative visits in both the AGV group ( P glaucoma medications (0.28 vs 1.30 [ P = 0.01]) and had better inflammation control ( P = 0.02). The surgical complication rates were similar between groups. In uveitic glaucoma, AGV with fluocinolone achieves a similar, desired IOP control but with fewer glaucoma medications than AGV alone.

  1. Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients.

    Bao, Ning; Jiang, Zheng-Xuan; Coh, Paul; Tao, Li-Ming

    2018-01-01

    To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). The mean follow-up was 53.3±8.5 (range 48 to 60)mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively ( P glaucoma medications was significantly decreased compared with baseline at all time points during the study period ( P glaucoma medications, and preserving vision for patients with uveitic glaucoma.

  2. Effect of glaucoma tube shunt parameters on cornea endothelial cells in patients with Ahmed valve implants.

    Koo, Euna B; Hou, Jing; Han, Ying; Keenan, Jeremy D; Stamper, Robert L; Jeng, Bennie H

    2015-01-01

    The aim of this study was to assess the effect of various tube parameters on corneal endothelial cell density (ECD) after insertion of Ahmed valves. Thirty-nine eyes of 33 patients with previous superotemporal (ST) Ahmed valve implantation and 20 eyes of 13 participants with previous uncomplicated phacoemulsification and intraocular lens implantation but no history of glaucoma surgery were evaluated. Various tube parameters were measured with anterior segment optical coherence tomography. ST, central, and inferonasal (IN) ECD and pachymetry were measured. Endothelial cell loss and corneal thickness in the ST cornea was compared with those in the IN cornea. The mean age of the operated patients was 58 ± 22 years, and the mean time since glaucoma surgery was 2.5 ± 2.6 years. Thirty-two of the 39 study eyes were pseudophakic. The ECD was significantly lower in the ST endothelium than in the IN endothelium in eyes with glaucoma tube surgery (P < 0.001), although this relative reduction in ST ECD was not greater than that seen in pseudophakic control eyes (P = 0.16). In univariate analysis, tube angle relative to the cornea and distance from the tip of the tube to the cornea were significant risk factors for decreased ST endothelial cell loss when assessed relative to the IN ECD (P = 0.01 and P = 0.02, respectively). In multivariate analysis, only the distance of the tube tip to the cornea remained significantly associated with ST endothelial cell loss. Although this was a retrospective study with inherent limitations, tubes that are closer to the cornea seem to lead to increased loss of adjacent endothelial cells.

  3. Implante ExPRESS-P en el glaucoma traumático

    Francisco Fumero González

    Full Text Available Se presenta un paciente masculino, blanco, de 32 años de edad, con antecedentes de trauma contuso en el ojo izquierdo a los 8 años de edad. El examen oftalmológico del ojo izquierdo reveló agudeza visual mejor corregida 60 VAR; presión intraocular 42 mmHg con terapia hipotensora máxima; catarata corticonuclear traumática y daño glaucomatoso avanzado. Como opción de tratamiento se realizó la cirugía combinada (facoemulsificación e implante de dispositivo ExPRESS, modelo P-50, asociado al uso de mitomicina C 0,2 %. Se obtuvo agudeza visual mejor corregida 97 VAR y presión intraocular 17 mmHg a los 3 meses posoperatorio. Este caso evidencia la necesidad del seguimiento de por vida luego de un trauma ocular, y fundamentalmente cuando existe un receso angular traumático, con la finalidad de diagnosticar precozmente la hipertensión ocular y prevenir la pérdida visual irreversible por glaucoma. La facoemulsificación combinada con el implante ExPRESS resulta una opción favorable para el tratamiento de casos complejos que presentan glaucoma y catarata.

  4. Short-term outcomes after EX-PRESS implantation versus trabeculectomy alone in patients with neovascular glaucoma

    Shinohara, Yoichiro; Akiyama, Hideo; Magori, Mikiya; Kishi, Shoji

    2017-01-01

    Yoichiro Shinohara, Hideo Akiyama, Mikiya Magori, Shoji Kishi Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG) who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation. Methods: The study designed as a retrospective observational analysis and was set in...

  5. Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

    Lee, Geun Young; Lee, Chong Eun; Lee, Kyoo Won; Seo, Sam

    2017-01-01

    AIM: To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS: In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. RESULTS...

  6. Adjunctive Mitomycin C or Amniotic Membrane Transplantation for Ahmed Glaucoma Valve Implantation: A Randomized Clinical Trial.

    Yazdani, Shahin; Mahboobipour, Hassan; Pakravan, Mohammad; Doozandeh, Azadeh; Ghahari, Elham

    2016-05-01

    To determine whether adjunctive mitomycin C (MMC) or amniotic membrane transplantation (AMT) improve the outcomes of Ahmed glaucoma valve (AGV) implantation. This double-blind, stratified, 3-armed randomized clinical trial includes 75 eyes of 75 patients aged 7 to 75 years with refractory glaucoma. Eligible subjects underwent stratified block randomization; eyes were first stratified to surgery in the superior or inferior quadrants based on feasibility; in each subgroup, eyes were randomly assigned to the study arms using random blocks: conventional AGV implantation (group A, 25 eyes), AGV with MMC (group B, 25 eyes), and AGV with AMT (group C, 25 eyes). The 3 study groups were comparable regarding baseline characteristics and mean follow-up (P=0.288). A total of 68 patients including 23 eyes in group A, 25 eyes in group B, and 20 eyes group C completed the follow-up period and were analyzed. Intraocular pressure was lower in the MMC group only 3 weeks postoperatively (P=0.04) but comparable at other time intervals. Overall success rate was comparable in the 3 groups at 12 months (P=0.217). The number of eyes requiring medications (P=0.30), time to initiation of medications (P=0.13), and number of medications (P=0.22) were comparable. Hypertensive phase was slightly but insignificantly more common with standard surgery (82%) as compared with MMC-augmented (60%) and AMT-augmented (70%) procedures (P=0.23). Complications were comparable over 1 year (P=0.28). Although adjunctive MMC and AMT were safe during AGV implantation, they did not influence success rates or intraocular pressure outcomes. Complications, including hypertensive phase, were also comparable.

  7. Use of Mitomycin C to reduce the incidence of encapsulated cysts following ahmed glaucoma valve implantation in refractory glaucoma patients: a new technique.

    Zhou, Minwen; Wang, Wei; Huang, Wenbin; Zhang, Xiulan

    2014-09-06

    To evaluate the surgical outcome of Ahmed glaucoma valve (AGV) implantation with a new technique of mitomycin C (MMC) application. This is a retrospective study. All patients with refractory glaucoma underwent FP-7 AGV implantation. Two methods of MMC application were used. In the traditional technique, 6 × 4 mm cotton soaked with MMC (0.25-0.33 mg/ml) was placed in the implantation area for 2-5mins; in the new technique, the valve plate first was encompassed with a thin layer of cotton soaked with MMC, then inserted into the same area. A 200 ml balanced salt solution was applied for irrigation of MMC. The surgical success rate, intraocular pressure (IOP), number of anti-glaucoma medications used, and postoperative complications were analyzed between the groups. The surgical outcomes of two MMC applied techniques were compared. The new technique group had only one case (2.6%) of encapsulated cyst formation out of 38 eyes, while there were eight (19.5%) cases out of 41 eyes the in traditional group. The difference was statistically significant (P = 0.030). According to the definition of success rate, there was 89.5% in the new technique group and 70.7% in the traditional group at the follow-up end point. There was a significant difference between the two groups (P = 0.035). Mean IOP in the new technique group were significantly lower than those of the traditional group at 3 and 6 months (P < 0.05). By using a thin layer of cotton soaked with MMC to encompass the valve plate, the new MMC application technique could greatly decrease the incidence of encapsulated cyst and increase the success rate following AGV implantation.

  8. Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

    Yakin, Mehmet; Eksioglu, Umit; Sungur, Gulten; Satana, Banu; Demirok, Gulizar; Ornek, Firdevs

    2017-01-01

    To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD). A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery. Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed. This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).

  9. Ahmed glaucoma valve implantation with tube insertion through the ciliary sulcus in pseudophakic/aphakic eyes.

    Eslami, Yadolla; Mohammadi, Massood; Fakhraie, Ghasem; Zarei, Reza; Moghimi, Sasan

    2014-02-01

    To report the efficacy and safety of Ahmed glaucoma valve (AGV) insertion into the ciliary sulcus in pseudophakic/aphakic patients. A chart review was done on patients with uncontrolled glaucoma, who underwent AGV implantation with tube inserted into the ciliary sulcus. Baseline intraocular pressure (IOP) and number of medications were compared with that of postoperative follow-up visits. Surgical success was defined as last IOP glaucoma control, and without loss of light perception. Postoperative complications were recorded. Twenty-three eyes of 23 patients were recruited with the mean follow-up of 9 months (range, 3 to 24 mo). The mean (SD) age of patients was 49.9 (16.9) years (range, 22 to 80 years). The mean (SD) IOP (mm Hg) was reduced from 37.9 (12.4) before surgery to 16.2 (3.6) at the last follow-up visit (P<0.001). The mean (SD) number of medications was reduced from 3.3 (0.9) preoperatively to 1 (1.1) at the last follow-up (P<0.001). Success rate was 18/23 (78.6%). Complications included endophthalmitis in 1 eye, tube exposure in 1 diabetic patient, and vitreous tube occlusion in 1 eye. No case of corneal decompensation or graft failure was seen during follow-up. Ciliary sulcus placement of the tube of AGV effectively reduces IOP and medication use in short term. It has the potential to lower corneal complications of anterior chamber tube insertion and avoids the need for pars plana vitrectomy and tube insertion in patients at higher risk of corneal decompensation.

  10. [Management of corneal endothelial decompensation with Descemet's membrane endothelial keratoplasty in a patient with Ahmed glaucoma valve implant].

    Röck, T; Bartz-Schmidt, K-U; Röck, D; Yoeruek, E

    2014-05-01

    Currently, the main causes for developing bullous keratopathy are from problems related to intraocular surgery, trauma, infection, Fuchs' endothelial dystrophy and chronically elevated intraocular pressure. In the 1990s penetrating keratoplasty was once considered the therapy of choice for treatment of bullous keratopathy but in recent years it has been replaced by posterior lamellar keratoplasty. The Descemet membrane endothelial keratoplasty (DMEK) procedure represents the final development of posterior lamellar keratoplasty. The question now arises whether DMEK can be used in patients with bullous keratopathy and Ahmed glaucoma valve implant. A 72-year-old man was referred to our hospital for further evaluation with the diagnosis of bullous keratopathy and pseudoexfoliative glaucoma. The bullous keratopathy was caused by a variety of previous operations as well as decompensation of intraocular pressure. This article describes the therapy of bullous keratopathy by DMEK with existing Ahmed glaucoma valve implant. After surgery the cornea became clear and the best-corrected visual acuity improved from hand movement to 0.2. The intraocular pressure remained normal (10-14 mmHg) without antiglaucoma medication and the endothelial cell count decreased only slightly over a follow-up of 13 months. No complications were encountered. The DMEK surgical procedure seems to be possible in patients with Ahmed glaucoma valve implant and endothelial decompensation. However, further studies with a larger number of patients should follow to validate the replacement of penetrating keratoplasty and other posterior lamellar procedures by DMEK.

  11. Effect of mitomycin c and 5-flurouracil adjuvant therapy on the outcomes of Ahmed glaucoma valve implantation.

    Cui, Qi N; Hsia, Yen C; Lin, Shan C; Stamper, Robert L; Rose-Nussbaumer, Jennifer; Mehta, Nitisha; Porco, Travis C; Naseri, Ayman; Han, Ying

    2017-03-01

    To examine the effect of mitomycin c and 5-flurouracil on treatment outcomes following Ahmed glaucoma valve implantation. Retrospective consecutive case series. Fifty patients who received Ahmed glaucoma valve implantation from 1999 to 2013 in the San Francisco Veterans Administration Hospital. The +INJECTION group received intraoperative mitomycin c followed by postoperative mitomycin c and/or 5-flurouracil, whereas the -INJECTION group did not. Primary outcome was treatment success at 1 year post-implantation. Intraocular pressure, hypertensive phase, and the number of glaucoma medications were also examined. Twenty-six patients/eyes in the +INJECTION group and 24 patients/eyes in the -INJECTION group were included. Treatment success was higher in the +INJECTION compared with the -INJECTION group (86 vs. 58%; P = 0.04). Intraocular pressure was lower in the +INJECTION compared with the -INJECTION group at 1, 3, 6 and 12 months (P ≪ 0.00001, P = 0.00003, 0.0008 and 0.024). Hypertensive phase occurred less often in the +INJECTION compared with the -INJECTION group (3.8 vs. 54%; P = 0.021). The +INJECTION group required fewer medications compared with the -INJECTION group (P = 0.02, 0.002, 0.003 and 0.008 at 1, 3, 6 and 12 months). Complication rates were comparable between groups (46.2 and 54.2%; P = 0.63). Adjuvant treatment with antifibrotics following Ahmed glaucoma valve implantation decreased the hypertensive phase and improved surgical outcomes without impacting complication rates at 1 year. This study postulates a role for antifibrotics in the postoperative management of Ahmed glaucoma valves. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  12. Improvement in Outflow Facility by Two Novel Microinvasive Glaucoma Surgery Implants

    Hays, Cassandra L.; Gulati, Vikas; Fan, Shan; Samuelson, Thomas W.; Ahmed, Iqbal Ike K.; Toris, Carol B.

    2014-01-01

    Purpose. To determine improvement in outflow facility (C) in human anterior segments implanted with a novel Schlemm's canal scaffold or two trabecular micro-bypasses. Methods. Human anterior segments were isolated from 12 pairs of eyes from donors with no history of ocular disease and then perfused at 50, 40, 30, 20, and 10 mm Hg pressures for 10 minutes each. Baseline C was calculated from perfusion pressures and flow rates. The scaffold was implanted into Schlemm's canal of one anterior segment, and two micro-bypasses were implanted three clock-hours apart in the contralateral anterior segment. Outflow facility and resistance were compared at various standardized perfusion pressures and between each device. Results. Compared to baseline, C increased by 0.16 ± 0.12 μL/min/mm Hg (74%) with the scaffold, and 0.08 ± 0.12 μL/min/mm Hg (34%) with two micro-bypasses. The scaffold increased C at perfusion pressures of 50, 40, 30, and 20 mm Hg (P glaucoma. PMID:24550367

  13. Dynamic tube movement after reimplantation of Ahmed glaucoma valve in a child with glaucoma in aphakia

    Senthil, Sirisha; Badakare, Akshay

    2014-01-01

    A 10-year-old girl underwent an Ahmed glaucoma valve (AGV) implantation as a primary procedure for glaucoma in aphakia due to congenital cataract surgery. Following an unintended accidental excision of AGV tube during bleb revision for hypertensive phase, AGV was explanted and a second AGV was implanted in the same quadrant after 2 weeks. This resulted in a rare complication of dynamic tube movement in the anterior chamber with tube corneal touch and localised corneal oedema. Excision of the offending unstable tube and placement of a paediatric AGV in a different quadrant led to resolution of this complication, stable vision and well-controlled intraocular pressure. This case highlights the possible causes of dynamic tube, related complications and its management. This case also highlights the importance of understanding the various physiological phases after glaucoma drainage device implantation and their appropriate management. PMID:24695662

  14. Adjunctive triamcinolone acetonide for Ahmed glaucoma valve implantation: a randomized clinical trial.

    Yazdani, Shahin; Doozandeh, Azadeh; Pakravan, Mohammad; Ownagh, Vahid; Yaseri, Mehdi

    2017-06-26

    To evaluate the effect of intraoperative sub-Tenon injection of triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. In this triple-blind randomized clinical trial, 104 eyes with refractory glaucoma were randomly assigned to conventional AGV (non-TA group) or AGV with adjunctive triamcinolone (TA group). In the TA group, 10 mg TA was injected in the sub-Tenon space around the AGV plate intraoperatively. Patients were followed for 1 year. The main outcome measure was intraocular pressure (IOP). Other outcome measures included best-corrected visual acuity (BCVA), occurrence of hypertensive phase (HP), peak IOP, number of antiglaucoma medications, and complications. A total of 90 patients were included in the final analysis. Mean IOP was lower in the TA group at most follow-up visits; however, the difference was statistically significant only at the first month (p = 0.004). Linear mixed model showed that mean IOP was 1.5 mm Hg lower in the TA group throughout the study period (p = 0.006). Peak postoperative IOP was significantly lower in the TA group (19.3 ± 4.8 mm Hg versus 29 ± 9.2 mm Hg, p = 0.032). Rates of success (defined as 6 2 lines was more common in the non-TA group (p = 0.032). Adjunctive intraoperative TA injection during AGV implantation can blunt peak IOP levels and reduce mean IOP up to 1 year. Visual outcomes also seem to be superior to standard surgery.

  15. Partial Tenon’s capsule resection with adjunctive mitomycin C in Ahmed glaucoma valve implant surgery

    Susanna, R

    2003-01-01

    Aim: To verify if partial intraoperative Tenon’s capsule resection (PTCR) with adjunctive mitomycin C is effective in developing thin, avascular blebs in eyes undergoing Ahmed glaucoma valve insertion, and to assess the efficacy and safety of this procedure. Methods: A multicentre, prospective, alternating case assignment, investigator unmasked, parallel group, comparative interventional study was conducted in four Latin American countries (Argentina, Brazil, Colombia, and Peru). Ahmed glaucoma valve implant insertion with PTCR (group A) and without PCTR (group B) was performed in neovascular glaucomatous eyes without previous surgery. Adjunctive mitomycin C (MMC) was used in both groups. Patients were examined 1 day, 10 days, 1 month, 2 months, 3 months, 6 months, and 1 year following the surgery. Intraocular pressure (IOP) and the appearance of the bleb were evaluated at each examination. Appearance of the bleb was classified at both the 1 month mark and last examinations into one of three groups: flat and vascularised; elevated avascular; or elevated and not avascular. Results: 92 eyes from 92 patients were included in the study. The preoperative mean IOP was 50.0 (SD 10.5) mm Hg in group A and 48.4 (11.7) in group B (p>0.05). Statistically significant IOP reductions were observed at all periods of follow up. 12 months after surgery, the mean IOP was 17.2 (5.0) mm Hg in group A and 18.3 (8.7) mm Hg in group B (p>0.05). A hypertensive phase occurred in 40.0% in group A and in 46.8% in group B (p>0.05). At the 1 month and the final follow up, the blebs in all eyes were considered elevated and not avascular. The success rate (IOP⩽21 mm Hg) at 1 year after surgery was 70.4% in group A and 77.7% in group B (p>0.05). Overall, 74.2% of the patients achieved an IOP ⩽21 mm Hg and 55.2% an IOP⩽17 mm Hg, with or without additional medication administered to lower IOP. The incidence of complications was similar in both groups. Conclusions: In eyes undergoing Ahmed

  16. Partial Tenon's capsule resection with adjunctive mitomycin C in Ahmed glaucoma valve implant surgery.

    Susanna, R

    2003-08-01

    To verify if partial intraoperative Tenon's capsule resection (PTCR) with adjunctive mitomycin C is effective in developing thin, avascular blebs in eyes undergoing Ahmed glaucoma valve insertion, and to assess the efficacy and safety of this procedure. A multicentre, prospective, alternating case assignment, investigator unmasked, parallel group, comparative interventional study was conducted in four Latin American countries (Argentina, Brazil, Colombia, and Peru). Ahmed glaucoma valve implant insertion with PTCR (group A) and without PCTR (group B) was performed in neovascular glaucomatous eyes without previous surgery. Adjunctive mitomycin C (MMC) was used in both groups. Patients were examined 1 day, 10 days, 1 month, 2 months, 3 months, 6 months, and 1 year following the surgery. Intraocular pressure (IOP) and the appearance of the bleb were evaluated at each examination. Appearance of the bleb was classified at both the 1 month mark and last examinations into one of three groups: flat and vascularised; elevated avascular; or elevated and not avascular. 92 eyes from 92 patients were included in the study. The preoperative mean IOP was 50.0 (SD 10.5) mm Hg in group A and 48.4 (11.7) in group B (p>0.05). Statistically significant IOP reductions were observed at all periods of follow up. 12 months after surgery, the mean IOP was 17.2 (5.0) mm Hg in group A and 18.3 (8.7) mm Hg in group B (p>0.05). A hypertensive phase occurred in 40.0% in group A and in 46.8% in group B (p>0.05). At the 1 month and the final follow up, the blebs in all eyes were considered elevated and not avascular. The success rate (IOP0.05). Overall, 74.2% of the patients achieved an IOP glaucoma, PCTR with MMC augmentation showed no additional benefits or complications over MMC augmentation alone; no avascular bleb was obtained with this technique. The incidence of a hypertensive phase was lower than reported in previous studies.

  17. Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

    Jin-Tao Sun

    2017-03-01

    Full Text Available AIM: To evaluate the efficacy and safety of intravitreal ranibizumab (IVR with panretinal photocoagulation (PRP followed by trabeculectomy compared with Ahmed glaucoma valve (AGV implantation in neovascular glaucoma (NVG. METHODS: This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes, and retinal vein occlusion (20 eyes. All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA were converted to the logarithms of the minimum angle of resolution (logMAR for the statisitical analyses. Intraocular pressure (IOP, the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo. RESULTS: A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468, P<0.05, and the mean postoperative logMAR BCVA was also significantly improved (F=10.964, P<0.05 with no significant difference between two groups. CONCLUSION: It is safe and effective to treat NVG with this combined procedure, and we

  18. Flow Test to Predict Early Hypotony and Hypertensive Phase After Ahmed Glaucoma Valve (AGV) Surgical Implantation.

    Cheng, Jason; Beltran-Agullo, Laura; Buys, Yvonne M; Moss, Edward B; Gonzalez, Johanna; Trope, Graham E

    2016-06-01

    To assess the validity of a preimplantation flow test to predict early hypotony [intraocular pressure (IOP)≤5 mm Hg on 2 consecutive visits and hypertensive phase (HP) (IOP>21 mm Hg) after Ahmed Glaucoma Valve (AGV) implantation. Prospective interventional study on patients receiving an AGV. A preimplantation flow test using a gravity-driven reservoir and an open manometer was performed on all AGVs. Opening pressure (OP) and closing pressure (CP) were defined as the pressure at which fluid was seen to flow or stop flowing through the AGV, respectively. OP and CP were measured twice per AGV. Patients were followed for 12 weeks. In total, 20 eyes from 19 patients were enrolled. At 12 weeks the mean IOP decreased from 29.2±9.1 to 16.8±5.2 mm Hg (P<0.01). The mean AGV OP was 17.5±5.4 mm Hg and the mean CP was 6.7±2.3 mm Hg. Early (within 2 wk postoperative) HP occurred in 37% and hypotony in 16% of cases. An 18 mm Hg cutoff for the OP gave a sensitivity of 0.71, specificity of 0.83, positive predictive value of 0.71, and negative predictive value of 0.83 for predicting an early HP. A 7 mm Hg cutoff for the CP yielded a sensitivity of 1.0, specificity of 0.38, positive predictive value of 0.23, and negative predictive value of 1.0 for predicting hypotony. Preoperative OP and CP may predict early hypotony or HP and may be used as a guide as to which AGV valves to discard before implantation surgery.

  19. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

    Wang, Rui; Bi, Chun-Chao; Lei, Chun-Ling; Sun, Wen-Tao; Wang, Shan-Shan; Dong, Xiao-Juan

    2014-01-01

    AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation.METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Opht...

  20. Comparison of Generalized Estimating Equations and Quadratic Inference Functions in superior versus inferior Ahmed Glaucoma Valve implantation

    Razieh Khajeh-Kazemi

    2011-01-01

    Full Text Available Background: The celebrated generalized estimating equations (GEE approach is often used in longitudinal data analysis While this method behaves robustly against misspecification of the working correlation structure, it has some limitations on efficacy of estimators, goodness-of-fit tests and model selection criteria The quadratic inference functions (QIF is a new statistical methodology that overcomes these limitations Methods : We administered the use of QIF and GEE in comparing the superior and inferior Ahmed glaucoma valve (AGV implantation, while our focus was on the efficiency of estimation and using model selection criteria, we compared the effect of implant location on intraocular pressure (IOP in refractory glaucoma patients We modeled the relationship between IOP and implant location, patient′s sex and age, best corrected visual acuity, history of cataract surgery, preoperative IOP and months after surgery with assuming unstructured working correlation Results : 63 eyes of 63 patients were included in this study, 28 eyes in inferior group and 35 eyes in superior group The GEE analysis revealed that preoperative IOP has a significant effect on IOP (p = 0 011 However, QIF showed that preoperative IOP, months after surgery and squared months are significantly associated with IOP after surgery (p < 0 05 Overall, estimates from QIF are more efficient than GEE (RE = 1 272 Conclusions : In the case of unstructured working correlation, the QIF is more efficient than GEE There were no considerable difference between these locations, our results confirmed previously published works which mentioned it is better that glaucoma patients undergo superior AGV implantation

  1. Short-term outcomes after EX-PRESS implantation versus trabeculectomy alone in patients with neovascular glaucoma

    Shinohara Y

    2017-12-01

    Full Text Available Yoichiro Shinohara, Hideo Akiyama, Mikiya Magori, Shoji Kishi Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation. Methods: The study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes with NVG, were treated using trabeculectomy alone (Trab group; n=39 or EX-PRESS implantation (EX group; n=50. All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP, visual acuity (VA, number of medications, complications, additional therapy, and success rate. Results: The mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045. The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively. The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047. Conclusion: Implantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS. Keywords: trabeculectomy, EX-PRESS, neovascular glaucoma, surgery, tube shunt

  2. Outcomes of Ahmed Valve Implant Following a Failed Initial Trabeculotomy and Trabeculectomy in Refractory Primary Congenital Glaucoma

    Dave, Paaraj; Senthil, Sirisha; Choudhari, Nikhil; Sekhar, Garudadri Chandra

    2015-01-01

    Purpose: The aim was to report the outcome of Ahmed glaucoma valve (AGV) (New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation as a surgical intervention following an initial failed combined trabeculotomy + trabeculectomy (trab + trab) in refractory primary congenital glaucoma (RPCG). Materials and Methods: Retrospective chart review of 11 eyes of 8 patients who underwent implantation of AGV (model FP8) for RPCG between 2009 and 2011. Prior trab + trab had failed in all the eyes. Success was defined as an intraocular pressure (IOP) >5 and ≤ 18 mmHg during examination under anesthesia with or without medications and without serious complications or additional glaucoma surgery. Results: The mean age at AGV implantation was 15.4 ± 4.9 months. The mean preoperative IOP was 28 ± 5.7 mmHg which reduced to 13.6 ± 3.4 mmHg postoperatively at the last follow-up (P < 0.0001). The number of topical antiglaucoma medications reduced from a mean of 2.6 ± 0.5 to 1.6 ± 0.9 postoperatively (P = 0.009). The definition of qualified success was met in 10 (90%) eyes. One eye developed a shallow anterior chamber with choroidal detachment at 1-week, which resolved spontaneously with medications. None of the eyes developed a hypertensive phase. One eye had a long tube resulting in tube corneal touch that required trimming of the tube. One eye developed tube retraction, which was treated with a tube extender. The mean follow-up was 17.9 ± 9.3 (6.2-35.4) months. Conclusion: Managing RPCG remains a challenge. AGV implant was successful in a significant proportion of cases. PMID:25624676

  3. A new method for the evacuation of aqueous humor in uncontrolled glaucoma. The vitreo-tenonian tube.

    Haut, J; Larricart, P; Le Mer, Y; Abboud, E

    1987-02-01

    The vitreo-tenonian tube is a new procedure, used in uncontrolled glaucoma, for the drainage of aqueous humor. It presents three original characteristics: it is made of a stainless metal, it is implanted in the posterior segment after vitrectomy and it drains the aqueous humor in the subtenonian space. We will describe first the surgical technique for the implantation of the tube, and then we will present the results of the first eight cases treated by this method. The advantages and drawbacks of this type of drainage are discussed: they are compared with the other surgical techniques used in cases of glaucoma which is uncontrolled by the classical methods.

  4. Experience with the Ahmed Glaucoma Valve

    Design:Aprospective study of three glaucoma patients who had the Ahmed glaucoma valve implant at the. University of Benin ... Key words: glaucoma, glaucoma valve implant, ... introduced the micro-trephination with a diameter of. 0.6mm in ...

  5. Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

    Geun Young Lee

    2017-09-01

    Full Text Available AIM: To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG. METHODS: In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. RESULTS: The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038. A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810. The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05. CONCLUSION: ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.

  6. Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma.

    Lee, Geun Young; Lee, Chong Eun; Lee, Kyoo Won; Seo, Sam

    2017-01-01

    To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group ( P =0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups ( P =0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group ( P =0.05). ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.

  7. Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

    Lee, Geun Young; Lee, Chong Eun; Lee, Kyoo Won; Seo, Sam

    2017-01-01

    AIM To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. RESULTS The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). CONCLUSION ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density. PMID:28944196

  8. Boston keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma

    Bhaskar Srinivasan

    2012-01-01

    Full Text Available Congenital anterior staphyloma entails grave visual prognosis. The majority of reported patients have undergone enucleation. We report a promising result of staphylectomy with implantation of a keratoprosthesis and a glaucoma drainage device in a seven-month-old child with a large, congenital anterior staphyloma.

  9. Changes in Corneal Endothelial Cell after Ahmed Glaucoma Valve Implantation and Trabeculectomy: 1-Year Follow-up.

    Kim, Min Su; Kim, Kyoung Nam; Kim, Chang-Sik

    2016-12-01

    To compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy. Changes in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups. Forty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group ( p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group ( p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group ( p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months ( p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months ( p = 0.027). Both the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.

  10. Clinical outcomes of trabeculectomy vs. Ahmed glaucoma valve implantation in patients with penetrating keratoplasty : (Trabeculectomy vs. Ahmed galucoma valve in patients with penetrating keratoplasty).

    Akdemir, Mehmet Orcun; Acar, Banu Torun; Kokturk, Furuzan; Acar, Suphi

    2016-08-01

    The aim of this study was to compare the visual outcomes, intraocular pressure (IOP), and endothelial cell loss caused by trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation in patients who had previously undergone penetrating keratoplasty (PKP). The data from all patients who underwent surgical treatment of glaucoma after PKP were reviewed at the Cornea Department of Haydarpasa Numune Education and Research Hospital. Eighteen patients who had undergone surgical treatment of glaucoma after PKP were included in this retrospective study. Time between PKP and glaucoma surgeries, visual acuity results, IOP results, endothelial cell counts (ECC) before the surgery, at 1st, 6th, and 12th month of surgery were recorded. Differences between two groups were evaluated. Mean loss of ECC was 315 cells/mm(2) in the AGV group and 197 cells/mm(2) in TRAB group at 12th month of glaucoma surgery. The difference between endothelial cell loss at 12th month of surgery was statistically significant and higher in AGV group (p glaucoma. Ahmed glaucoma valve had a significantly better IOP lowering but higher endothelial cell loss effect.

  11. Conjunctival inclusion cyst following repair of tube erosion in a child with aphakic glaucoma, leading to endophthalmitis

    Roy, Avik Kumar

    2015-05-01

    Full Text Available Introduction: Glaucoma in aphakia is a major long term complication following congenital cataract surgery. Implantation of glaucoma drainage device provides an effective approach to manage refractory paediatric glaucoma. However implant surgery in young individuals is not free of complications. The prompt detection and management of tube erosion is of utmost importance to prevent devastating sequel of endophthalmitis. Implantation cyst following repair of tube erosion has not been reported so far. This case illustrates the rare occurrence of inclusion cyst following repair of tube erosion, the possible causes and its consequences. Case description: A 2-year-old child with aphakia developed intractable glaucoma. Following a failed glaucoma filtering surgery he underwent sequential Ahmed Glaucoma Valve implantation in both the eyes. Six weeks following right eye surgery, the child presented with conjunctival erosion overlying the tube, which was treated with scleral patch graft and conjunctival advancement. One month after the repair of tube erosion, the child presented with implantation cyst under the scleral patch graft, which was treated by drainage with a 29G needle. The child presented with endophthalmitis of his right eye following an episode of bilateral conjunctivitis. This was managed by an emergency pars plana vitrectomy, intraocular antibiotics and tube excision. At the last follow up visit, the IOP was 20 mmHg with 2 topical antiglaucoma medications in the right eye following a trans scleral photocoagulation.Discussion: Lifelong careful follow-up of paediatric eyes with implant surgery is mandatory to look for complication such as tube erosion. It is important to place additional sutures to secure the patch graft during implantation of glaucoma drainage devices in children to prevent graft displacement and consequent tube erosion. During repair of tube erosion, it is crucial to remove all the conjunctival epithelium around the tube

  12. Conjunctival inclusion cyst following repair of tube erosion in a child with aphakic glaucoma, leading to endophthalmitis.

    Roy, Avik Kumar; Senthil, Sirisha

    2015-01-01

    Glaucoma in aphakia is a major long term complication following congenital cataract surgery. Implantation of glaucoma drainage device provides an effective approach to manage refractory paediatric glaucoma. However implant surgery in young individuals is not free of complications. The prompt detection and management of tube erosion is of utmost importance to prevent devastating sequel of endophthalmitis. Implantation cyst following repair of tube erosion has not been reported so far. This case illustrates the rare occurrence of inclusion cyst following repair of tube erosion, the possible causes and its consequences. A 2-year-old child with aphakia developed intractable glaucoma. Following a failed glaucoma filtering surgery he underwent sequential Ahmed Glaucoma Valve implantation in both the eyes. Six weeks following right eye surgery, the child presented with conjunctival erosion overlying the tube, which was treated with scleral patch graft and conjunctival advancement. One month after the repair of tube erosion, the child presented with implantation cyst under the scleral patch graft, which was treated by drainage with a 29G needle. The child presented with endophthalmitis of his right eye following an episode of bilateral conjunctivitis. This was managed by an emergency pars plana vitrectomy, intraocular antibiotics and tube excision. At the last follow up visit, the IOP was 20 mmHg with 2 topical antiglaucoma medications in the right eye following a trans scleral photocoagulation. Lifelong careful follow-up of paediatric eyes with implant surgery is mandatory to look for complication such as tube erosion. It is important to place additional sutures to secure the patch graft during implantation of glaucoma drainage devices in children to prevent graft displacement and consequent tube erosion. During repair of tube erosion, it is crucial to remove all the conjunctival epithelium around the tube, thus not to incorporate epithelial tissue within the surgical

  13. A microinvasive technique for management of corneal edema secondary to glaucoma drainage device tube-corneal touch

    Harsh Kumar

    2018-01-01

    Full Text Available We present a case of tube endothelial touch where a suture technique for repositioning of the Ahmed glaucoma valve was performed. Advantage of this technique is that it is minimally invasive and anterior chamber stability is maintained during the procedure.

  14. Understanding practice patterns of glaucoma sub-specialists in India

    Nikhil S. Choudhari

    2017-10-01

    Full Text Available AIM: To obtain information on the prevailing practice patterns of glaucoma specialists in India. METHODS: Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India (GSI were surveyed. This survey, conducted in 2013, was based on an interactive audience response system. RESULTS: The information was obtained from 146 glaucoma specialists. Approximately half (n=83; 57% had ≥10y of experience in managing glaucoma and were in institutional practice (n=74, 51%. Goldmann applanation tonometry was preferred by 103 (72% specialists whilst n=25 (17.4% used non-contact tonometer. Indentation gonioscopy was favoured by two-thirds (n=90, 66% whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed (n=115, 86% and n=114; 83% respectively. Nearly three quarter specialists (n=96; 72% preferred optical coherence tomography for imaging. The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser (iridotomy, n=117; 93% and medical management (prostaglandin analogue, n=104; 78%, respectively. Approximately only a third of the specialists surveyed (n=37; 28% were performing both trabeculectomy and implantation of a glaucoma drainage device and about half (n=64; 47% were not operating on congenital glaucoma at all. CONCLUSION: This survey has found conformance with preferred practice patterns in several areas of diagnosis and management of glaucoma, but there was diversity in a few areas. The information is a significant step towards improvement of glaucoma care in India, including planning for future strategies.

  15. Phacoemulsification with intraocular lens implantation in primary angle-closure suspect, primary angle-closure and primary angle-closure glaucoma with cataract

    Kun Zeng

    2013-08-01

    Full Text Available AIM: To evaluate the features and clinical outcomes of cataract extraction by phacoemulsification with intraocular lens implantation in primary angle-closure suspect(PACS, primary angle-closure(PACand primary angle-closure glaucoma(PACGwith cataract.METHODS:Phacoemulsification with intraocular lens implantation was performed on 86 cases(86 eyesdiagnosed as PACS, PAC and PACG co-existing cataract from January to December 2012. All cases were followed up for 3 months to 1 year. Pre-operative and post-operative visual acuity, intraocular pressure(IOP, gonioscopy, ultrasound biomicroscopy(UBM, visual field and usage of anti-glaucomaous eye drops were recorded.RESULTS:Zonular dialysis existed in 19 eyes(22%. The post-operative visual acuity improved in 84 eyes(98%. The post-operative visual acuity was CONCLUSION: PACS, PAC and PACG co-existing zonular dialysis is common. Phacoemulsification with IOL implantation can reduce IOP, deepen anterior chamber and open angle.

  16. Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation.

    Kim, Kyoung Nam; Lee, Sung Bok; Lee, Yeon Hee; Lee, Jong Joo; Lim, Hyung Bin; Kim, Chang-Sik

    2016-07-01

    To evaluate changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve (AGV) implantation. This study was retrospective and observational case series. Patients with refractory glaucoma who underwent AGV implantation and were followed >5 years were consecutively enrolled. We reviewed the medical records, including the results of central corneal specular microscopy. Of the 127 enrolled patients, the annual change in ECD (%) was determined using linear regression for 72 eyes evaluated at least four times using serial specular microscopic examination and compared with 31 control eyes (fellow glaucomatous eyes under medical treatment). The main outcome measures were cumulative risk of corneal decompensation and differences in the ECD loss rates between subjects and controls. The mean follow-up after AGV implantation was 43.1 months. There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time and statistical significance compared with control eyes disappeared after 2 years postoperatively: -10.7% from baseline to 1 year (p<0.01), -7.0% from 1 year to 2 years (p=0.037), -4.2% from 2 years to 3 years (p=0.230) and -2.7% from 3 years to the final follow-up (p=0.111). In case of uncomplicated AGV implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation. The ECD loss was statistically greater in eyes with AGV than in control eyes without AGV, but the difference was significant only up to 2 years post surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): study protocol for a randomized controlled trial.

    Azuara-Blanco, Augusto; Burr, Jennifer M; Cochran, Claire; Ramsay, Craig; Vale, Luke; Foster, Paul; Friedman, David; Quayyum, Zahidul; Lai, Jimmy; Nolan, Winnie; Aung, Tin; Chew, Paul; McPherson, Gladys; McDonald, Alison; Norrie, John

    2011-05-23

    Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care. EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of

  18. The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE: study protocol for a randomized controlled trial

    Chew Paul

    2011-05-01

    Full Text Available Abstract Background Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle and medical treatment (to reduce intraocular pressure. If these treatments fail, glaucoma surgery (eg, trabeculectomy is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care. EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care. Methods/Design EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible. The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy, costs to the health services and patients, and adverse events. A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat. 400 participants (200 in each group will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05

  19. Comparison of polypropylene and silicone Ahmed® glaucoma valves in the treatment of neovascular glaucoma: A 2-year follow-up.

    Lubiński, Wojciech; Krzystolik, Karol; Gosławski, Wojciech; Kuprjanowicz, Leszek; Mularczyk, Maciej

    2018-01-01

    Inflammation associated with biomaterials of Ahmed® glaucoma drainage devices may cause the formation of a capsule around the device and can thus have a significant influence on the level of intraocular pressure reduction. The objective of this study was to compare the clinical outcomes after the implantation of a polypropylene or silicone Ahmed® glaucoma valve in patients with neovascular glaucoma. In the study, 27 eyes with neovascular glaucoma (group 1) received silicon Ahmed® valves and 23 eyes (group 2) received polypropylene valves. The best corrected distance visual acuity (BCDVA), intraocular pressure (IOP) and number of anti-glaucomatous drugs were recorded preoperatively and during a follow-up period of 24 months after surgery. Success was defined by the following criteria: 1) intraocular pressure in the rage of 6-21 mm Hg; 2) IOP reduction of at least 30% relative to preoperative values. All complications were registered. One month postoperatively, the mean BCDVA increased significantly in both groups compared to preoperative values (p glaucoma, the implantation of a silicone valve is associated with a significantly higher probability of long-term reduction of IOP below 21 mm Hg and with a lower risk of valve encapsulation in comparison to polypropylene valves. The obtained results suggest that silicone Ahmed® valves are more effective in the treatment of patients with neovascular glaucoma.

  20. Methods to reduce intraocular pressure on secondary glaucoma after severe eye burns

    A. V. Solovieva

    2014-07-01

    Full Text Available Purpose: Show the results of treatment of secondary glaucoma after severe eye burns.Methods: We observed 70 patients (108 eyes with severe burns the eyes and their consequences, secondary glaucoma was observed in 40 patients (58 eyes. All patients with secondary glaucoma received traditional antihypertensive therapy, with its failure to resort to antiglaucomatous surgery. Cataract extraction performed in 24 cases, 16 of them in combination with other surgery: the reconstruction of the anterior chamber, penetrating keratoplasty, sinustrabeculectomy, diode laser cyclocoagulation. Diode laser cy- clocoagulation performed 42 times in 8 of them in combination with other antiglaucomatous surgery: cataract surgery, reconstruction of the anterior chamber. Sinustrabeculectomy in patients with secondary glaucoma was performed in 7 cases, 4 of them with collagen implant drainage. Ahmed glaucoma drainage implant performed in 5 cases.Results: In 23 out of 58 (39.6% of long-term compensation glaucoma IOP was achieved antihypertensive therapy without sur- gery. After cataract extraction resistant compensated IOP was achieved in 10 cases, a temporary (1 to 42 months — in 11 cases, IOP is not reduced in 2 cases. After completing diode laser cyclocoagulation stable normalization of IOP occurred in 16 cases, the temporary (from 1 month to 2 years — in 20 cases, 4 cases of IOP reduction was not achieved. As a result sinustrabeculectomy in 4 cases IOP decreased, in one case the hypotensive effect is not there. After implantation Ahmed glaucoma valve in 2 cases was achieved stable normalization of IOP, in the 2 cases — the temporary; in 1 case developed endophthalmitis, and the device was removed.Conclusion: the immediate effect of antiglaucomatous treatment was 96.6%, but the high incidence of IOP decompensation (73.7% suggesting the need for continuous follow-up patients after severe eye burn injury, and a readiness to use other methods to reduce IOP.

  1. Methods to reduce intraocular pressure on secondary glaucoma after severe eye burns

    A. V. Solovieva

    2012-01-01

    Full Text Available Purpose: Show the results of treatment of secondary glaucoma after severe eye burns.Methods: We observed 70 patients (108 eyes with severe burns the eyes and their consequences, secondary glaucoma was observed in 40 patients (58 eyes. All patients with secondary glaucoma received traditional antihypertensive therapy, with its failure to resort to antiglaucomatous surgery. Cataract extraction performed in 24 cases, 16 of them in combination with other surgery: the reconstruction of the anterior chamber, penetrating keratoplasty, sinustrabeculectomy, diode laser cyclocoagulation. Diode laser cy- clocoagulation performed 42 times in 8 of them in combination with other antiglaucomatous surgery: cataract surgery, reconstruction of the anterior chamber. Sinustrabeculectomy in patients with secondary glaucoma was performed in 7 cases, 4 of them with collagen implant drainage. Ahmed glaucoma drainage implant performed in 5 cases.Results: In 23 out of 58 (39.6% of long-term compensation glaucoma IOP was achieved antihypertensive therapy without sur- gery. After cataract extraction resistant compensated IOP was achieved in 10 cases, a temporary (1 to 42 months — in 11 cases, IOP is not reduced in 2 cases. After completing diode laser cyclocoagulation stable normalization of IOP occurred in 16 cases, the temporary (from 1 month to 2 years — in 20 cases, 4 cases of IOP reduction was not achieved. As a result sinustrabeculectomy in 4 cases IOP decreased, in one case the hypotensive effect is not there. After implantation Ahmed glaucoma valve in 2 cases was achieved stable normalization of IOP, in the 2 cases — the temporary; in 1 case developed endophthalmitis, and the device was removed.Conclusion: the immediate effect of antiglaucomatous treatment was 96.6%, but the high incidence of IOP decompensation (73.7% suggesting the need for continuous follow-up patients after severe eye burn injury, and a readiness to use other methods to reduce IOP.

  2. Bleb Analysis and Short-Term Results of Biodegradable Collagen Matrix-Augmented Ahmed Glaucoma Valve Implantation: 6-Month Follow-up.

    Rho, Seungsoo; Sung, Youngje; Ma, Kyoung Tak; Rho, Sae Heun; Kim, Chan Yun

    2015-09-01

    To evaluate the short-term efficacy of a biodegradable collagen matrix (BCM) as an adjuvant for Ahmed valve implantation surgery to prevent the hypertensive phase. This prospective study included 43 refractory glaucoma eyes, all followed for 6 months. Refractory glaucoma was defined as an IOP higher than 20 mm Hg with antiglaucoma eye drops without previous glaucoma surgery. Conventional method was performed in 21 eyes and BCM-augmented Ahmed valve implantation (BAAVI) in 22 eyes. In the BAAVI group, a 10 × 10 × 2-mm BCM was sutured on an Ahmed glaucoma valve FP7 model. Complete success was defined as an IOP of 21 mm Hg or lower (target IOP 1) or 17 mm Hg or lower (target IOP 2) without antiglaucoma medications and qualified success as an IOP of 21 mm Hg or lower with or without medications. Maximal bleb thickness was measured using anterior segment optical coherence tomography images. The preoperative IOPs and numbers of preoperative antiglaucoma medications were similar for both groups. Complete target IOP 1 success rates were 38.1% and 86.4%, complete target IOP 2 success rates were 19.0% and 59.1%, and qualified success rates were 52.4% and 90.9% in the conventional and BAAVI groups, respectively (P < 0.05). The hypertensive phase rate was lower in the BAAVI group (4.5% vs. 47.6%, P = 0.002). Maximal bleb thickness was increased in the BAAVI group on postoperative days 30 and 180 (P < 0.05). Success rates were higher in the BAAVI group than in the conventional group with the change of bleb morphology. Furthermore, use of BCM significantly decreased the need for antiglaucoma medications for at least 6 months postoperatively.

  3. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma.

    Wang, Rui; Bi, Chun-Chao; Lei, Chun-Ling; Sun, Wen-Tao; Wang, Shan-Shan; Dong, Xiao-Juan

    2014-01-01

    To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation. Non-comparative retrospective observational case series. 30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations. The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis. To take early treatment of traumatic lens

  4. Glaucoma after corneal replacement.

    Baltaziak, Monika; Chew, Hall F; Podbielski, Dominik W; Ahmed, Iqbal Ike K

    Glaucoma is a well-known complication after corneal transplantation surgery. Traditional corneal transplantation surgery, specifically penetrating keratoplasty, has been slowly replaced by the advent of new corneal transplantation procedures: primarily lamellar keratoplasties. There has also been an emergence of keratoprosthesis implants for eyes that are high risk of failure with penetrating keratoplasty. Consequently, there are different rates of glaucoma, pathogenesis, and potential treatment in the form of medical, laser, or surgical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Glaucoma Symptoms

    ... up You can help find a cure for glaucoma Give now Signs & Symptoms The most common types ... have completely different symptoms. Symptoms of Open-Angle Glaucoma Most people who develop open-angle glaucoma don’ ...

  6. Combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for refractory primary congenital glaucoma in Egyptian patients: a long-term follow-up

    Helmy, Hazem

    2016-01-01

    Introduction Primary congenital glaucoma (PCG) is the most common type of glaucoma in pediatric patients. The aim of this study was to compare the effectiveness of combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for cases of PCG refractory to traditional incisional angle surgery (goniotomy and trabeculotomy) in the Egyptian population. Methods The study was conducted in the Glaucoma Clinic of the Research Institute of Ophthalmology (Egypt). The study included 66 eyes of 66 patients (in two groups) with advanced PCG who had previous failed goniotomy, trabeculotomy, or both. Group 1 included 33 patients who underwent trabeculotomy-trabeculectomy procedures; group 2 included 33 patients who underwent FP 8 Ahmed valve implantation. The main outcome measures were intraocular pressure (IOP) reduction, corneal diameter, and axial length stability in both groups. Secondary outcome measures included detection of complications in both groups. Results The average ages of the patients were 13.5 ± 3.9 months and 15.3 ± 5.8 months in groups 1 and 2, respectively. Ten patients (30.3%) in group 1 and 9 patients (27.3%) in group 2 had family histories of PCG. Positive consanguinity was present in 26 patients (78.8%) in group 1 and in 27 patients (81.8%) in group 2. In group 1, the mean intraocular pressure (IOP) value decreased from 33.6 ± 3.4 mmHg preoperatively to 13.8 ± 0.6, 16.9 ± 1.5, 18.2 ± 2.5, 19.8 ± 3.6, and 20.2 ± 3.1 mmHg in the first postoperative month and after years 1, 2, 3, and 4, respectively (p Ahmed valve implantation are suitable options in advanced PCG with failed trabeculotomy and goniotomy. Ahmed valve implanation has a better long-term survival, but trabeculotomy-trabeculectomy provides a second chance for surgical intervention. PMID:27053995

  7. A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction

    Dorairaj SK

    2018-04-01

    Full Text Available Syril K Dorairaj,1 Malik Y Kahook,2 Blake K Williamson,3 Leonard K Seibold,4 Mohammed K ElMallah,5 Inder P Singh6 On behalf of the KDB Goniotomy Study Group 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, 2School of Medicine, University of Colorado, Denver, CO, 3Williamson Eye Center, Baton Rouge, LA, 4School of Medicine, University of Colorado, Aurora, CO, 5Ocala Eye, Ocala, FL, 6The Eye Center of Racine and Kenosha, Kenosha, WI, USA Purpose: The aim of this study was to compare intraocular pressure (IOP outcomes in eyes with cataract and glaucoma undergoing phacoemulsification (phaco in combination with goniotomy using the Kahook Dual Blade (KDB or implantation of a single iStent trabecular bypass device.Methods: Retrospective analysis of IOP and IOP-lowering medication reduction in eyes undergoing phaco-goniotomy with KDB (n=237 or phaco-iStent (n=198. Preoperative, intraoperative, and postoperative data were collected through 6 months of follow-up. Outcome measures included mean IOP reduction, mean reduction in IOP-lowering medications, and the proportion of eyes achieving ≥20% IOP reduction or ≥1 medication reduction from baseline.Results: Mean IOP in the phaco-goniotomy with KDB group decreased from 17.9±4.4 mmHg at baseline to 13.6±2.7 mmHg at Month 6 (P<0.001, with mean medication use decreasing from 1.7±0.9 to 0.6±1.0 (P<0.001. In the phaco-iStent group, mean IOP decreased from 16.7±4.4 mmHg to 13.9±2.7 mmHg (P<0.001, with mean IOP-lowering medication use decreasing from 1.9±0.9 to 1.0±1.0 (P<0.001. Mean IOP reduction from baseline was significantly greater in the phaco-goniotomy with KDB group at Month 6 (phaco-goniotomy with KDB −4.2 mmHg [23.7%] vs phaco-iStent −2.7 mmHg [16.4%]; P<0.001. IOP-lowering medication reduction was greater in the phaco-goniotomy with KDB group compared to the phaco-iStent group (1.1 vs 0.9 medications, respectively; P=0.001. The most common adverse event was IOP spikes

  8. Sutureless human sclera donor patch graft for Ahmed glaucoma valve.

    Zeppa, Lucio; Romano, Mario R; Capasso, Luigi; Tortori, Achille; Majorana, Mara A; Costagliola, Ciro

    2010-01-01

    To report the safety and effectiveness of a sutureless human sclera donor patch graft covering the subconjunctival portion of glaucoma drainage implant tube to prevent its erosion throughout the overlying conjunctiva. This was a prospective pilot study. Fifteen eyes of 15 consecutive patients not responsive to medical and to not-implant surgical glaucoma treatment underwent Ahmed glaucoma valve (AGV) implant surgery with sutureless human sclera donor patch graft. The surgical procedure included AVG implant placed 8 mm behind the corneal limbus and fixed to the sclera with two 9-0 black nylon sutures. The tube was passed through the scleral tunnel, parallel to the corneal limbus, and shortened at the desired length. The anterior part of the tube was covered with human donor scleral graft and kept in place with fibrin glue (Tissue Coll) under the conjunctiva. Examinations were scheduled at baseline and then at 1 week and 1, 3, 6, and 12 months after surgery. At 12-month follow-up, the best-corrected visual acuity did not significantly improve from baseline 0.78+/-1.2 logMAR, whereas mean intraocular pressure significantly decreased from preoperative values of 29.8 (SD 8.4) mmHg. In all cases, the scleral patch was found in place at each check during the follow-up period. No conjunctival erosion over the AGV tube nor sign of endophthalmitis was recorded at any time during the follow-up period. AVG implant surgery with sutureless human sclera donor patch graft represents an effective and relatively safe surgical procedure for complicated glaucomas, avoiding conjunctival erosions over the AGV tube.

  9. Prevalent practice patterns in glaucoma: Poll of Indian ophthalmologists at a national conference

    Nikhil Shreeram Choudhari

    2016-01-01

    Full Text Available Purpose: The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis and management of glaucoma among subspecialists and general ophthalmologists in India. Materials and Methods: This is an interactive audience response system (ARS based poll of ophthalmologists attending the annual conference of the Glaucoma Society of India in 2013. Results: The information was obtained from 379 ophthalmologists (146 glaucoma specialists, 54 nonglaucoma subspecialists, and 179 general ophthalmologists. The majority of polled ophthalmologists (236; 62% had 10 or more years of experience in ophthalmology. The glaucoma specialists differed from nonglaucomatologists in their preference for Goldmann applanation tonometer (P < 0.01, four-mirror gonioscope (P < 0.01, Humphrey perimeter (P < 0.01, laser peripheral iridotomy in primary angle closure disease (P = 0.03, postiridotomy gonioscopy (P < 0.01, and usage of antifibrotic agents during filtering surgery (P < 0.01. Optical coherence tomography was the most preferred imaging modality and was utilized more often by the subspecialists than general ophthalmologists. The ophthalmologists also differed in their choice of antiglaucoma medications. More glaucoma specialists were performing surgery on children with congenital glaucoma (P < 0.01, implanting glaucoma drainage devices (P < 0.01, and using scientific journals to upgrade knowledge (P = 0.03 than the other ophthalmologists. Conclusions: This poll is the first of its kind in India, in its usage of the ARS, and in comparing the practice patterns of care for glaucoma among subspecialists and general ophthalmologists. It has revealed substantial diversity in a few areas among those who did and did not receive specialty training in glaucoma.

  10. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

    Rui Wang

    2014-04-01

    Full Text Available AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL implantation.METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi''an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13. Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL

  11. Facts about Glaucoma

    ... Information » Glaucoma » Facts About Glaucoma Listen Facts About Glaucoma This information was developed by the National Eye ... is the best person to answer specific questions. Glaucoma Defined What is Glaucoma? Glaucoma is a group ...

  12. Glaucoma: Symptoms and Causes

    ... types of glaucoma include the following: Open-angle glaucoma Open-angle glaucoma is the most common form ... re even aware of a problem. Angle-closure glaucoma Angle-closure glaucoma, also called closed-angle glaucoma, ...

  13. Assessment of thermal effects in a model of the human head implanted with a wireless active microvalve for the treatment of glaucoma creating a filtering bleb

    Schaumburg, F.; Guarnieri, F. A.

    2017-05-01

    A 3D anatomical computational model is developed to assess thermal effects due to exposure to the electromagnetic field required to power a new investigational active implantable microvalve for the treatment of glaucoma. Such a device, located in the temporal superior eye quadrant, produces a filtering bleb, which is included in the geometry of the model, together with the relevant ocular structures. The electromagnetic field source—a planar coil—as well as the microvalve antenna and casing are also included. Exposure to the electromagnetic field source of an implanted and a non-implanted subject are simulated by solving a magnetic potential formulation, using the finite element method. The maximum SAR10 is reached in the eyebrow and remains within the limits suggested by the IEEE and ICNIRP standards. The anterior chamber, filtering bleb, iris and ciliary body are the ocular structures where more absorption occurs. The temperature rise distribution is also obtained by solving the bioheat equation with the finite element method. The numerical results are compared with the in vivo measurements obtained from four rabbits implanted with the microvalve and exposed to the electromagnetic field source.

  14. Glaucoma (image)

    Glaucoma is a condition of increased fluid pressure inside the eye. The increased pressure causes compression of ... nerve which can eventually lead to nerve damage. Glaucoma can cause partial vision loss, with blindness as ...

  15. Glaucoma Foundation

    ... Options: SIZE CONTRAST Search Home About TGF About Glaucoma About Exfoliation Syndrome Research Center Contact Us Get ... tear glands, and a common preservative in many glaucoma medications can worsen the symptoms. The main treatment ...

  16. A prospective 3-year follow-up trial of implantation of two trabecular microbypass stents in open-angle glaucoma

    Donnenfeld ED

    2015-11-01

    Full Text Available Eric D Donnenfeld,1 Kerry D Solomon,2 Lilit Voskanyan,3 David F Chang,4 Thomas W Samuelson,5 Iqbal Ike K Ahmed,6 L Jay Katz7 1Ophthalmic Consultants of Long Island, Rockville Centre, NY, 2Carolina Eyecare Physicians, Mt Pleasant, SC, USA; 3S.V. Malayan Ophthalmology Centre, Yerevan, Armenia; 4Altos Eye Physicians, Los Altos, CA, 5Minnesota Eye Consultants, Minneapolis, MN, USA; 6University of Toronto, Toronto, ON, Canada; 7Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA, USA Purpose: To evaluate 3-year safety and intraocular pressure (IOP following two trabecular microbypass stents in phakic and pseudophakic subjects with open-angle glaucoma (OAG not controlled on preoperative medication. Patients and methods: In this prospective pilot study, phakic or pseudophakic subjects with OAG and IOP between 18 mmHg and 30 mmHg on one preoperative topical ocular hypotensive medication underwent medication washout. Thirty-nine qualified subjects with preoperative unmedicated IOP ≥22 mmHg and ≤38 mmHg received two stents. Postoperative examinations were scheduled at Day 1, Week 1, Months 1, 3, 6, and 12, and semiannually through Month 60. Ocular hypotensive medication was considered if postoperative IOP exceeded 21 mmHg. IOP, medication use, and safety were assessed at each visit. Subject follow-up through Month 36 was completed. Results: Thirty-six eyes (92.3%; 95% confidence interval [CI] 79.1%, 98.4% achieved the primary efficacy end point of Month 12 reduction in IOP ≥20% from baseline (unmedicated IOP without ocular hypotensive medication. Four subjects required medication during the Month 36 follow-up period. Mean IOP at 36 months for subjects not taking medication was 15.2 mmHg. At 36 months, subjects sustained mean IOP decrease of 9.1±2.7 mmHg (95% CI 8.0 mmHg, 10.14 mmHg, or 37% IOP reduction, from unmedicated baseline IOP. Compared to preoperative medicated IOP, subjects had mean reduction at Month 36 of 5.5±2

  17. [Uveitic Secondary Glaucoma].

    Lommatzsch, Claudia; Heinz, Carsten

    2018-05-01

    An intraocular pressure increase with development of glaucomatous damage is a common complication of uveitis. The prevalence has a wide range depending on various factors such as the underlying uveitis type and the duration of the disease. Pathogenetically, a distinction must be made between a secondary angle closure component and the more frequently occurring open-angle glaucoma. In diagnostics, in addition to the clinical optic nerve head assessment, perimetry and tonometry, the use of imaging examination equipment, such as OCT and HRT, are recommended. In the context of uveitic glaucoma, it must be considered in the evaluation, because the glaucoma-typical changes are generally less pronounced or can be concealed by retinal swelling in comparison with other forms of glaucoma. Therapeutically, drug therapy in the form of eye drops continues to be a first-line recommendation, with the use of topical carbonic anhydrase inhibitors or beta-blockers primarily preferred, depending on the contraindications. An operative therapy follows after unsuccessful or inadequate conservative therapy: the adequate surgical technique depends on the respective finding and includes actually techniques such as filtering procedures and glaucoma drainage devices. Georg Thieme Verlag KG Stuttgart · New York.

  18. [Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage].

    Schnetzke, M; Aytac, S; Herrmann, P; Wölfl, C; Grützner, P A; Heppert, V; Guehring, T

    2015-06-01

    Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.

  19. Glaucoma Research Foundation

    ... born with glaucoma. Read her story » Learn About Glaucoma Glaucoma is a complicated disease in which damage ... Christopher doesn't ever want to go blind » Glaucoma 360 Glaucoma 360 — three days of events uniting ...

  20. Equine Glaucoma.

    Michau, Tammy Miller

    2017-12-01

    Glaucoma is a multifactorial neurodegenerative ocular disease leading to progressive loss of retinal ganglion cells and their axons that form the optic nerve, causing blindness. Knowledge of the pathogenesis and development of equine glaucoma is in its infancy compared with human glaucoma. Glaucoma occurs most commonly secondary to uveitis and may be underdiagnosed or misdiagnosed in horses suffering from uveitis. Recognition and clinical diagnosis of glaucoma in the horse is improved with clinician awareness and the availability of handheld tonometers. Therapy for glaucoma is aimed at decreasing aqueous humor production through medical and surgical means. Even with therapy, long-term prognosis for vision is poor. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Micro-invasive glaucoma surgery (MIGS: a review of surgical procedures using stents

    Pillunat LE

    2017-08-01

    Full Text Available Lutz E Pillunat,1 Carl Erb,2 Anselm GM Jünemann,3 Friedemann Kimmich4 1Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden, 2Augenklinik am Wittenbergplatz, Berlin, Germany; 3Department of Ophthalmology University of Rostock, Rostock, Germany; 4eyecons, Karlsruhe, Germany Abstract: Over the last decade several novel surgical treatment options and devices for glaucoma have been developed. All these developments aim to cause as little trauma as possible to the eye, to safely, effectively, and sustainably reduce intraocular pressure (IOP, to produce reproducible results, and to be easy to adopt. The term “micro-invasive glaucoma surgery (MIGS” was used for summarizing all these procedures. Currently MIGS is gaining more and more interest and popularity. The possible reduction of the number of glaucoma medications, the ab interno approach without damaging the conjunctival tissue, and the probably safer procedures compared to incisional surgical methods may explain the increased interest in MIGS. The use of glaucoma drainage implants for lowering IOP in difficult-to-treat patients has been established for a long time, however, a variety of new glaucoma micro-stents are being manufactured by using various materials and are available to increase aqueous outflow via different pathways. This review summarizes published results of randomized clinical studies and extensive case report series on these devices, including Schlemm’s canal stents (iStent®, iStent® inject, Hydrus, suprachoroidal stents (CyPass®, iStent® Supra, and subconjunctival stents (XEN. The article summarizes the findings of published material on efficacy and safety for each of these approaches. Keywords: glaucoma, micro-invasive glaucoma surgery, MIGS, iStent, iStent inject, CyPass, Hydrus, XEN

  2. The Ahmed Glaucoma Valve in Refractory Glaucoma: Experiences in Southwest Ethiopia.

    Gessesse, Girum W

    2015-07-01

    The management of refractory glaucoma is a challenging task for any glaucoma surgeon. This study is aimed to evaluate the efficacy of Ahmed Glaucoma Valve implantation in refractory glaucomas in South-West Ethiopia. A retrospective review was conducted on the charts of consecutive patients treated with Ahmed glaucoma valve implantation at Jimma University Specialized Hospital between August 2012 and August 2014. Success was defined as Intraocular Pressure (IOP) less than 22 mm Hg and greater than 5mm Hg at 6 months, with at least 30% reduction from baseline, without medical therapy (complete success) or either with or without medication (qualified successes). A total of 12 eyes of 11 patients were included. The mean age of patients was 40.7 (SD= 19.0) years; 63.6% of them were males. The main types of glaucoma were pseudoexfoliative (3 eyes), uveitic (2 eyes), chronic angle closure (2 eyes) and Juvenile Open Angle (JOAG) (2 eyes). The mean IOP was reduced from preoperative level (32.75±7.14 mmHg) to (15.75 ±4.35 mmHg) at six postoperative months, (PAhmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas with success rate comparable with those reported from other studies. Ahmed glaucoma valve, refractory glaucoma, complications, Ethiopia.

  3. Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching.

    Kostanyan, Tigran; Shazly, Tarek; Kaplowitz, Kevin B; Wang, Steven Z; Kola, Sushma; Brown, Eric N; Loewen, Nils A

    2017-12-01

    To apply propensity score matching to compare Baerveldt glaucoma drainage implant (BGI) to Trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma. BGI and AIT patients with at least 1 year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients with neovascular glaucoma, with prior glaucoma surgery, or without a close match were excluded. Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma, the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6 ± 6.3 mmHg compared to 21.5 ± 7.4 for AIT on 2.8 ± 1.1 medications and 2.5 ± 2.3 respectively. At 30 months, the mean IOP was 15.0 ± 3.9 mmHg for AIT versus 15.0 ± 5.7 mmHg for BGI (p > 0.05), while the number of drops was 1.5 ± 1.3 for AIT (change: p = 0.001) versus 2.4 ± 1.2 for BGI (change: p = 0.17; AIT vs BGI: 0.007). Success, defined as IOP  0.05) and 50% versus 52% at 2.5 years. A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through 1 year. AIT required fewer medications.

  4. On-Chip Implantable Antennas for Wireless Power and Data Transfer in a Glaucoma-Monitoring SoC

    Marnat, Loic; Arsalan, Muhammad; Ouda, Mahmoud H.; Salama, Khaled N.; Shamim, Atif

    2013-01-01

    For the first time separate transmit and receive onchip antennas have been designed in a eye environment for implantable intraocular pressure monitoring application. The miniaturized antennas fit on a 1.4 mm3 CMOS (0.18 μm) chip with the rest

  5. Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

    Javanbakht, Mehdi; Azuara-Blanco, Augusto; Burr, Jennifer M; Ramsay, Craig; Cooper, David; Cochran, Claire; Norrie, John; Scotland, Graham

    2017-01-01

    Objective To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon. Setting 22 hospital eye services in the UK. Population Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care. Results The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years. Trial registration number ISRCTN44464607; Results. PMID:28087548

  6. What Is Glaucoma?

    ... Stories Español Eye Health / Eye Health A-Z Glaucoma Sections What Is Glaucoma? What Are the Symptoms ... Diagnosis Glaucoma Treatment Glaucoma Vision Simulator What Is Glaucoma? Leer en Español: ¿Qué es el glaucoma? Written ...

  7. Initial clinical experience with the trabecular micro-bypass stent in patients with glaucoma.

    Spiegel, Detlev; Wetzel, Wolfgang; Haffner, David S; Hill, Richard A

    2007-01-01

    This study was undertaken to evaluate the efficiency of a trabecular micro-bypass stent designed to allow direct aqueous drainage from the anterior chamber into Schlemm's canal in patients with glaucoma. In this prospective case series of 6 patients with open-angle glaucoma, the microstent was inserted ab interno under local anesthesia in an ophthalmic operating room. Patients were seen postoperatively at 1 to 2 d, 1 wk, and 1, 2, 6, and 12 mo. All stents were successfully placed within Schlemm's canal. Mean intraocular pressure (IOP) at preoperative baseline was 20.2+/-6.3 mm Hg (range, 14-31 mm Hg). Mean IOP decreased during the immediate postoperative period to approximately 12 to 13 mm Hg and was stabilized at 14 to 15 mm Hg with reduction of medication throughout 1 y of follow-up. No major complications occurred. According to observations reported in this feasibility study, the microstent was effective in reducing IOP and in decreasing the number of glaucoma medications required to control IOP. Implantation procedures were safe, and stents remained in place throughout the follow-up period. None of the complications traditionally associated with filtering surgery were reported. Further research on this stent in a larger group of patients is needed to assess its role in glaucoma therapy.

  8. Novel surgical procedures in glaucoma: advances in penetrating glaucoma surgery.

    Filippopoulos, Theodoros; Rhee, Douglas J

    2008-03-01

    Despite late modifications and enhancements, traditional penetrating glaucoma surgery is not without complications and is reserved for patients in whom pharmacologic treatment and/or laser trabeculoplasty do not suffice to control the intraocular pressure. This article critically reviews recent advances in penetrating glaucoma surgery with particular attention paid to two novel surgical approaches: ab interno trabeculectomy with the Trabectome and implantation of the Ex-PRESS shunt. Ab interno trabeculectomy (Trabectome) achieves a sustained 30% reduction in intraocular pressure by focally ablating and cauterizing the trabecular meshwork/inner wall of Schlemm's canal. It has a remarkable safety profile with respect to early hypotonous or infectious complications as it does not generate a bleb, but it can be associated with early postoperative intraocular pressure spikes that may necessitate additional glaucoma surgery. The Ex-PRESS shunt is more commonly implanted under a partial thickness scleral flap, and appears to have similar efficacy to standard trabeculectomy offering some advantages with respect to the rate of early complications related to hypotony. Penetrating glaucoma surgery will continue to evolve. As prospective randomized clinical trials become available, we will determine the exact role of these surgical techniques in the glaucoma surgical armamentarium.

  9. Use of subconjunctival injections of 5-fluorouracil to rescue and prolong intraocular pressure reduction for a failing Ahmed glaucoma implant.

    Kaplowitz, Kevin; Khodadadeh, Sarah; Wang, Samantha; Lee, Daniel; Tsai, James C

    2017-06-01

    5-Fluorouracil (5-FU) has been well described for a failing trabeculectomy bleb, but not for aqueous shunts. We sought to determine whether subconjunctival 5-FU prolongs the intraocular pressure (IOP) efficacy of Ahmed shunts. We included all patients with Ahmed FP-7 implantation by one surgeon at Yale University. Patients with  21 on >2 medications. Five-milligram (0.1 cc) injections were made over the plate. The control group consisted of Ahmed FP-7 patients without injections. The main outcome measure was IOP. Secondary outcome was success (IOP Ahmed shunts. Outcomes between eyes receiving injections and controls were statistically similar.

  10. Childhood glaucoma surgery in the 21st Century

    Papadopoulos, M; Edmunds, B; Fenerty, C; Khaw, P T

    2014-01-01

    Most children with glaucoma will require surgery in their lifetime, often in their childhood years. The surgical management of childhood glaucoma is however challenging, largely because of its greater potential for failure and complications as compared with surgery in adults. The available surgical repertoire for childhood glaucoma has remained relatively unchanged for many years with most progress owing to modifications to existing surgery. Although the surgical approach to childhood glaucoma varies around the world, angle surgery remains the preferred initial surgery for primary congenital glaucoma and a major advance has been the concept of incising the whole of the angle (circumferential trabeculotomy). Simple modifications to the trabeculectomy technique have been shown to considerably minimise complications. Glaucoma drainage devices maintain a vital role for certain types of glaucoma including those refractory to other surgery. Cyclodestruction continues to have a role mainly for patients following failed drainage/filtering surgery. Although the prognosis for childhood glaucoma has improved significantly since the introduction of angle surgery, there is still considerable progress to be made to ensure a sighted lifetime for children with glaucoma all over the world. Collaborative approaches to researching and delivering this care are required, and this paper highlights the need for more high-quality prospective surgical trials in the management of the childhood glaucoma. PMID:24924446

  11. Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study

    Panda, Anita; Prakash, Vadivelu Jaya; Dada, Tanuj; Gupta, Anoop Kishore; Khokhar, Sudarshan; Vanathi, Murugesan

    2011-01-01

    Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG). Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up. PMID:21586837

  12. The use of Ahmed glaucoma valve in the management of pediatric glaucoma.

    Balekudaru, Shantha; Vadalkar, Juhie; George, Ronnie; Vijaya, Lingam

    2014-08-01

    To assess the intraocular pressure control (IOP), changes in visual acuity, complications, reoperation rates and risk factors for failure following Ahmed glaucoma valve implantation in pediatric eyes with glaucoma. The medical records of consecutive patients with glaucoma who underwent Ahmed glaucoma valve implantation from January 2000 to December 2009) were retrospectively reviewed. Only one eye of each patient was included. Subgroup analysis was performed in three groups; group 1 included phakic eyes with primary congenital glaucoma, juvenile open-angle glaucoma, or glaucoma associated with ocular anomalies; group 2 included eyes with glaucoma in aphakia or pseudophakia; group 3 included eyes with other diagnoses. A successful outcome was defined as final IOP between 6 mm Hg and 18 mm Hg without loss of light perception or reoperation for glaucoma. A total of 71 eyes in 71 patients: 15 (21%) in group 1, 47 (66%) in group 2, and 9 (13%) in group 3 were included Successful IOP control was achieved in 44 eyes of 44 patients (62%). Cumulative probabilities of success by Kaplan-Meier analysis at 12 and 24 months was 97% and 80% for the entire group, 100% and 82% for group 1, 95% and 86% for group 2, and 90% and 42% for group 3. Reoperation was necessary for 18 patients (25%), either for tube-related complications or for IOP control. The only significant risk factor for failure was the category of diagnosis (P = 0.029). Ahmed glaucoma valve implantation is an option in the management of pediatric glaucoma; however, reoperations for tube related complications or for persistent elevated IOP is frequently needed. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  13. Glaucoma maligno en paciente con cirugía previa de catarata traumática e implante valvular: reporte de caso

    Juan Carlos Serna-Ojeda

    2015-07-01

    Full Text Available El glaucoma maligno es un glaucoma secundario asociado con un bloqueo ciliar y dirección equivocada del flujo del humor acuoso. Se presenta el caso de un paciente masculino de 19 años con antecedente de explosión de filtro metálico en ojo derecho. Se encuentra con una presión intraocular de 52 mmHg y cristalino luxado a cámara anterior. Se inicia terapia máxima para glaucoma y se realiza facoemulsificación con posterior colocación de válvula de Ahmed, y 3 semanas después de la cirugía presenta hallazgos clínicos compatibles con glaucoma maligno. Se presenta el seguimiento del paciente y los estudios de imagen indicados

  14. Glaucoma, Open-Angle

    ... Home » Statistics and Data » Glaucoma, Open-angle Listen Glaucoma, Open-angle Open-angle Glaucoma Defined In open-angle glaucoma, the fluid passes ... 2010 2010 U.S. Age-Specific Prevalence Rates for Glaucoma by Age and Race/Ethnicity The prevalence of ...

  15. On-Chip Implantable Antennas for Wireless Power and Data Transfer in a Glaucoma-Monitoring SoC

    Marnat, Loic

    2013-04-17

    For the first time separate transmit and receive onchip antennas have been designed in a eye environment for implantable intraocular pressure monitoring application. The miniaturized antennas fit on a 1.4 mm3 CMOS (0.18 μm) chip with the rest of the circuitry. A 5.2 GHz novel inductive fed and loaded receive monopole antenna is used for wireless powering the chip and is conjugately matched to the rectifier in the energy harvesting and storage unit. The 2.4 GHz transmit antenna is an octagonal loop which also acts as the inductor of the voltage control oscillator resonant tank. To emulate the eye environment in measurements, a custom test setup is developed which comprises plexiglass cavities filled with saline solution. A transition, employing a balun, is also designed which transforms the differential impedance of on-chip antennas immersed in saline solution to a 50 ! single-ended micrsotrip line. The antennas on a lossy Si substrate and eye environment provide sufficient gain to establish wireless communication with an external reader placed few cm away from the eye.

  16. Aqueous shunts for glaucoma.

    Tseng, Victoria L; Coleman, Anne L; Chang, Melinda Y; Caprioli, Joseph

    2017-07-28

    three reported one-year outcomes. At one-year, the difference in IOP between aqueous shunt groups and trabeculectomy groups was uncertain (mean difference (MD) 2.55 mmHg, 95% confidence interval (CI) -0.78 to 5.87; 380 participants; very low-certainty evidence). The difference in logMAR visual acuity was also uncertain (MD 0.12 units, 95% CI -0.07 to 0.31; 380 participants; very low-certainty evidence). In two trials, the difference in visual field score was uncertain (MD -0.25, 95% CI -1.91 to 1.40; 196 participants; very low-certainty evidence). The mean number of antiglaucoma medications was higher in the aqueous shunt group than the trabeculectomy group in one trial (MD 0.80, 95% CI 0.48 to 1.12; 184 participants; low-certainty evidence). The effect on needing additional glaucoma surgery was uncertain between groups in two trials (risk ratio (RR) 0.24, 95% CI 0.04 to 1.36; 329 participants; very low-certainty evidence). In one trial, fewer total adverse events were reported in the aqueous shunt group than the trabeculectomy group (RR 0.59, 95% CI 0.43 to 0.81; 212 participants; very low-certainty evidence). No trial reported quality-of-life outcomes at one-year follow-up.Two trials that compared the Ahmed implant with the Baerveldt implant for glaucoma found higher mean IOP in the Ahmed group at one-year follow-up (MD 2.60 mmHg, 95% CI 1.58 to 3.62; 464 participants; moderate-certainty evidence). The difference in logMAR visual acuity was uncertain between groups (MD -0.07 units, 95% CI -0.27 to 0.13; 501 participants; low-certainty evidence). The MD in number of antiglaucoma medications was within one between groups (MD 0.35, 95% CI 0.11 to 0.59; 464 participants; moderate-certainty evidence). More participants in the Ahmed group required additional glaucoma surgery than the Baerveldt group (RR 2.77, 95% CI 1.02 to 7.54; 514 participants; moderate-certainty evidence). The two trials reported specific adverse events but not overall number of adverse events. Neither

  17. Glaucoma: Symptoms, Diagnosis & Treatment

    ... of this page please turn JavaScript on. Feature: Glaucoma Symptoms, Treatment and Research Past Issues / Spring 2015 ... vision, without any pain. Photo courtesy of NEI Glaucoma Symptoms At first, open-angle glaucoma has no ...

  18. Get Tested for Glaucoma!

    ... of this page please turn Javascript on. Feature: Glaucoma Get Tested for Glaucoma! Past Issues / Fall 2009 Table of Contents Taylor ... aoa.org/ When were you finally diagnosed with glaucoma? Not until 1969, after a game of basketball. ...

  19. New continuous air pumping technique to improve clinical outcomes of descemet-stripping automated endothelial keratoplasty in asian patients with previous ahmed glaucoma valve implantation.

    Chang-Min Liang

    Full Text Available BACKGROUND: To evaluate the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK with the use of continuous air pumping technique in Asian eyes with previous Ahmed glaucoma valve implantation. METHODS: The DSAEK procedure was modified in that complete air retention of the anterior chamber was maintained for 10 min using continuous air pumping at 30 mm Hg. The primary outcome measurement was graft survival, and postoperative clinical features including, rate of graft detachment, endothelial cell count, intraocular pressure (IOP, surgical time and cup/disc ratio were also recorded. RESULTS: A total of 13 eyes of 13 patients which underwent modified DSAEK and 6 eyes of 6 patients which underwent conventional DSAEK were included. There was a significant difference in graft survival curves between two groups (P = 0.029; the 1-year graft survival rates were estimated as 100% and 66.7% for patients with modified DSAEK and those with traditional DSAEK, respectively. The rate of graft detachment were 0% and 33.3% for the modified DSAEK and conventional DSAEK groups, respectively (P = 0.088. The significantly lowered surgical time for air tamponade was noted in the modified DSAEK group compared to that in the conventional DSAEK group [median (IQR: 10.0 (10.0, 10.0 min vs. 24.5 (22.0, 27.0 min; P<0.001] Postoperatively, patients in the modified DSAEK group had significantly lower IOP as compared to the conventional DSAEK group [12.0 (11.0, 15.0 mm Hg vs. 16.0 (15.0, 18.0 mm Hg; P = 0.047]. Modified DSAEK patients had higher endothelial cell counts as compared to conventional DSAEK patients [2148.0 (1964.0, 2218.0 vs. 1529.0 (713.0, 2014.0], but the difference did not reach statistical significance (P = 0.072. CONCLUSIONS: New continuous air pumping technique in DSAEK can be performed safely and effectively in patients with prior GDDs placement who have corneal failure.

  20. The Ex-PRESS glaucoma shunt versus trabeculectomy in open-angle glaucoma: a prospective randomized study

    de Jong, Leo A. M. S.

    2009-01-01

    The purpose of this study was to establish the efficacy and safety of the Ex-PRESS (Optonol Ltd., Neve Ilan, Israel) mini glaucoma shunt in open-angle glaucoma. This was a prospective, randomized trial. Eyes from enrolled patients were randomly assigned to either Ex-PRESS implantation under a

  1. [Ahmed valve in glaucoma surgery].

    Bikbov, M M; Khusnitdinov, I I

    This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

  2. Early Clinical Results of a Novel Ab Interno Gel Stent for the Surgical Treatment of Open-angle Glaucoma.

    Sheybani, Arsham; Dick, H Burkhard; Ahmed, Iqbal I K

    2016-07-01

    To evaluate the intraocular pressure (IOP) lowering effect of the XEN140 microfistula gel stent implant for the surgical treatment of open-angle glaucoma. Forty-nine eyes of 49 patients with an IOP>18 mm Hg and ≤35 mm Hg were studied in a prospective nonrandomized multicenter cohort trial of the surgical implantation of the XEN140 implant in patients with open-angle glaucoma. Complete success was defined as a postoperative IOP≤18 mm Hg with ≥20% reduction in IOP at 12 months without any glaucoma medications. Failure was defined as vision loss of light perceptions vision or worse, need for additional glaucoma surgery, or glaucoma.

  3. Glaukos iStent inject® Trabecular Micro-Bypass Implantation Associated with Cataract Surgery in Patients with Coexisting Cataract and Open-Angle Glaucoma or Ocular Hypertension: A Long-Term Study

    Pedro Arriola-Villalobos

    2016-01-01

    Full Text Available Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT. Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP, topical hypotensive medications required, and best-corrected visual acuity (BCVA. Results. 20 patients were enrolled. Mean follow-up was 47.4±18.46 months. Mean baseline IOP was 19.95±3.71 mmHg with medication and 26±3.11 mmHg after washout. Mean end-follow-up IOP was 16.25±1.99 mmHg, representing an IOP decrease of 36.92%, 9.74±3.14 mmHg (P<0.001, from baseline washout IOP. The mean number of medications was significantly reduced from 1.3±0.66 to 0.75±0.79 (P=0.017. 45% of patients were medication-free by the end of follow-up. Mean log⁡MAR BCVA improved significantly from 0.42±0.16 to 0.18±0.16 (P<0.001. No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT and cataract.

  4. A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: ‘Scleral Sleeve Method’

    Charudutt Kalamkar

    2017-10-01

    Full Text Available Purpose: To present a new surgical technique ‘Scleral Sleeve Method’ which would reduce the risk of Ahmed Glaucoma Valve (AGV tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA for refractory glaucoma. Design: Prospective, Non-Randomized, hospital based interventional case series. Subjects: A total of 16 eyes of adult patients (10 males and 6 females with refractory glaucoma. Methods: Instead of using sutures to fix the AGV tube to sclera, we devised a novel method of intra-scleral tube fixation by creating a scleral tunnel fashioned in form of sleeve. Main outcome measure: Post-operative tube related complications. Result: There were no tube related complications such as exposure, extrusion or retraction in any of the cases. Conclusion: Use of scleral sleeve method for tube fixation, along with graft to cover the tube, will provide additional safety measure and reduce the risks of tube related complications. Keywords: Ahmed Glaucoma Valve, Scleral Sleeve Method, Intra-scleral tube fixation

  5. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review

    Mohammad Reza Razeghinejad

    2016-09-01

    Full Text Available Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.

  6. The role of matricellular proteins in glaucoma.

    Wallace, Deborah M

    2014-07-01

    Glaucoma is an optic neuropathy affecting approximately 60million people worldwide and is the second most common cause of irreversible blindness. Elevated intraocular pressure (IOP) is the main risk factor for developing glaucoma and is caused by impaired aqueous humor drainage through the trabecular meshwork (TM) and Schlemm\\'s canal (SC). In primary open angle glaucoma (POAG), this elevation in IOP in turn leads to deformation at the optic nerve head (ONH) specifically at the lamina cribrosa (LC) region where there is also a deposition of extracellular matrix (ECM) molecules such as collagen and fibronectin. Matricellular proteins are non-structural secreted glycoproteins that help cells communicate with their surrounding ECM. This family of proteins includes connective tissue growth factor (CTGF), also known as CCN2, thrombospondins (TSPs), secreted protein acidic and rich in cysteine (SPARC), periostin, osteonectin, and Tenascin-C and -X and other ECM proteins. All members appear to play a role in fibrosis and increased ECM deposition. Most are widely expressed in tissues particularly in the TM and ONH and deficiency of TSP1 and SPARC have been shown to lower IOP in mouse models of glaucoma through enhanced outflow facility. The role of these proteins in glaucoma is emerging as some have an association with the pathophysiology of the TM and LC regions and might therefore be potential targets for therapeutic intervention in glaucoma.

  7. Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study

    Tharwat H. Mokbel

    2018-04-01

    Full Text Available AIM: To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network (CGRN classification retrospectively to evaluate its convenience. METHODS: A retrospective study in which the medical files of all glaucoma patients <16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included: age, gender, laterality, visual acuity (VA, refraction, intraocular pressure (IOP, corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs (AGD at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared. RESULTS: A total of 305 eyes of 207 patients were included classified into 6 groups: primary congenital glaucoma (PCG, juvenile open angle glaucoma (JOAG, glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type (55.1% followed by acquired glaucoma (29.5%. Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis (21.9±30.0mo. The shortest corneal diameter was recorded in post cataract group (10.4±0.5 mm. Highest cup-disc ratio was found in the PCG group (P<0.0005. Glaucoma associated with systemic disease presented with the highest baseline IOP (34.5±5.0 mm Hg. All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients (74.2% in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest

  8. Glaucoma in Asian Populations

    ... Involved News About Us Donate In This Section Glaucoma In Asian Populations email Send this article to ... lower than in their Asian counterparts. Normal Tension Glaucoma affects Japanese Japanese populations, however, have a substantially ...

  9. African Americans and Glaucoma

    ... Us Donate In This Section African Americans and Glaucoma email Send this article to a friend by ... and eventually, in developing more effective treatments. Does glaucoma treatment differ? Although treatment varies for all individuals, ...

  10. Screening for Glaucoma

    Understanding Task Force Recommendations Screening for Glaucoma The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Glaucoma . This final recommendation statement ...

  11. Five Common Glaucoma Tests

    ... About Us Donate In This Section Five Common Glaucoma Tests en Español email Send this article to ... year or two after age 35. A Comprehensive Glaucoma Exam To be safe and accurate, five factors ...

  12. Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy

    Cham A

    2016-06-01

    Full Text Available Abdourahman Cham,1,2 Mayank Bansal,3 Himanshu K Banda,4 Young Kwon,1 Paul S Tlucek,1 Alexander G Bassuk,5 Stephen H Tsang,6,7 Warren M Sobol,8 James C Folk,1 Steven Yeh,4 Vinit B Mahajan1,2 1Department of Ophthalmology and Visual Sciences, 2Omics Laboratory, University of Iowa, Iowa City, IA, USA; 3Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 4Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 5Department of Pediatrics, University of Iowa, Iowa City, IA, 6Barbara and Donald Jonas Laboratory of Stem Cells and Regenerative Medicine and Bernard and Shirlee Brown Glaucoma Laboratory, Department of Pathology and Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, 7Edward S Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 8Retina Physicians & Surgeons, Inc., Dayton, OH, USA Objective: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV, a hereditary autoimmune uveitis due to mutations in CAPN5. Patients and methods: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP, visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT were also analyzed. Results: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5 required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser

  13. Ahmed glaucoma valve in children: A review☆

    Nassiri, Nariman; Nouri-Mahdavi, Kouros; Coleman, Anne L.

    2011-01-01

    Pediatric glaucoma is potentially a blinding disease. Although goniotomy and trabeculotomy are associated with good early success rates, eventually 20% of these procedures fail and many children will require additional surgery to control the IOP in the long-term. In this review, we reported that adequate IOP control can be achieved with the placement of Ahmed glaucoma valve and can last 5 or more years. However, most patients will need one or more glaucoma medications at some point after surgery. In addition, the implants may be associated with pupillary irregularities, lenticular opacification as well as tube-related complications, particularly in the first year of life, as the globe is enlarging with age. PMID:23960945

  14. Peripheral iridotomy for pigmentary glaucoma

    Michelessi, Manuele; Lindsley, Kristina

    2016-01-01

    Background Glaucoma is a chronic optic neuropathy characterized by retinal ganglion cell death resulting in damage to the optic nerve head and the retinal nerve fiber layer. Pigment dispersion syndrome is characterized by a structural disturbance in the iris pigment epithelium (the densely pigmented posterior surface of the iris) that leads to dispersion of the pigment and its deposition on various structures within the eye. Pigmentary glaucoma is a specific form of open-angle glaucoma found in patients with pigment dispersion syndrome. Topcial medical therapy is usually the first-line treatment; however, peripheral laser iridotomy has been proposed as an alternate treatment. Peripheral laser iridotomy involves creating an opening in the iris tissue to allow drainage of fluid from the posterior chamber to the anterior chamber and vice versa. Equalizing the pressure within the eye may help to alleviate the friction that leads to pigment dispersion and prevent visual field deterioration. However, the effectiveness of peripheral laser iridotomy in reducing the development or progression of pigmentary glaucoma is unknown. Objectives The objective of this review was to assess the effects of peripheral laser iridotomy compared with other interventions, including medication, trabeculoplasty, and trabeculectomy, or no treatment, for pigment dispersion syndrome and pigmentary glaucoma. Search methods We searched a number of electronic databases including CENTRAL, MEDLINE and EMBASE and clinical trials websites such as (mRCT) and ClinicalTrials.gov. We last searched the electronic databases on 2 November 2015. Selection criteria We included randomized controlled trials (RCTs) that had compared peripheral laser iridotomy versus no treatment or other treatments for pigment dispersion syndrome and pigmentary glaucoma. Data collection and analysis We used standard methodological procedures for systematic reviews. Two review authors independently screened articles for eligibility

  15. External trabeculectomy with T-Flux implant.

    Jungkim, S

    2012-02-03

    PURPOSE: To evaluate the efficacy and safety of T-Flux implant in nonpenetrating glaucoma surgery. METHODS: This clinical interventional case series study included 35 eyes of 35 patients with medically uncontrolled primary open angle glaucoma. External trabeculectomy with T-Flux (ETTF) is a technique of nonpenetrating glaucoma surgery, in which after removing deep scleral tissue and un-roofing the canal of Schlemn (CS) the external trabecular tissue is peeled off to enhance the aqueous drainage without opening the anterior chamber. A non-absorbable T-Flux implant (IOL TECH Laboratories, France) was sutured in deep intrascleral space to keep it patent. Snellen\\'s best-corrected visual acuity, slit lamp biomicroscopy, intraocular pressure (IOP), gonioscopy, funduscopy, and optic disc assessment were performed preoperatively and postoperatively at 1 day, 1 week, and 1, 3 , 6, and 12 months. Visual field testing was performed preoperatively and at 6 and 12 months postoperatively. RESULTS: For three eyes, surgery was converted to standard trabeculectomy owing to the perforation of trabeculo-Descemet\\'s membrane and iris prolapse and excluded from the study. The results of the remaining 32 eyes were included in the study. Preoperative IOP (mean +\\/- SD) of 32.88 +\\/- 5.7 mmHg decreased to 15.44 +\\/- 1.6 mmHg after 12 months. Ten eyes (28.6%) had microhyphema that resolved spontaneously; 3 eyes (8.6%) had microperforation without iris prolapse so ETTF was proceeded routinely. The preoperative number of antiglaucoma medications per patient reduced from (mean +\\/- SD) 2.74 +\\/- 0.61 to 0.11 +\\/- 0.32 postoperatively at 12 months. Visual acuity and visual fields remained stable. CONCLUSIONS: ETTF appears to provide significant control of IOP and have low incidence of complications.

  16. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico

    Lazcano-Gomez, Gabriel; Alvarez-Ascencio, Daniela; Haro-Zuno, Cindy; Turati-Acosta, Mauricio; Garcia-Huerta, Magdalena; Jimenez-Arroyo, Jesus; Castañeda-Diez, Rafael; Castillejos-Chevez, Armando; Gonzalez-Salinas, Roberto; Dominguez-Dueñas, Francisca; Jimenez-Roman, Jesus

    2017-01-01

    Aim To determine the glaucoma specialists’ preferences for the different brands of topical glaucoma medications available in Mexico. Materials and methods A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Results Data from 111 (74%) glaucoma s...

  17. Glaucoma associated with the management of rhegmatogenous retinal detachment

    Mangouritsas G

    2013-04-01

    Full Text Available George Mangouritsas, Spyridon Mourtzoukos, Dimitra M Portaliou, Vassilios I Georgopoulos, Anastasia Dimopoulou, Elias Feretis Eye Clinic, General Hospital "Hellenic Red Cross", Athens, Greece 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. Keywords: retinal detachment, intraocular pressure elevation, glaucoma, vitrectomy, intravitreal gas, silicone oil

  18. Retinal complications after aqueous shunt surgical procedures for glaucoma.

    Law, S K; Kalenak, J W; Connor, T B; Pulido, J S; Han, D P; Mieler, W F

    1996-12-01

    To assess retinal complications and to identify risk factors for retinal complications following aqueous shunt procedures. Records of 38 consecutive aqueous shunt procedures that were performed on 36 patients at the Eye Institute of the Medical College of Wisconsin, Milwaukee, from June 1993 to March 1995 (minimum follow-up, 6 months) were reviewed. The mean +/- SD follow-up was 11.4 +/- 5.2 months (median, 10.5 months). Twelve patients (32%) had the following retinal complications: 4 serous choroidal effusions (10%) that required drainage, 3 suprachoroidal hemorrhages (8%), 2 vitreous hemorrhages (5%), 1 rhegmatogenous retinal detachment (3%), 1 endophthalmitis (3%), and 1 scleral buckling extrusion (3%). Surgical procedures for retinal complications were required in 8 (67%) of these 12 patients. Visual acuity decreased 2 lines or more in 9 (75%) of these 12 patients. The median onset of a postoperative retinal complication was 12.5 days, with 10 patients (83%) experiencing complications within 35 days. Serous choroidal effusions developed in 10 other patients (26%), and these effusions resolved spontaneously. Visual acuity decreased 2 lines or more in 2 (20%) of these additional 10 patients. Patients who experienced serious retinal complications were significantly older, had a higher rate of hypertension, and postoperative ocular hypotony. Serious retinal complications were distributed evenly among patients with Krupin valves with discs and Molteno and Baerveldt devices. Experience with the Ahmed glaucoma valve implant was limited. Aqueous shunt procedures may be associated with significant retinal complications and subsequent visual loss.

  19. [Music and Glaucoma].

    Plange, N

    2017-02-01

    Music may have multiple influences on the human organism. A possible therapeutic effect for patients with glaucoma has been postulated, aside from the known impact of music on the cardiovascular system, psychogenic effects and a short-term improvement in mental performance (Mozart effect). The higher level of mental stress in patients with glaucoma and type-A personality behaviour may be related to higher intraocular pressure in patients with glaucoma. Relaxing music may have a positive impact in these patients, related to a reduction in intraocular pressure or its fluctuations. However, only limited data exist on the effects of music on intraocular pressure. No clinical studies have yet been performed to investigate the effect of music or music therapy on glaucoma progression. The music of Mozart may influence visual field examinations, possibly due to a positive short term effect on mental performance. This factor needs to be addressed in studies dealing with the effect of music in glaucoma. The relevance of intraocular pressure increases in professional wind instrument players is controversial. An increased level of care might be advisable in patients with advanced glaucoma. The influences of music on humans, altered personality profiles in patients with glaucoma and the studies showing some effect of stress on intraocular pressure stress the relevance of psychological support for glaucoma patients, who are confronted with a disease with a high longterm risk of blindness. Georg Thieme Verlag KG Stuttgart · New York.

  20. Nanotechnology Applications for Glaucoma.

    Cetinel, Sibel; Montemagno, Carlo

    2016-01-01

    Glaucoma is the second leading cause of blindness worldwide, and the antiglaucoma treatments currently available suffer from various complications. Nanotechnology-based treatments show a great deal of promise in overcoming these complications and form the basis for next-generation glaucoma treatment strategies, with the help of applications such as controlled release, targeted delivery, increased bioavailability, diffusion limitations, and biocompatibility. Significant progress has been made in nanomedicine in the efficiency of antiglaucoma medications, nanofabrication systems such as microelectromechanical systems that remove the limitations of nanodevices, and tissue regeneration vesicles for developing glaucoma treatments not based on intraocular pressure. With the use of these advanced technologies, the prevention of glaucoma-induced blindness will be possible in the near future. Herein, we reviewed the recent advances in nanotechnology-based treatment strategies for glaucoma.

  1. Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study

    Anita Panda

    2011-01-01

    Full Text Available Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV in post-penetrating-keratoplasty glaucoma (PKPG. Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7 implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 < IOP < 21 mmHg and qualified success as 5 < IOP < 21 mmHg with medications or minor procedures. Results: The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P < 0.001 and the use of medications dropped from 2.92 to 0.39 (P < 0.001 after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy. Conclusions: Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.

  2. Comparison of polypropylene and silicone Ahmed Glaucoma Valves.

    Ishida, Kyoko; Netland, Peter A; Costa, Vital P; Shiroma, Lineu; Khan, Baseer; Ahmed, Iqbal Ike K

    2006-08-01

    To evaluate and compare the clinical outcomes after implantation of the silicone plate and the polypropylene plate Ahmed Glaucoma Valves. Prospective, multicenter, comparative series. A total of 132 patients with uncontrolled glaucoma were treated with either the silicone or polypropylene Ahmed Glaucoma Valve implant. Success was defined according to 2 criteria: (1) intraocular pressure (IOP) of 6 mmHg or more or 21 mmHg or less, and (2) IOP reduction of at least 30% relative to preoperative values. Eyes requiring further glaucoma surgery, including cyclophotocoagulation, or showing loss of light perception were classified as failures. Average follow-up was 12.8 months (range, 6-30 months) for the silicone plate group and 14.5 months (range, 6-30 months) for the polypropylene plate group (P = 0.063). At the last follow-up examination, the mean IOP was 13.8+/-3.9 mmHg and 17.3+/-6.5 mmHg (PAhmed Glaucoma Valve (model FP7) showed improved IOP reduction compared with the polypropylene (model S2) implant. Differences observed in mean IOP, success rate, and complications suggest that plate material may influence clinical outcome.

  3. Glaucoma-related adverse events in the first five years after unilateral cataract removal in the Infant Aphakia Treatment Study

    Freedman, Sharon F.; Lynn, Michael J.; Beck, Allen D.; Bothun, Erick D.; Orge, Faruk H.; Lambert, Scott R.

    2015-01-01

    Importance Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia versus primary intraocular lens (IOL) implantation remains unsettled. Objective To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma+glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of five years. Design, Setting, and Participants A multicenter randomized controlled trial of 114 infants with unilateral congenital cataract who were between age 1–6 months at surgery. Interventions Participants were randomized at cataract surgery to either primary IOL, or no IOL implantation (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis. Main Outcome Measures Development of glaucoma and glaucoma+glaucoma suspect in operated eyes up to age five years, plus intraocular pressure, visual acuity, and axial length at age five years. Results Product limit estimates of the risk of glaucoma and glaucoma+glaucoma suspect at 4.8 years after surgery were 17% (95%CI=11%–25%) and 31% (95%CI=24%–41%), respectively. The CL and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio(HR)=0.8[95%CI=0.3–2.0],p=0.62); glaucoma+glaucoma suspect: (HR=1.3[95%CI=0.6–2.5],p=0.58). Younger (versus older) age at surgery conferred increased risk of glaucoma (26% versus 9%, respectively at 4.8 years after surgery (HR=3.2[95%CI=1.2–8.3]), and smaller (versus larger) corneal diameter showed increased risk for glaucoma+glaucoma suspect (HR=2.5[95%CI=1.3–5.0]). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19/20 cases, 95%), most eyes received medication (19/20, 95%), and 8/20 (40%) eyes had surgery. Conclusions and Relevance These results suggest that glaucoma-related adverse events

  4. Glaucoma: Screening Can Save Your Sight!

    ... of this page please turn Javascript on. Feature: Glaucoma Glaucoma: Screening Can Save Your Sight! Past Issues / Fall 2009 Table of Contents People with glaucoma see the world through a tunnel. Glaucoma is ...

  5. Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients

    Salim S

    2012-06-01

    Full Text Available Sarwat Salim, Haiming Du, Sumalee Boonyaleephan, Jim WanUniversity of Tennessee Health Science Center, Memphis, TN, USAPurpose: To compare the surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients.Design: Retrospective comparative case series.Methods: This was a comparative case series of 36 eyes of 36 African Americans and 43 eyes of 43 whites that underwent placement of the Ex-PRESS glaucoma filtration device under a partial-thickness scleral flap for uncontrolled glaucoma. All eyes received intraoperative mitomycin C. The primary outcome measures were intraocular pressure (IOP, number of postoperative glaucoma medications, and surgical success. Surgical success was defined as IOP between 5 and 18 mm Hg, with or without glaucoma medications, without further glaucoma surgery, or loss of light perception vision. Results: Average follow-up was 31.9 ± 9.8 (range, 14.6–47 months for African Americans and 30.7 ± 8.6 (range, 14.3–47 months for whites. At 33 months, surgical success was 80.0% in the African American group and 83.3% in the white group (P = 1.00. Reasons for surgical failure included increased IOP (3 eyes, 3.8%, persistent hypotony with maculopathy (1 eye, 1.3%, and further surgery (4 eyes, 5.06%. Compared with preoperative values, the mean postoperative IOP and number of glaucoma medications were significantly reduced in both groups, and no statistical difference was observed between the two groups at 33 months. Postoperative complications were similar in the two groups.Conclusions: Similar surgical outcomes were observed in African American and white glaucoma patients after implantation of the Ex-PRESS glaucoma filtration device. This latest modification of glaucoma filtration surgery may be a better surgical option for African Americans given its potential advantages of no tissue removal, predictable outcomes related to consistent lumen size and controlled flow, fewer

  6. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma.

    Mierlo, Camille Van; Pinto, Luis Abegão; Stalmans, Ingeborg

    2015-01-01

    Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32.

  7. Subsurface drainage

    Van Der

    1993-09-01

    Full Text Available and long term behavior were evaluated. Laboratory tests for geotextile selection are recommended and tentative criteria given. The use of fin drains was evaluated in the laboratory and a field study to monitor the efficacy of drainage systems was started...

  8. Combined Cataract and Glaucoma Surgery: An assessment of 68 ...

    Objective: To assess the best corrected visual acuity and average intraocular pressure at 6 months and one (1) year in patients with cataracts in glaucoma that had combined trabeculectomy and cataract surgery with lens implantation. Methods: A retrospective review of the case notes of patients who underwent combined ...

  9. Complications and 2-year valve survival following Ahmed valve implantation during the first 2 years of life.

    Almobarak, F; Al-Mobarak, F; Khan, A O

    2009-06-01

    To report complications and 2-year valve survival following Ahmed valve implantation during the first 2 years of life. Retrospective institutional case series. Forty-two eyes of 36 patients with Ahmed valve implantation (without prior drainage device surgery) during the first 2 years of life and 2 years' postsurgical follow-up were identified. Most eyes had primary congenital glaucoma (28/42, 66.7%), aphakic glaucoma (5/42, 11.9%) or Peters anomaly (5/42, 11.9%). All but three eyes had prior ocular surgery. Surgery was at a mean age of 11.83 months (m) (SD 5.63). The most common significant postoperative complications were tube malpositioning requiring intervention (11/42, 26.2%), endophthalmitis (3/42, 7.1%; one with tube exposure) and retinal detachment (3/42, 7.1%). Thirty-six eyes (85.8%) required resumption of antiglaucoma medications to maintain intraocular pressure (IOP) valve survival (IOPendophthalmitis and retinal detachment are known potential complications following any incisional surgery for advanced buphthalmos; however, tube exposure is a unique potential problem following aqueous shunt implantation that can lead to intraocular infection. Cumulative valve survival 2 years following implantation was 63.3%.

  10. Daily Life with Glaucoma

    ... Size Small Text Medium Text Large Text Contrast Dark on Light Light on Dark Donate Search Menu Donate What is Glaucoma? Care ... Low Vision Resources Medication Guide Resources on the Web » See All Articles Where the Money Goes Have ...

  11. Glaucoma in developing countries

    Ravi Thomas

    2012-01-01

    Full Text Available Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases. Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and

  12. Surgical effect of traumatic lens dislocation with secondary glaucoma

    Xiao-Dan Zhang

    2014-10-01

    Full Text Available AIM: To retrospectively evaluate the effect of lens extraction combined with vitrectomy to treat traumatic lens dislocation with secondary glaucoma.METHODS:Thirty-one eyes(31 casesof lens dislocation caused by blunt trauma with secondary glaucoma were treated respectively with cataract extraction combined with anterior vitrectomy, trabeculectomy and intraocular lens implantation. The visual acuity and pressure were observed 1wk, 1 and 3mo after operative. RESULTS:Thirty-one eyes were all complete the operation successfully, and 6 eyes were given combined trabeculectomy, 9 eyes were implanted anterior chamber intraocular lens implantation(IOLand 15 eyes were given posterior chamber suture fixation. Sixteen eyes were implanted in one-stage operation, while 8 eyes were implanted in two-stage operation. All intraocular pressure(IOPwere controlled to the normal level after operation and 23 eyes had visual acuity of more than 0.3.CONCLUSION:Lens extraction combined with vitrectomy is an effective method for treatment of lens dislocation with secondary glaucoma. In order to control the IOP and get well visual function, we should choose IOL implantation or trabeculectomy according to the patient's condition.

  13. Efficacy of Bevacizumab combined with EX-PRESS in the treatment of refractory glaucoma

    Qian Wang

    2018-03-01

    Full Text Available AIM:To investigate the efficacy of Bevacizumab intravitreal injection combined with EX-PRESS in the treatment of refractory glaucoma. METHODS: The research objects were 150 cases(150 eyesof patients with refractory glaucoma from June 2014 to December 2016 in our hospital. All patients were treated with EX-PRESS glaucoma drainage device implantation, and their medicine data were analyzed retrospectively. Totally 70 cases(70 eyeswere treated with EX-PRESS only were set as the control group; 80 cases(80 eyesreceived bevacizumab intravitreal injection on the basis of the treatment of the control group were set as the observation group. The successful rate of operation was evaluated, the intraocular pressure was measured before operation and at 7d, 1, 3, 6mo after treatment by non-contact conometer, followed by record of the visual acuity and complications before and after 6mo of treatment. RESULTS: The observation group's total surgical success rate was 72.5%, which was sharply higher than that of the control group(58.6%; while the partial success rate was 17.5%, which was significantly lower than that of the control group(30.0%, with statistical significance(χ2=5.453, P=0.028; χ2=4.213, P=0.047. Two groups' surgical failure rate had no distinct difference(χ2=0.000, P=1.000. There was no significant difference in visual acuity of the two groups before and after operation(P>0.05. There was no significant difference in intraocular pressure between the two groups(Fgroups=982.27, PFtime=941.88, PPP>0.05. The observation group's low intraocular pressure, anterior chamber bleeding and shallow anterior chamber incidence were significantly lower than those of the control group, there was statistical meaning(PCONCLUSION: Intravitreal injection of bevacizumab combined with EX-PRESS in the treatment of refractory glaucoma can improve the complete success rate, as well as perform effective control on complications such as short-term intraocular pressure

  14. Clinical Metabolomics and Glaucoma.

    Barbosa-Breda, João; Himmelreich, Uwe; Ghesquière, Bart; Rocha-Sousa, Amândio; Stalmans, Ingeborg

    2018-01-01

    Glaucoma is one of the leading causes of irreversible blindness worldwide. However, there are no biomarkers that accurately help clinicians perform an early diagnosis or detect patients with a high risk of progression. Metabolomics is the study of all metabolites in an organism, and it has the potential to provide a biomarker. This review summarizes the findings of metabolomics in glaucoma patients and explains why this field is promising for new research. We identified published studies that focused on metabolomics and ophthalmology. After providing an overview of metabolomics in ophthalmology, we focused on human glaucoma studies. Five studies have been conducted in glaucoma patients and all compared patients to healthy controls. Using mass spectrometry, significant differences were found in blood plasma in the metabolic pathways that involve palmitoylcarnitine, sphingolipids, vitamin D-related compounds, and steroid precursors. For nuclear magnetic resonance spectroscopy, a high glutamine-glutamate/creatine ratio was found in the vitreous and lateral geniculate body; no differences were detected in the optic radiations, and a lower N-acetylaspartate/choline ratio was observed in the geniculocalcarine and striate areas. Metabolomics can move glaucoma care towards a personalized approach and provide new knowledge concerning the pathophysiology of glaucoma, which can lead to new therapeutic options. © 2017 S. Karger AG, Basel.

  15. Neuroprotection in glaucoma

    Azadeh Doozandeh

    2016-01-01

    Full Text Available Glaucoma is a degenerative optic neuropathy characterized by retinal ganglion cell (RGC loss and visual field defects. It is known that in some glaucoma patients, death of RGCs continues despite intraocular pressure (IOP reduction. Neuroprotection in the field of glaucoma is defined as any treatment, independent of IOP reduction, which prevents RGC death. Glutamate antagonists, ginkgo biloba extract, neurotrophic factors, antioxidants, calcium channel blockers, brimonidine, glaucoma medications with blood regulatory effect and nitric oxide synthase inhibitors are among compounds with possible neuroprotective activity in preclinical studies. A few agents (such as brimonidine or memantine with neuroprotective effects in experimental studies have advanced to clinical trials; however the results of clinical trials for these agents have not been conclusive. Nevertheless, lack of compelling clinical evidence has not prevented the off-label use of some of these compounds in glaucoma practice. Stem cell transplantation has been reported to halt experimental neurodegenerative disease processes in the absence of cell replacement. It has been hypothesized that transplantation of some types of stem cells activates multiple neuroprotective pathways via secretion of various factors. The advantage of this approach is a prolonged and targeted effect. Important concerns in this field include the secretion of unwanted harmful mediators, graft survival issues and tumorigenesis. Neuroprotection in glaucoma, pharmacologically or by stem cell transplantation, is an interesting subject waiting for broad and multidisciplinary collaborative studies to better clarify its role in clinical practice.

  16. [OCT and neovascular glaucoma].

    Bellotti, A; Labbé, A; Fayol, N; El Mahtoufi, A; Baudouin, C

    2007-06-01

    Neovascular glaucoma is a chronic and sight-threatening disease. Four different grades have been described. Anterior chamber optical coherence tomography (OCT) is a new imaging technique allowing the visualization of the anterior segment. The purpose of our study was to describe the appearance of the different neovascular glaucoma grades with the OCT in order to refine the clinical analysis of this disease. Eleven patients (nine men and two women) with different grades of neovascular glaucoma were analyzed in this study. Neovascular glaucoma complicated central retinal vein occlusion in seven patients and diabetic retinopathy in four patients. All patients had bilateral biomicroscopical examination and OCT analysis. OCT images and clinical examination were then compared. No modifications could be observed using OCT in patients with grade 1 neovascular glaucoma. For grade 2, a slightly hyper-reflective linear iris secondary to neovascularization was observed. For grade 3, OCT images showed a thickened hyper-reflective iridocorneal angle with possible iridocorneal synechiae. For grade 4, the iridocorneal angle was closed and associated with iris contraction and uveae ectropion. OCT is a new promising technique for the precise analysis of different grades of neovascular glaucoma. It certainly helps in the management of such cases.

  17. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

    Jesus Jimenez-Roman

    2017-09-01

    Full Text Available AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP in patients with primary open angle glaucoma (POAG and pseudoexfoliation glaucoma (PXG. METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS: The study enrolled 88 patients (88 eyes. After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001. In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP was evidenced between groups (P=0.005. The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20% over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.

  18. Device-modified trabeculectomy for glaucoma.

    Wang, Xue; Khan, Rabeea; Coleman, Anne

    2015-12-01

    Glaucoma is an optic neuropathy that leads to vision loss and blindness. It is the second most common cause of irreversible blindness worldwide. The main treatment for glaucoma aims to reduce intraocular pressure (IOP) in order to slow or prevent further vision loss. IOP can be lowered with medications, and laser or incisional surgeries. Trabeculectomy is the most common incisional surgical procedure to treat glaucoma. Device-modified trabeculectomy is intended to improve drainage of the aqueous humor to lower IOP. Trabeculectomy-modifying devices include Ex-PRESS, Ologen, amniotic membrane, expanded polytetrafluoroethylene (E-PTFE) membrane, Gelfilm and others. However, the effectiveness and safety of these devices are uncertain. To assess the relative effectiveness, primarily with respect to IOP control and safety, of the use of different devices as adjuncts to trabeculectomy compared with standard trabeculectomy in eyes with glaucoma. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to December 2014), EMBASE (January 1980 to December 2014), PubMed (1948 to December 2014), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 22 December 2014. We included randomized controlled trials comparing devices used during trabeculectomy with trabeculectomy alone. We also included studies where antimetabolites were used in either or both treatment groups. We used standard procedures

  19. Reversible Venting Stitch for Fenestrating Valve-less Glaucoma Shunts.

    Akil, Handan; Vu, Priscilla Q; Nguyen, Anhtuan H; Nugent, Alexander; Chopra, Vikas; Francis, Brian A; Tan, James C

    2017-12-01

    The purpose of this is to describe a venting stitch modification for valveless glaucoma aqueous shunts and characterize early postoperative intraocular pressure (IOP) and glaucoma medication use following the modification. Retrospective chart review of 61 sequential patients undergoing Baerveldt glaucoma implant (BGI)-350 implantation at the Doheny Eye Institute. Twenty-four patients received a glaucoma shunt with venting stitch modification (modified BGI) and 37 patients received an unmodified shunt (BGI-only). IOP, number of glaucoma medications, and number of hypotony cases (intraocular pressure ≤5 mm Hg) were compared between the groups. T-tests were used for statistical analysis. At postoperative-day 1, mean IOP was significantly lower compared with preoperatively in the modified BGI group (14 mm Hg; reduced by 51%; P<0.0001) but not the BGI-only group (27 mm Hg; P=0.06). IOP difference between groups persisted till immediately before tube opening (P=0.005) and fewer IOP-lowering medications needed in the modified BGI group (P<0.0001). One case (4.2%) of postoperative hypotony was encountered with BGI modification, which resolved after the stitch was removed in clinic. The venting stitch valveless shunt modification allows for effective, reliable, and safe control of early postoperative IOP.

  20. New Tool to Predict Glaucoma

    ... In This Section A New Tool to Predict Glaucoma email Send this article to a friend by ... Close Send Thanks for emailing that article! Tweet Glaucoma can be difficult to detect and diagnose. Measurement ...

  1. Does Your Child Have Glaucoma?

    ... Donate In This Section Does Your Child Have Glaucoma? email Send this article to a friend by ... a pediatric ophthalmologist. Signs and Symptoms of Childhood Glaucoma What to watch for in children under the ...

  2. Does Marijuana Help Treat Glaucoma?

    ... time, reducing side vision. It sometimes leads to blindness. One cause of optic nerve damage in glaucoma ... high doses, can cause problems with short-term memory and concentration. As scientists learn more about glaucoma, ...

  3. The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma: a meta-analysis.

    Wang, Shiming; Gao, Xiaoming; Qian, Nana

    2016-06-08

    The purpose of this study was to compare the efficacy and tolerability of the Ahmed glaucoma valve (AGV) implant and the Baerveldt implant for the treatment of refractory glaucoma. We comprehensively searched four databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library databases, selecting the relevant studies. The continuous variables, namely, intraocular pressure reduction (IOPR) and a reduction in glaucoma medication, were pooled by the weighted mean differences (WMDs), and the dichotomous outcomes, including success rates and tolerability estimates, were pooled by the odds ratio (ORs). A total of 929 patients from six studies were included. The WMDs of the IOPR between the AGV implant and the Baerveldt implant were 1.58 [95 % confidence interval (CI): -2.99 to 6.15] at 6 months, -1.01 (95 % CI: -3.40 to 1.98) at 12 months, -0.54 (95 % CI: -4.89 to 3.82) at 24 months, and -0.47 (95 % CI: -3.29 to 2.35) at 36 months. No significant difference was detected between the two groups at any point in time. The pooled ORs comparing the AGV implant with the Baerveldt implant were 0.51 (95 % CI: 0.33 to 0.80) for the complete success rate and 0.67 (95 % CI: 0.50 to 0.91) for qualified success rate. The Baerveldt implant was associated with a reduction in glaucoma medication at -0.51 (95 % CI: -0.90 to -0.12). There were no significant differences between the AGV implant and the Baerveldt implant on the rates of adverse events. The Baerveldt implant is more effective in both its surgical success rate and reducing glaucoma medication, but it is comparable to the AGV implant in lowering IOP. Both implants may have comparable incidences of adverse events.

  4. Histopathological Evaluation of a Hydrophobic Terpolymer (PTFE-PVD-PP) as an Implant Material for Nonpenetrating Very Deep Sclerectomy.

    Leszczynski, Rafal; Gumula, Teresa; Stodolak-Zych, Ewa; Pawlicki, Krzysztof; Wieczorek, Jaroslaw; Kajor, Maciej; Blazewicz, Stanislaw

    2015-08-01

    The purpose of the study was to assess the biocompatibility of porous terpolymer (polytetrafluoroethylene-co-polyvinylidene fluoride-co-polypropylene, PTFE-PVDF-PP) membranes as an implant material to be placed during nonpenetrating very deep sclerectomy (NPVDS). Another study objective was to determine whether the polymer membrane under investigation could be used to manufacture a new-generation implant, which would actively delay the process of fistula closure and facilitate aqueous humor drainage. Histological response and tissue tolerance of the implant material were assessed. The study was performed on 38 eyeballs of 19 New Zealand white rabbits (19 implanted, 19 control). Histological assessment was carried out between 2 and 52 weeks after surgery. We routinely assessed inflammatory infiltrate, neovascularization, hemorrhage, and stromal edema as well as connective tissue attachment to the implant and adjacent tissues. At 52 weeks of observation, a statistically significant difference was revealed between the study and control groups in terms of resorptive granulation, tissue, and the inflammatory infiltrate. No features of acute inflammatory response to the implant were observed, and there was an absence of histological features of acute inflammatory infiltrates and subsidence of chronic inflammatory infiltrates and resorptive granulation over time. Slight fibrotic response and insignificant changes in neighboring eye tissues all indicate good tolerance to bioimplant materials. This allows for some optimism regarding the use of hydrophobic terpolymer in the construction of new intrascleral implants. However, the ultimate decision regarding its usefulness and safety in the treatment of glaucoma requires further investigation.

  5. Glaucoma treatment trends: a review.

    Conlon, Ronan; Saheb, Hady; Ahmed, Iqbal Ike K

    2017-02-01

    Glaucoma is one of the most common causes of blindness worldwide, and its prevalence is increasing. The aim of the present review is to describe the current medical and surgical treatment trends in the management of open-angle glaucoma. There has been an increase in the availability of glaucoma medications and the use of laser trabeculoplasty over the past decade, with a subsequent decrease in invasive incisional surgery. In addition, a new class of glaucoma procedures, termed microinvasive glaucoma surgery, has emerged, which aims to fill the gap between conservative medical management and more invasive surgery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  6. [Results of fistulizing and Ahmed valve surgery for treatment of refractory glaucoma].

    Bikbov, M M; Babushkin, A E; Chaĭka, O V; Orenburkina, O I; Matiukhina, E N

    2014-01-01

    Surgical results of 76 patients (76 eyes) aged 25-79 years with secondary refractory glaucoma were analyzed. The best hypotensive effect and visual functions integrity were achieved with Ahmed valve implantation (86.7% and 83.3% of cases respectively); after conventional fistulizing surgery the hypotensive effect was observed in 45.5%, noncompromised vision--in 54.5% of cases. Tunnel trabeculectomy with iridocycloretraction led to normalization of intraocular pressure and stabilization of visual functions in 81.3% and 68.8% of cases respectively and thus can be considered as an alternative to fistulizing surgery in patients with secondary refractory glaucoma. Uveal glaucoma is a relative contraindication to Ahmed valve implantation, while neovascular glaucoma is that to tunnel trabeculectomy with iridocycloretraction.

  7. Pediatric glaucoma: current perspectives

    Marchini G

    2014-05-01

    Full Text Available Giorgio Marchini, Marco Toscani, Francesca Chemello Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy Abstract: “Childhood glaucoma” is a heterogeneous group of severe pediatric conditions often associated with significant visual loss and characterized by elevated intraocular pressure (IOP and optic-disk cupping. Successful IOP control is crucial but challenging and most often achieved surgically, with medical therapy playing a supportive role. There are many classifications of childhood glaucoma, but they can simply be divided into primary, in which a developmental abnormality of the anterior chamber angle only exists, and secondary, in which aqueous outflow is reduced due to independent mechanisms that secondarily impair the function of the filtration angle. The worldwide prevalence of childhood blindness ranges from 0.03% in high-income countries to 0.12% in undeveloped countries. The majority of cases do not have an identified genetic mutation and, where the mutation is known, the genes often account for only a small proportion of cases. Several pathogenetic mechanisms are known to contribute to the development of childhood glaucoma. Whatever the cause, it results in a reduced aqueous outflow at the level of the trabecular meshwork. Age of onset and magnitude of the elevated IOP largely determine the clinical manifestation the high variability of clinical manifestations. Glaucoma from any cause in a neonate and infant is characterized by the classic triad of epiphora, photophobia, and blepharospasm, and could be associated with eye enlargement (buphthalmos and Haab striae. The eye examination, usually performed under general anesthesia, includes: tonometry, anterior-segment examination, gonioscopy, corneal diameter and axial length measurement, dilated fundoscopy with optic-nerve-head evaluation. Medical therapy, considering the high frequency of side effects, is generally used as

  8. Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

    Tariq Alasbali

    2015-06-01

    Full Text Available AIM:To evaluate the outcomes of Ahmed glaucoma valve (AGV implantation surgery for refractory glaucoma.METHODS:This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure (IOP greater than 21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation, data were collected on IOP, the best corrected visual acuity (BCVA and glaucoma medications preoperatively and 4, 6, 12, 24 and 56wk postoperatively. Logarithm values of IOP were calculated and compared.RESULTS: The study group was comprised of 30 patients (30 eyes, 16 males and 14 females with refractory glaucoma. Mean preoperative IOP was 39.3±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg, 19.6±12.8 mm Hg and 13.9±14.2 mm Hg at 12, 24 and 56wk respectively. BCVA was ≥ 6/60 in 11 eyes preoperatively, and five eyes had BCVA≥6/60 at 56wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At 12wk postoperatively, no medications were required to control IOP in 20 eyes. At 56wk postoperatively, at least one medication was required to control IOP in 10 eyes. Over the entire follow up period, four eyes were treated with yttrium aluminium garnet (YAG laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.

  9. Glaucoma: Hot Topics in Pharmacology.

    Balendra, Shiama I; Shah, Parth Arvind; Jain, Mishank; Grzybowski, Andrzej; Cordeiro, Maria F

    2017-01-01

    Glaucoma comprises a group of neurodegenerative diseases resulting in retinal ganglion cell death within the optic nerve head. It is projected to affect almost 80 million people worldwide by 2020. The condition's asymptomatic nature translates to over half of glaucoma sufferers being unaware of their condition. By the time of diagnosis, irreversible blindness is likely to have occurred. Prime areas of glaucoma research therefore include identification and optimization of risk factors for the disease, accurate and early diagnostic tools and novel therapeutic methods. The goal of this review was to summarize main areas of latest glaucoma research into risk factors of glaucoma, diagnostic tools and treatments. PubMed was used to search for terms including glaucoma risk factors, glaucoma diagnostics, glaucoma treatment, glaucoma drug delivery and glaucoma IOP. The evidence for risk factors of low CSF pressure, IOP, smoking, vascular risk factors and light toxicity is described. Latest diagnostic and monitoring techniques for glaucoma include SD-OCT, DARC and IOP telemetry. Current and emerging medical and surgical treatments in glaucoma are discussed. Rho kinase inhibitors have the potential to both lower IOP and also provide neuroprotection, several of which are in clinical trials. Several other new medical treatments such as calcium channel blockers and neurotrophic agents also have the capacity to provide neuroprotection. Minimally Invasive Glaucoma Surgery (MIGS) devices provide an improved safety profile compared to traditional trabeculectomy; the latest ab interno and ab externo devices are described. Novel drug delivery methods, including punctual plugs and contact lenses, help overcome the challenges with patient adherence. The ultimate goals are to reduce the individual patient risk factors associated with glaucoma, diagnose the condition early and to find treatments that not only reduce IOP but also reverse neurodegeneration of RGCs. The usage of combinations

  10. Glaucoma Monitoring in a Clinical Setting Glaucoma Progression Analysis vs Nonparametric Progression Analysis in the Groningen Longitudinal Glaucoma Study

    Wesselink, Christiaan; Heeg, Govert P.; Jansonius, Nomdo M.

    Objective: To compare prospectively 2 perimetric progression detection algorithms for glaucoma, the Early Manifest Glaucoma Trial algorithm (glaucoma progression analysis [GPA]) and a nonparametric algorithm applied to the mean deviation (MD) (nonparametric progression analysis [NPA]). Methods:

  11. Clinical Outcomes of FP-7/8 Ahmed Glaucoma Valves in the Management of Refractory Glaucoma in the Mainland Chinese Population.

    Yingting Zhu

    Full Text Available To evaluate the efficacy and safety of the Ahmed glaucoma valve (AGV and the risk factors associated with AGV implantation failure in a population of Chinese patients with refractory glaucoma.In total, 79 eyes with refractory glaucoma from 79 patients treated in our institution from November 2007 to November 2010 were enrolled in this retrospective study. The demographic data, preoperative and postoperative intraocular pressures (IOPs, best corrected visual acuity (BCVA, number of anti-glaucoma medications used, completed and qualified surgery success rates and postoperative complications were recorded to evaluate the outcomes of AGV implantation. Factors that were associated with implant failure were determined using Cox proportional hazard regression model analysis and multiple linear regression analysis.The average follow-up time was 12.7±5.8 months (mean±SD. We observed a significant reduction in the mean IOP from 39.9±12.6 mm Hg before surgery to 19.3±9.6 mm Hg at the final follow-up. The complete success rate was 59.5%, and the qualified success rate was 83.5%. The number of previous surgeries was negatively correlated with qualified success rate (P<0.05, OR=0.736, 95% CI 0.547-0.99. Patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control IOP (P<0.01. The primary complication was determined to be a flat anterior chamber (AC.AGV implantation was safe and effective for the management of refractory glaucoma. Patients with a greater number of previous surgeries were more likely to experience surgical failure, and patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control postoperative IOP.

  12. Challenges in Glaucoma Management

    James Standefer

    Glaucoma has been referred to as the 'orphan child' of Vision. 2020 because, though it is the world's leading cause of irreversible blindness, it was not included in its initial list. The main reasons include the inability to restore lost vision, and the need for upgrading the substandard clinical skill levels of many developing ...

  13. Classic papers in glaucoma

    Ritch, Robert; Caronia, Ronald M

    1999-01-01

    ... Elimination of Intraocular Fluid J.S. Friedenwald The Formation of the Intraocular Fluid. Proctor Award Lecture of the Association for Research in Ophthalmology W.M. Grant, Tonographic Method for Measuring the Facility and Rate of Aqueous Flow in Human Eyes P.A. Chandler , Malignant Glaucoma B. Becker, Decrease in Intraocular Pressure in Man by a Carbo...

  14. Pesquisaje de glaucoma

    Aldo Sigler Villanueva

    1996-06-01

    Full Text Available Se efectuó un pesquisaje de glaucoma mediante un chequeo masivo al 92,1 % (210 pacientes de la población mayor de 40 años de edad atendida en un consultorio del médico de la familia del municipio Morón. Se encontró que el 9,6 % (20 pacientes presentaban cifras de tensión ocular por encima de los valores normales, así como 3 pacientes que tenían tensión ocular normal, pero con excavaciones de papilas sospechosas y 2 pacientes con antecedentes familiares de glaucoma, los cuales se enviaron a la consulta especializada del Hospital General Provincial Docente de Moron para confirmar o no el diagnóstico.The 92,1 % (210 patients of the population over 40 years treated at a family physician's office in Morón municipality took part in a glaucoma mass screening. It was found that 9,6 % (20 patients showed figures of ocular tension exceeding normal values and that 3 patients had normal ocular tension but presented suspicious excavation of the optic disc. Two patients having glaucoma family history were referred to the specialist at the Provincial General Teaching Hospital of Moron in order to confirm the diagnosis.

  15. open angle glaucoma (poag)?

    there is a build up of pressure due to poor outflow of aqueous humor. The outflow obstruction could occur at the trabecular meshwork of the anterior chamber angle or subsequently in the episcleral vein due to raised venous pressure. Such build up of pressure results in glaucoma . Elevated intraocular pressure remains the ...

  16. Glaucomas in Africas

    Murdoch

    happens in all secondary glaucomas. There was confusion some years ago in our understanding of the disease, since intraocular pressure was included in the definition of the disease. With the advent of population studies it became apparent that, in some populations, a significant proportion of those with the characteristic ...

  17. Clinical study of secondary glaucoma after silicone oil tamponade

    Xiao-Chun Chen

    2013-12-01

    Full Text Available AIM: To evaluate the related risk factors and treatment method of secondary glaucoma after pars plana vitrectomy and silicone oil tamponade.METHODS: The retrospective study analyzed 114 patients(118 eyeswho were treated with pars plana vitrectomy combined with silicone oil tamponade. Lenses were reserved in 78 eyes and were taken away in 40 eyes among which intraocular lens were implanted in 17 eyes. There were 39 eyes in which the filling time of silicone was no more than 6 months while 79 eyes in which the filling time was more than 6 months. The follow-up time was(16.2±4.9months. Primary and secondary glaucoma were excluded before the vitrectomy. Silicone oil glaucoma(SOGwas diagnosed when intraocular pressure(IOPwas measured higher than 21mmHg(1mmHg=0.133kPathree times in succession at least 1 month after silicone oil tamponade and inflammation and neovascular glaucoma should be excluded. Anti-glaucoma drugs were administrated once SOG was diagnosed. If the IOP was not controlled after 2 weeks, the silicone oil was taken away. If the IOP was still high, the anti-glaucoma surgery was operated. The data was analyzed by the SPSS 16.0 software using a binary logistic regression analysis. RESULTS: Among the 32 eyes of SOG, lenses were removed in 16 eyes(50%. The filling time of silicone oil was more than 6 months in 27 eyes(84.4%and silicone oil emulsion happened in 20 eyes(62.5%. IOP returned normal in 17 eyes after administrating anti-glaucoma medication within 2 weeks. Silicone oils were taken away in 15 eyes. However, 4 eyes still had high IOP after surgery; one of them was given anti-glaucoma drugs once more; two of them underwent trabeculectomy and one of them underwent cyclophotocoagulation. The lens conditions(whether it was taken away or not, P=0.024, the silicone oil filling time(whether the time was more than 6 months, P=0.014, and the status of the silicone oil(whether emulsification occurred or not, P=0.000were all found to be

  18. Current Surgical Options for the Management of Pediatric Glaucoma

    Jose Morales

    2013-01-01

    Full Text Available Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm’s canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging.

  19. The treatment of malignant glaucoma in nanophthalmos: a case report.

    Wang, Jie; Du, Ergang; Tang, Jinfei

    2018-02-23

    The management of eyes with nanophthalmos is a dilemma for ophthalmologists due to various complications, especial the eye with malignant glaucoma. We report a case of effective treatment for malignant glaucoma in nanophthalmos. An 82-year-old man was performed phacoemulsification in the right eye with normal ocular pressure and nanophthalmos. The surgery was uneventful: an intraocular lens (IOL) was placed and centered in the capsular bag. 2 months later, the patient presented with malignant glaucoma, and the intraocular pressure fluctuated between 18.6 mmHg and 30.8 mmHg with antiglaucoma medications. The patient did not respond to surgical peripheral iridotomy and goniosynechialysis. Then a single treatment with laser peripheral lens posterior capsulotomy and vitreous anterior membranectomy was performed. The intraocular pressure normalized, and the anterior chamber deepened within 24 h. The patient's condition remained stable for 9 months with no further treatment, and his Snellen corrected distance visual acuity was 20/50. The left eye of this patient was treated by combined surgery including phacoemulsification, IOL implantation, anterior vitrectomy, surgical peripheral iridotomy (PI), and goniosynechialysis. No intraoperative or postoperative complications were observed. This case suggests that it is essential to choose a suitable treatment for nanophthalmos patients to deal with malignant glaucoma and to reduce the incidence of malignant glaucoma.

  20. Genetics Home Reference: early-onset glaucoma

    ... called a syndrome. If glaucoma appears before the age of 5 without other associated abnormalities, it is called primary congenital glaucoma. Other individuals experience early onset of primary open-angle glaucoma, the most ...

  1. Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research

    ... of this page please turn Javascript on. Feature: Glaucoma Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research Past Issues / Fall 2009 Table of Contents Symptoms and Diagnosis Glaucoma can develop in one or both eyes. Often ...

  2. Subinternal limiting membrane hemorrhage post-Ahmed glaucoma valve in vitrectomized eye

    Bhuvan Chanana

    2018-01-01

    Full Text Available Glaucoma drainage devices are mostly used for refractory glaucoma. Early postoperative complications include flat anterior chamber, choroidal effusion, and suprachoroidal hemorrhage. An 8-year-old male patient with a prior history of vitreous surgery for traumatic vitreous hemorrhage, presented to us with angle recession glaucoma in his right eye. His intraocular pressure (IOP was 44 mmHg despite maximum antiglaucoma medication. Ahmed glaucoma valve (AGV surgery was performed to control his IOP. In the early postoperative period, the patient developed premacular subinternal limiting membrane (ILM hemorrhage, which did not resolve even after 4 weeks. Vitreoretinal intervention involving removal of the thickened ILM and sub-ILM bleed had to be performed. To the best of our knowledge, no case has been reported with sub-ILM bleed post aqueous humor shunts. Here, we report a case of premacular sub-ILM bleed following AGV in vitrectomized eye.

  3. A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome.

    Sousa, David Cordeiro; Leal, Inês; Faria, Mun Yueh; Pinto, Luís Abegão

    2016-01-01

    To report a case of a patient who developed uveitis-glaucoma-hyphema (UGH) syndrome after an uneventful cataract surgery and to discuss risk factors, diagnostic challenges, management options, and clinical implications. Uveitis-glaucoma-hyphema syndrome is a rare but potentially serious cataract surgery complication. Clinical manifestations include increased intraocular pressure (IOP), anterior chamber inflammation, and recurrent hyphema or microhyphema. Uveitis-glaucoma-hyphema Plus syndrome also includes accompanying vitreous hemorrhage. Although classically associated with rigid anterior chamber intraocular lenses (lOLs), cases of malpositioning and subluxated posterior chamber lOLs have also been described as possible triggers. We report a case of a 70-year-old Caucasian man who developed UGH Plus syndrome after an uneventful cataract surgery with an lOL implanted in the capsular bag. During postoperative follow-up, persistent intraocular inflammation, increased IOP, hyphema, and vitreous hemorrhage were consistent with this diagnosis. Slit-lamp examination demonstrated progressive localized iris atrophy, compatible with chafing of the posterior iris by the IOL haptic as the trigger for UGH syndrome. A pars plana vitrectomy was performed and a retropupillary intraocular lens was implanted. No further complications occurred during follow-up. Given the increasing prevalence of single-piece lOLs implanted in the capsular bag, it is important to recognize UGH syndrome as a rare but potentially serious complication. How to cite this article: Sousa DC, Leal I, Faria MY, Pinto LA. A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome. J Curr Glaucoma Pract 2016;10(2):76-78.

  4. Study of surgical treatment on neovascular glaucoma

    Xiao-Nü Liu

    2014-05-01

    Full Text Available AIM: To compare the effect of two surgical methods on neovascular glaucoma(NVG. METHODS: The clinical date of 46 cases(57 eyeswith NVG underwent surgical treatment were retrospectively analyzed and followed-up. Patients were divided into Ahmed glaucoma valve(AGVimplantation group(group A, 24 cases, 31 eyesand semiconductor diode laser transscleral ciliary body photocoagulation(TSCPCgroup(group B, 22cases, 26 eyesaccording to the surgical approach. The intraocular pressure, visual acuity and postoperative complications were compared before and after operation. RESULTS: The intraocular pressure postoperative in two groups were significantly lower than those preoperative(P P>0.05. The changes of visual acuity postoperative showed no statistical difference between the two groups(P>0.05. The postoperative complications of group A was significantly lower than that in group B, in which the incidence of eye pain, anterior chamber bleeding were significant differences between two groups(P CONCLUSION: AGV implantation treatment and TSCPC for NVG are both valid, but AGV implantation is filtration surgery, and TSCPC isciliary body destructive surgery, and the latter has higher rate of postoperative complications.

  5. Ahmed glaucoma valve in eyes with preexisting episcleral encircling element.

    Choudhari, Nikhil Shreeram; George, Ronnie; Shantha, Balekudaru; Neog, Aditya; Tripathi, Shweta; Srinivasan, Bhaskar; Vijaya, Lingam

    2014-05-01

    To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element. This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010. The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the final postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of significant postoperative complications.

  6. Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Eyes With Prior Incisional Glaucoma Surgery.

    Grover, Davinder S; Godfrey, David G; Smith, Oluwatosin; Shi, Wei; Feuer, William J; Fellman, Ronald L

    2017-01-01

    To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. A retrospective review was performed for all patients who underwent a GATT procedure with a history of prior incisional glaucoma surgery. Thirty-five eyes of 35 patients were treated. The mean age was 67.7 years. Nineteen eyes had a prior trabeculectomy, 13 eyes had a prior glaucoma drainage device, 4 eyes had a prior trabectome, and 5 eyes had prior endocyclophotocoagulation. Mean follow-up time was 22.7 months. For all eyes, the mean preoperative intraocular pressure (IOP) (SD) was 25.7 (6.5) mm Hg on 3.2 (1.0) glaucoma medications and at 24 months, the mean IOP (SD) was 15.4 (4.9) mm Hg on 2.0 (1.4) glaucoma medications (P<0.001). The prior trabeculectomy group had a preoperative IOP (SD) of 24.6 (6.4) mm Hg on 3.2 (1.0) medications and at month 24, the mean IOP (SD) was 16.7 (5.6) mm Hg on 2.1 (1.4) glaucoma medications. In the prior glaucoma drainage device group, the mean preoperative IOP (SD) was 27.0 (7.1) mm Hg on 3.4 (1.1) glaucoma medications and at 24 months, the mean IOP (SD) was 12.9 (2.6) mm Hg on 2.1 (1.2) glaucoma medications. At 24 months, the cumulative proportion of failure was 0.4 and the cumulative proportion of reoperation was 0.29. GATT appears to be safe and successful in treating 60% to 70% of open-angle patients with prior incisional glaucoma surgery. When considering all eyes, there was a significant decrease in IOP and required glaucoma medications at 24 months. This surgery should be considered in certain patients with open angles who have failed a primary traditional glaucoma surgery.

  7. YBR/EiJ mice: a new model of glaucoma caused by genes on chromosomes 4 and 17

    K. Saidas Nair

    2016-08-01

    Full Text Available A variety of inherited animal models with different genetic causes and distinct genetic backgrounds are needed to help dissect the complex genetic etiology of glaucoma. The scarcity of such animal models has hampered progress in glaucoma research. Here, we introduce a new inherited glaucoma model: the inbred mouse strain YBR/EiJ (YBR. YBR mice develop a form of pigmentary glaucoma. They exhibit a progressive age-related pigment-dispersing iris disease characterized by iris stromal atrophy. Subsequently, these mice develop elevated intraocular pressure (IOP and glaucoma. Genetic mapping studies utilizing YBR as a glaucoma-susceptible strain and C57BL/6J as a glaucoma-resistant strain were performed to identify genetic loci responsible for the iris disease and high IOP. A recessive locus linked to Tyrp1b on chromosome 4 contributes to iris stromal atrophy and high IOP. However, this is not the only important locus. A recessive locus on YBR chromosome 17 causes high IOP independent of the iris stromal atrophy. In specific eyes with high IOP caused by YBR chromosome 17, the drainage angle (through which ocular fluid leaves the eye is largely open. The YBR alleles of genes on chromosomes 4 and 17 underlie the development of high IOP and glaucoma but do so through independent mechanisms. Together, these two loci act in an additive manner to increase the susceptibility of YBR mice to the development of high IOP. The chromosome 17 locus is important not only because it causes IOP elevation in mice with largely open drainage angles but also because it exacerbates IOP elevation and glaucoma induced by pigment dispersion. Therefore, YBR mice are a valuable resource for studying the genetic etiology of IOP elevation and glaucoma, as well as for testing new treatments.

  8. Glaucoma in patients with uveitis.

    Panek, W C; Holland, G N; Lee, D A; Christensen, R E

    1990-01-01

    The records of 100 patients (161 eyes) with uveitis were reviewed retrospectively to determine the prevalence of increased intraocular pressure, the forms of uveitis most commonly associated with glaucoma, and the forms that require specific glaucoma therapy. Secondary glaucoma was present in 23 patients (31 eyes): three of 24 patients with acute uveitis (three eyes, 12% of acute uveitis patients) and 20 of 76 patients with chronic uveitis (28 eyes, 26% of chronic uveitis patients). Eighteen ...

  9. Clinical Outcomes of FP-7/8 Ahmed Glaucoma Valves in the Management of Refractory Glaucoma in the Mainland Chinese Population.

    Zhu, Yingting; Wei, Yantao; Yang, Xuejiao; Deng, Shuifeng; Li, Zuohong; Li, Fei; Zhuo, Yehong

    2015-01-01

    To evaluate the efficacy and safety of the Ahmed glaucoma valve (AGV) and the risk factors associated with AGV implantation failure in a population of Chinese patients with refractory glaucoma. In total, 79 eyes with refractory glaucoma from 79 patients treated in our institution from November 2007 to November 2010 were enrolled in this retrospective study. The demographic data, preoperative and postoperative intraocular pressures (IOPs), best corrected visual acuity (BCVA), number of anti-glaucoma medications used, completed and qualified surgery success rates and postoperative complications were recorded to evaluate the outcomes of AGV implantation. Factors that were associated with implant failure were determined using Cox proportional hazard regression model analysis and multiple linear regression analysis. The average follow-up time was 12.7±5.8 months (mean±SD). We observed a significant reduction in the mean IOP from 39.9±12.6 mm Hg before surgery to 19.3±9.6 mm Hg at the final follow-up. The complete success rate was 59.5%, and the qualified success rate was 83.5%. The number of previous surgeries was negatively correlated with qualified success rate (Pglaucoma drugs to control IOP (Pglaucoma. Patients with a greater number of previous surgeries were more likely to experience surgical failure, and patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control postoperative IOP.

  10. Cambridge community Optometry Glaucoma Scheme.

    Keenan, Jonathan; Shahid, Humma; Bourne, Rupert R; White, Andrew J; Martin, Keith R

    2015-04-01

    With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. 1733 patients were evaluated by this scheme between 2010 and 2013. Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. The number of false positive referrals from initial referral into the scheme. Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

  11. Aortitis requiring aortic repair associated with glaucoma, thyroiditis, glaucoma, and neuropathy: case report

    Bayer Günther

    2011-05-01

    Full Text Available Abstract Aortitis may be due to infectious and non-infectious causes. We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman. Despite antibiotic therapy, inflammatory signs persisted and resolved only after initiation of glucocorticoid therapy. Increasing aortic ectasia necessitated resection of the ascending aorta and implantation of a Vascutek 30 mm prosthesis. Histologically a granulomatous aortitis was diagnosed. Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

  12. Neuroprotective therapies for glaucoma

    Song W

    2015-03-01

    Full Text Available Wei Song, Ping Huang, Chun Zhang Department of Ophthalmology, Peking University Third Hospital, Beijing, People’s Republic of China Abstract: Glaucoma is the second leading cause for blindness worldwide. It is mainly caused by glaucomatous optic neuropathy (GON characterized by retinal ganglion cell loss, which leads to visual field defect and blindness. Up to now, the main purpose of antiglaucomatous therapies has been to lower intraocular pressure (IOP through surgeries and medications. However, it has been found that progressive GON is still present in some patients with effective IOP decrease. Therefore, risk factors other than IOP elevation, like neurotrophin deprivation and excitotoxicity, contribute to progressive GON. Novel approaches of neuroprotection may be more effective for preserving the function of the optic nerve. Keywords: glaucoma, glaucomatous optic neuropathy, retinal ganglion cells, neuro­protection

  13. Neuroprotection in glaucoma

    Vasudevan, Sushil K; Gupta, Viney; Crowston, Jonathan G

    2011-01-01

    Glaucoma is a neurodegenerative disease characterized by loss of retinal ganglion cells and their axons. Recent evidence suggests that intraocular pressure (IOP) is only one of the many risk factors for this disease. Current treatment options for this disease have been limited to the reduction of IOP; however, it is clear now that the disease progression continues in many patients despite effective lowering of IOP. In the search for newer modalities in treating this disease, much data have emerged from experimental research the world over, suggesting various pathological processes involved in this disease and newer possible strategies to treat it. This review article looks into the current understanding of the pathophysiology of glaucoma, the importance of neuroprotection, the various possible pharmacological approaches for neuroprotection and evidence of current available medications. PMID:21150020

  14. An effective method of surgical treatment of refractory glaucoma patients using Ex-PRESSTM filtering device

    Sergey Yuryevich Astakhov

    2013-03-01

    Full Text Available Based on data obtained from examination and subsequent follow-up of 47 patients (50 eyes with refractory glaucoma, an efficacy estimation of a new method of the Ex-PRESSTM filtering device implantation was performed. The data analysis showed that the proposed surgical procedure has a low level of intra- and post-operative complications, is characterized by technical ease, and provides a long term stabilization of the glaucomatous process. Therefore it is possible to draw a conclusion that the Ex-PRESSTM filtering device implantation is an effective method for the treatment of refractory glaucoma.

  15. Ceratoplastia penetrante e glaucoma Penetrating keratoplasty and glaucoma

    Márcio Eulálio Barreto Soares

    2007-08-01

    Full Text Available O objetivo deste artigo é discutir os conhecimentos atuais sobre a abordagem clínica e terapêutica da ceratoplastia penetrante e do glaucoma a ela associado.The aim of this article is to make a review about glaucoma associated with penetrating keratoplasty, describing since its incidence and risk factors until the different options for treatment.

  16. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico.

    Lazcano-Gomez, Gabriel; Alvarez-Ascencio, Daniela; Haro-Zuno, Cindy; Turati-Acosta, Mauricio; Garcia-Huerta, Magdalena; Jimenez-Arroyo, Jesus; Castañeda-Diez, Rafael; Castillejos-Chevez, Armando; Gonzalez-Salinas, Roberto; Dominguez-Dueñas, Francisca; Jimenez-Roman, Jesus

    2017-01-01

    To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico. A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences. Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option. This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition. How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez

  17. Outcomes of glaucoma reoperations in the Tube Versus Trabeculectomy (TVT) Study.

    Saheb, Hady; Gedde, Steven J; Schiffman, Joyce C; Feuer, William J

    2014-06-01

    To describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study. Cohort study of patients in a multicenter randomized clinical trial. The TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350 mm(2) Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/mL for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP ≤5 mm Hg, additional glaucoma surgery, or loss of light perception vision). Additional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (P = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in the tube group and 30.5 ± 20.4 months in the trabeculectomy group (P = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (P = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (P = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43%, respectively, in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (P = .28). Reoperations to manage complications were required in 1 patient in the tube group and 5 patients in the trabeculectomy group (P = .63). The rate of reoperation for glaucoma was higher following

  18. A model to measure lymphatic drainage from the eye.

    Kim, Minhui; Johnston, Miles G; Gupta, Neeru; Moore, Sara; Yücel, Yeni H

    2011-11-01

    Intraocular pressure (IOP) is the most important risk factor for glaucoma development and progression. Most anti-glaucoma treatments aim to lower IOP by enhancing aqueous humor drainage from the eye. Aqueous humor drainage occurs via well-characterized trabecular meshwork (TM) and uveoscleral (UVS) pathways, and recently described ciliary body lymphatics. The relative contribution of the lymphatic pathway to aqueous drainage is not known. We developed a sheep model to quantitatively assess lymphatic drainage along with TM and UVS outflows. This study describes that model and presents our initial findings. Following intracameral injection of (125)I-bovine serum albumin (BSA), lymph was continuously collected via cannulated cervical lymphatic vessels and the thoracic lymphatic duct over either a 3-h or 5-h time period. In the same animals, blood samples were collected from the right jugular vein every 15 min. Lymphatic and TM drainage were quantitatively assessed by measuring (125)I-BSA in lymph and plasma, respectively. Radioactive tracer levels were also measured in UVS and "other" ocular tissue, as well as periocular tissue harvested 3 and 5 h post-injection. Tracer recovered from UVS tissue was used to estimate UVS drainage. The amount of (125)I-BSA recovered from different fluid and tissue compartments was expressed as a percentage of total recovered tracer. Three hours after tracer injection, percentage of tracer recovered in lymph and plasma was 1.64% ± 0.89% and 68.86% ± 9.27%, respectively (n = 8). The percentage of tracer in UVS, other ocular and periocular tissues was 19.87% ± 5.59%, 4.30% ± 3.31% and 5.32% ± 2.46%, respectively. At 5 h (n = 2), lymphatic drainage was increased (6.40% and 4.96% vs. 1.64%). On the other hand, the percentage of tracer recovered from UVS and other ocular tissue had decreased, and the percentage from periocular tissue showed no change. Lymphatic drainage increased steadily over the 3 h post-injection period, while TM

  19. Glaucoma: a brief update for 2017

    glaucoma. Predictions are that glaucoma will affect almost ... Abstract. Glaucoma is a complex condition of the eye and the second leading cause of blindness around the globe. ..... a stinging sensation upon instilling the drops into the eyes, as well as dry eyes .... Dimitriou C, Broadway D. Pathophysiology of glaucoma.

  20. Arguments Against Funding Glaucoma Treatment and Rebuttal

    2018-03-01

    Mar 1, 2018 ... for the treatment of glaucoma at no cost to IWG at the point of delivery toward reducing glaucoma,s harmful impact on the .... and logistic reasons. Nigeria doesn .... cataract unlike from glaucoma can be reversed. This does not.

  1. The future of glaucoma surgery

    Arsham Sheybani

    2015-01-01

    Full Text Available Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

  2. Design, Fabrication, and In Vitro Testing of an Anti-biofouling Glaucoma Micro-shunt.

    Harake, Ryan S; Ding, Yuzhe; Brown, J David; Pan, Tingrui

    2015-10-01

    Glaucoma, one of the leading causes of irreversible blindness, is a progressive neurodegenerative disease. Chronic elevated intraocular pressure (IOP), a prime risk factor for glaucoma, can be treated by aqueous shunts, implantable devices, which reduce IOP in glaucoma patients by providing alternative aqueous outflow pathways. Although initially effective at delaying glaucoma progression, contemporary aqueous shunts often lead to numerous complications and only 50% of implanted devices remain functional after 5 years. In this work, we introduce a novel micro-device which provides an innovative platform for IOP reduction in glaucoma patients. The device design features an array of parallel micro-channels to provide precision aqueous outflow resistance control. Additionally, the device's microfluidic channels are composed of a unique combination of polyethylene glycol materials in order to provide enhanced biocompatibility and resistance to problematic channel clogging from biofouling of aqueous proteins. The microfabrication process employed to produce the devices results in additional advantages such as enhanced device uniformity and increased manufacturing throughput. Surface characterization experimental results show the device's surfaces exhibit significantly less non-specific protein adsorption compared to traditional implant materials. Results of in vitro flow experiments verify the device's ability to provide aqueous resistance control, continuous long-term stability through 10-day protein flow testing, and safety from risk of infection due to bacterial ingression.

  3. Radioactive implants for medical applications; Radioaktive Implantate fuer medizinische Anwendungen

    Schubert, M.

    2008-07-01

    dosimetry of 1-2 MeV electrons, the challenge arises from the short range (few millimeters only) in the tissue and the resulting steep dose decay. Therefore a Monte Carlo Simulation has been developed, based on the library GEANT4. In this dose planning system, apart form the possibility of schematic geometry, calculations based on patients computer tomography data have been made possible. For the validation of this simulation, a system for three-dimensional dosimetric measurements has been developed by means of a plastic scintillator in a water phantom. The simulations could be reproduced within a deviation of 10%. Furthermore, to establish a quality control for each implant produced, an electron counter system has been developed to measure activity. The calibration has been carried out by liquid scintillation counting. Additionally, Monte Carlo Simulations have been performed to allow for calibration of implant materials, which can hardly be diluted such as the used materials silicone or nickel titanium alloys. The measured changes of the material properties of silicone and the bioabsorbable polymer PLGA, which occur due to the production process, were reasonable, confirming the suitability as an implant material, in particular for the long-lasting fixation of the radionuclide. The implants have been tested in the context of two preclinical studies: (i) Otorhinolaryngology faces problems with congested paranasal sinuses, which entail infections. By the implantation of a radioactive silicone stent with an irradiation time of 7 days, it has been shown that an artificially created opening can be kept open on a long-term basis. (ii) In the field of ophthalmology the glaucoma is a wide-spread disease, which can cause blindness, resulting from an elevated intra-ocular pressure. However, it can be treated by a surgical intervention. For the first time, a bioabsorbable, radioactive implant has been used that is suitable to keep the artificially created drainage open, and hence, is

  4. Watch Out for Glaucoma | NIH MedlinePlus the Magazine

    ... of this page please turn JavaScript on. Feature: Glaucoma Watch Out for Glaucoma Past Issues / Spring 2015 Table of Contents A ... used to check eye pressure for signs of glaucoma. Photo courtesy of NEI Glaucoma is a group ...

  5. THE TREATMENT OF OPEN- AND NARROW-ANGLE GLAUCOMA

    1971-04-10

    Apr 10, 1971 ... glaucoma will be considered: narrow-angle glaucoma. (acute glaucoma) and ... emotional or a physical crisis. The pain is in the distribu- .... ness, not increased pressure, haunts people suffering from glaucoma'.' The saga of ...

  6. Combination immunotherapy in the treatment of chronic bilateral panuveitis and uveitic glaucoma during acute dengue fever infection in the Caribbean.

    Stewart, Kevin P; Tawakol, Jan B; Khan, Tasnim; Capriotti, Joseph A

    2015-01-01

    Ocular manifestations of the dengue fever virus include bilateral panuveitis that can occur after the acute systemic infection has resolved. In most reported cases, the inflammation resolves with topical or systemic steroid therapy. We report a case of chronic, refractory bilateral panuveitis and uveitic glaucoma that began during the acute phase of the systemic infection and required treatment with oral steroids, multiple steroid-sparing agents, and surgical therapy for glaucoma. A 22-year-old male with acute systemic dengue fever presented with bilateral pain and decreased vision. Clinical examination revealed bilateral panuveitis with elevated intraocular pressures. Management required oral steroids, mycophenolate mofetil, cyclosporine, and bilateral glaucoma valve implantation. This case highlights the fact that dengue-associated panuveitis can begin in the acute stage of systemic infection and persist long after convalescence with progression to chronic bilateral panuveitis and uveitic glaucoma. Dengue-associated chronic panuveitis with uveitic glaucoma may be effectively managed with a combination of steroid-sparing oral immunosuppression and glaucoma surgery. This is, to our knowledge, the first case of bilateral refractory dengue-associated panuveitis from the Caribbean treated with combination steroid-sparing oral immunosuppression and bilateral glaucoma valve implantation.

  7. Clinical investigation on angle-closure glaucoma patients with cataract treated by phacoemulsification combined with trabeculectomy

    Yu-Sheng Wang

    2013-11-01

    Full Text Available AIM: To investigate the effectiveness of phacoemulsification with intraocular lens(IOLimplantation combined with trabeculectomy in patients with cataract and angle-closure glaucoma.METHODS: In 36 cases(46 eyesof angle-closure glaucoma with cataract, phacoemulsification with foldable IOL implantation combined with trabeculectomy was performed. Data of pre- and post-operation, including visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, chamber angle, and funds were all recorded and analyzed in detail.RESULTS: During the follow-up of 3 months to 2 years,visual acuity of 43 eyes(93.5%got improved, and intraocular pressure in 44 eyes(95.7%were controlled in normal range(CONCLUSION: Phacoemulsification with IOL implantation combined with trabeculectomy is an effective and safe surgical technique for patients with angle-closure glaucoma and cataract, with satisfied control of intraocular pressure, deepening of anterior chamber, opening of anterior chamber angle, and improving visual function.

  8. Drainage of radioactive areas

    1981-04-01

    This Code of Practice covers all the drainage systems which may occur in the radioactive classified area of an establishment, namely surface water, foul, process and radioactive drainage. It also deals with final discharge lines. The Code of Practice concentrates on those aspects of drainage which require particular attention because the systems are in or from radioactive areas and typical illustrations are given in appendices. The Code makes references to sources of information on conventional aspects of drainage design. (author)

  9. Transient drainage summary report

    1996-09-01

    This report summarizes the history of transient drainage issues on the Uranium Mill Tailings Remedial Action (UMTRA) Project. It defines and describes the UMTRA Project disposal cell transient drainage process and chronicles UMTRA Project treatment of the transient drainage phenomenon. Section 4.0 includes a conceptual cross section of each UMTRA Project disposal site and summarizes design and construction information, the ground water protection strategy, and the potential for transient drainage

  10. Mine drainage treatment

    Golomeova, Mirjana; Zendelska, Afrodita; Krstev, Boris; Golomeov, Blagoj; Krstev, Aleksandar

    2012-01-01

    Water flowing from underground and surface mines and contains high concentrations of dissolved metals is called mine drainage. Mine drainage can be categorized into several basic types by their alkalinity or acidity. Sulfide rich and carbonate poor materials are expected to produce acidic drainage, and alkaline rich materials, even with significant sulfide concentrations, often produce net alkaline water. Mine drainages are dangerous because pollutants may decompose in the environment. In...

  11. Evaluation of a glaucoma patient

    Thomas, Ravi; Loibl, Klaus; Parikh, Rajul

    2011-01-01

    The diagnosis of glaucoma is usually made clinically and requires a comprehensive eye examination, including slit lamp, applanation tonometry, gonioscopy and dilated stereoscopic evaluation of the optic disc and retina. Automated perimetry is obtained if glaucoma is suspected. This establishes the presence of functional damage and provides a baseline for follow-up. Imaging techniques are not essential for the diagnosis but may have a role to play in the follow-up. We recommend a comprehensive eye examination for every clinic patient with the objective of detecting all potentially sight-threatening diseases, including glaucoma. PMID:21150033

  12. Evaluation of a glaucoma patient

    Thomas Ravi

    2011-12-01

    Full Text Available The diagnosis of glaucoma is usually made clinically and requires a comprehensive eye examination, including slit lamp, applanation tonometry, gonioscopy and dilated stereoscopic evaluation of the optic disc and retina. Automated perimetry is obtained if glaucoma is suspected. This establishes the presence of functional damage and provides a baseline for follow-up. Imaging techniques are not essential for the diagnosis but may have a role to play in the follow-up. We recommend a comprehensive eye examination for every clinic patient with the objective of detecting all potentially sight-threatening diseases, including glaucoma.

  13. Acupuncture for glaucoma.

    Law, Simon K; Li, Tianjing

    2013-05-31

    Glaucoma is a multifactorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although many treatments are available to manage glaucoma, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine approaches such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating relevant points on the body surface. The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to January 2013), ZETOC (January 1993 to January 2013), Allied and Complementary Medicine Database (AMED) (January 1985 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the National Center for Complementary and Alternative Medicine web site (NCCAM) (http://nccam.nih.gov). We did not use any language or date restrictions in the search for trials. We last searched the electronic databases on 8 January 2013 with the exception of NCCAM which was last searched on 14 July 2010. We also handsearched Chinese

  14. Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve.

    Eslami, Yadollah; Fakhraie, Ghasem; Moghimi, Sasan; Zarei, Reza; Mohammadi, Masoud; Nabavi, Amin; Yaseri, Mehdi; Izadi, Ali

    2017-12-01

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

  15. [Secondary glaucoma in Paraguay. Etiology and incidence].

    Strohl, A; Pozzi, S; Wattiez, R; Roesen, B; Miño de Kaspar, H; Klauss, V

    1999-06-01

    Glaucoma is the third-most-frequent cause of blindness in the world, with a total of 5.2 million blind people as a result of this disease; 80% live in developing countries. In Paraguay, after cataract it is the second-most-frequent-cause. Early detection of the risk factors and groups can help to avoid progress of this disease. Trauma, cataract and infectious uveitis represent special risks for developing secondary glaucoma, which is a more frequent cause of blindness in third-world countries than in industrialized nations. Until now there has been little data regarding the causes, disease course, and options for therapy. Therefore, secondary glaucoma was examined in Paraguay to obtain information on the situation in Latin America. The aim of the study was to explore the causes of secondary glaucoma for programs concerning prevention and therapy. From November 1996 to February 1997 patients with secondary glaucoma were examined at the University Hospital of Asunción, Paraguay. After the clinical examination the secondary glaucomas were classified. Patients with primary glaucoma were included in the same period of time as well in order to get the rate of secondary glaucoma. Altogether 293 patients were examined: 61 with secondary and 232 with primary glaucoma. The causes of secondary glaucoma in 73 eyes were: 20 (27%) with pseudoexfoliation glaucoma, 19 (26%) with post-traumatic glaucoma, 16 (22%) with neovascular glaucoma, 4 (5%) with lens-related glaucoma, 3 (4%) with glaucoma associated with ocular surgery, 2 (3%) with pigmentary and 2 (3%) with corticoid-induced glaucoma. A ratio of 4:1 primary glaucomas to secondary glaucomas was found. The development of special measures for prevention and early therapy is only possible if the causes of this severe disease are explored. The results of this study represent basic information and could help to introduce of prevention programs.

  16. [Surgical treatment of certain forms of secondary glaucoma].

    Dushin, N V; Trubilin, V N; Beliaev, V S; Barashkov, V I; Gonchar, P A; Frolov, M A; Kravchinina, V V; Semin, S B

    2003-01-01

    The technique of penetrating deep sclerectomy with suprachoroidal explanto-drainage as well as the results of postoperative follow-up, exceeding 2 years, and of the early-described sinustrabeculectomy with regulated filtration are presented in the article. Operations were made on 59 eyes (58 patients aged 13 to 70) with the below forms of secondary glaucomas: new-vascular, postuveal, dystrophic (at retinal detachment), posttraumatic (contusion-type), phakotopic, postoperative (aphakic), and hemolytic. The below goals were set while elaborating the methods: the possibility to regulate postoperatively the intraocular pressure, elimination of the pain syndrome, the organ-preserving effect, stabilization of the clinical cause and shaping-up of reliable drainage paths. The authors registered a positive effect in 87.5% of cases.

  17. Scanning laser polarimetry in glaucoma.

    Dada, Tanuj; Sharma, Reetika; Angmo, Dewang; Sinha, Gautam; Bhartiya, Shibal; Mishra, Sanjay K; Panda, Anita; Sihota, Ramanjit

    2014-11-01

    Glaucoma is an acquired progressive optic neuropathy which is characterized by changes in the optic nerve head and retinal nerve fiber layer (RNFL). White-on-white perimetry is the gold standard for the diagnosis of glaucoma. However, it can detect defects in the visual field only after the loss of as many as 40% of the ganglion cells. Hence, the measurement of RNFL thickness has come up. Optical coherence tomography and scanning laser polarimetry (SLP) are the techniques that utilize the evaluation of RNFL for the evaluation of glaucoma. SLP provides RNFL thickness measurements based upon the birefringence of the retinal ganglion cell axons. We have reviewed the published literature on the use of SLP in glaucoma. This review elucidates the technological principles, recent developments and the role of SLP in the diagnosis and monitoring of glaucomatous optic neuropathy, in the light of scientific evidence so far.

  18. The medical management of glaucoma

    medical and surgical interventions are accessible in the management of glaucoma. This article ..... Cannabinoids. With the recent attention cannabis has been receiving in the management of pain and other cancer related conditions, it.

  19. Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis.

    Mataftsi, Asimina; Haidich, Anna-Bettina; Kokkali, Stamatia; Rabiah, Peter K; Birch, Eileen; Stager, David R; Cheong-Leen, Richard; Singh, Vineet; Egbert, James E; Astle, William F; Lambert, Scott R; Amitabh, Purohit; Khan, Arif O; Grigg, John; Arvanitidou, Malamatenia; Dimitrakos, Stavros A; Nischal, Ken K

    2014-09-01

    Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P =

  20. Quantum dots trace lymphatic drainage from the mouse eye

    Tam, Alex L C; Gupta, Neeru; Zhang Zhexue; Yuecel, Yeni H, E-mail: yucely@smh.ca [Department of Ophthalmology and Vision Sciences, University of Toronto, M5T 2S8 (Canada)

    2011-10-21

    Glaucoma is a leading cause of blindness in the world, often associated with elevated eye pressure. Currently, all glaucoma treatments aim to lower eye pressure by improving fluid exit from the eye. We recently reported the presence of lymphatics in the human eye. The lymphatic circulation is known to drain fluid from organ tissues and, as such, lymphatics may also play a role in draining fluid from the eye. We investigated whether lymphatic drainage from the eye is present in mice by visualizing the trajectory of quantum dots once injected into the eye. Whole-body hyperspectral fluorescence imaging was performed in 17 live mice. In vivo imaging was conducted prior to injection, and 5, 20, 40 and 70 min, and 2, 6 and 24 h after injection. A quantum dot signal was observed in the left neck region at 6 h after tracer injection into the eye. Examination of immunofluorescence-labelled sections using confocal microscopy showed the presence of a quantum dot signal in the left submandibular lymph node. This is the first direct evidence of lymphatic drainage from the mouse eye. The use of quantum dots to image this lymphatic pathway in vivo is a novel tool to stimulate new treatments to reduce eye pressure and prevent blindness from glaucoma.

  1. Quantum dots trace lymphatic drainage from the mouse eye

    Tam, Alex L C; Gupta, Neeru; Zhang Zhexue; Yuecel, Yeni H

    2011-01-01

    Glaucoma is a leading cause of blindness in the world, often associated with elevated eye pressure. Currently, all glaucoma treatments aim to lower eye pressure by improving fluid exit from the eye. We recently reported the presence of lymphatics in the human eye. The lymphatic circulation is known to drain fluid from organ tissues and, as such, lymphatics may also play a role in draining fluid from the eye. We investigated whether lymphatic drainage from the eye is present in mice by visualizing the trajectory of quantum dots once injected into the eye. Whole-body hyperspectral fluorescence imaging was performed in 17 live mice. In vivo imaging was conducted prior to injection, and 5, 20, 40 and 70 min, and 2, 6 and 24 h after injection. A quantum dot signal was observed in the left neck region at 6 h after tracer injection into the eye. Examination of immunofluorescence-labelled sections using confocal microscopy showed the presence of a quantum dot signal in the left submandibular lymph node. This is the first direct evidence of lymphatic drainage from the mouse eye. The use of quantum dots to image this lymphatic pathway in vivo is a novel tool to stimulate new treatments to reduce eye pressure and prevent blindness from glaucoma.

  2. Central corneal thickness among glaucoma patients attending ...

    AAU_CHS

    ocular pressure measurement and is different among different ethnic population and subtypes of glaucoma. The central corneal thickness of different subtypes of glaucoma at Menelik II Hospital ... Intraocular pressure is a key element in the.

  3. Optineurin, a multifunctional protein involved in glaucoma

    MADHU

    Glaucomas are a heterogeneous group of neurodegenerative eye diseases that ... with normal tension glaucoma (a sub-type of adult onset primary open angle .... identifies variants at CSF1, OPTN and TNFRSF11A as genetic risk factors for.

  4. Comparison of the Ahmed and Baerveldt glaucoma shunts with combined cataract extraction.

    Rai, Amrit S; Shoham-Hazon, Nir; Christakis, Panos G; Rai, Amandeep S; Ahmed, Iqbal Ike K

    2018-04-01

    To compare the surgical outcomes of combined phacoemulsification with either Ahmed glaucoma valve (AGV) or Baerveldt glaucoma implant (BGI). Retrospective cohort study. A total of 104 eyes that underwent combined phacoemulsification with either AGV (PhacoAGV; n = 57) or BGI (PhacoBGI; n = 47) implantation. Failure was defined as uncontrolled intraocular pressure (IOP; glaucoma surgery, vision-threatening complications, or progression to no-light-perception vision. The PhacoAGV group was older (p = 0.03), had poorer baseline visual acuity (VA; p = 0.001), and had fewer previous glaucoma surgeries (p = 0.04). Both groups had similar baseline IOP (PhacoAGV: 26.4 ± 8.3 mm Hg; PhacoBGI: 25.7 ± 7.3; p = 0.66) and glaucoma medications (PhacoAGV: 3.8 ± 1.0; PhacoBGI: 3.6 ± 1.5; p = 0.54). At 2 years, failure rates were 44% in the PhacoAGV group and 23% in the PhacoBGI group (p = 0.02). Both groups had similar mean IOP reduction (PhacoAGV: 45%; PhacoBGI: 47%, p = 0.67) and medication use reduction (PhacoAGV: 47%; PhacoBGI: 58%, p = 0.38). The PhacoBGI group had higher IOP and medication use up to 1 month (p glaucoma medications, or complication rates between PhacoAGV and PhacoBGI at 2 years, despite BGIs being implanted in patients at higher risk for failure. The PhacoAGV group had higher failure rates at 2 years. Both groups had significant improvements in VA due to removal of their cataracts. The PhacoBGI group required more interventions, but most of these were minor slit-lamp procedures. Copyright © 2018. Published by Elsevier Inc.

  5. Normal-tension glaucoma (Low-tension glaucoma)

    Anderson, Douglas R

    2011-01-01

    Glaucoma is now considered an abnormal physiology in the optic nerve head that interacts with the level of intraocular pressure (IOP), with the degree and rate of damage depending on the IOP and presumably the degree of abnormal physiology. Diagnosis of normal-tension glaucoma (NTG), defined as glaucoma without a clearly abnormal IOP, depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss. Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, migraine headache with aura, and the like), or a family history of glaucoma. Possibly relevant, is a history of hemodynamic crisis, arterial obstructive disease, or sleep apnea. Neurological evaluation with imaging is needed only for atypical cases or ones that progress unexpectedly. Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. Therefore, it may often be wisein mild cases to determine whether the case is progressive and the rate of progression before deciding on how aggressivene to be with therapy. Efforts at neuroprotection and improvement in blood flow have not yet been shown effective. PMID:21150042

  6. Normal-tension glaucoma (Low-tension glaucoma

    Anderson Douglas

    2011-12-01

    Full Text Available Glaucoma is now considered an abnormal physiology in the optic nerve head that interacts with the level of intraocular pressure (IOP, with the degree and rate of damage depending on the IOP and presumably the degree of abnormal physiology. Diagnosis of normal-tension glaucoma (NTG, defined as glaucoma without a clearly abnormal IOP, depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss. Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, migraine headache with aura, and the like, or a family history of glaucoma. Possibly relevant, is a history of hemodynamic crisis, arterial obstructive disease, or sleep apnea. Neurological evaluation with imaging is needed only for atypical cases or ones that progress unexpectedly. Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. Therefore, it may often be wisein mild cases to determine whether the case is progressive and the rate of progression before deciding on how aggressivene to be with therapy. Efforts at neuroprotection and improvement in blood flow have not yet been shown effective.

  7. WATER DRAINAGE MODEL

    Case, J.B.

    2000-01-01

    The drainage of water from the emplacement drift is essential for the performance of the EBS. The unsaturated flow properties of the surrounding rock matrix and fractures determine how well the water will be naturally drained. To enhance natural drainage, it may be necessary to introduce engineered drainage features (e.g. drilled holes in the drifts), that will ensure communication of the flow into the fracture system. The purpose of the Water Drainage Model is to quantify and evaluate the capability of the drift to remove water naturally, using the selected conceptual repository design as a basis (CRWMS M andO, 1999d). The analysis will provide input to the Water Distribution and Removal Model of the EBS. The model is intended to be used to provide postclosure analysis of temperatures and drainage from the EBS. It has been determined that drainage from the EBS is a factor important to the postclosure safety case

  8. Provider Education about Glaucoma and Glaucoma Medications during Videotaped Medical Visits

    Betsy Sleath

    2014-01-01

    Full Text Available Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients’ visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.

  9. Clinical analysis of 34 cases with glaucoma secondary to hypermature cataract

    Lin Jing

    2016-03-01

    Full Text Available AIM:To analyze the clinical symptoms, treatments and prognosis of the glaucoma secondary to hypermature cataract to offer some references for the diagnosis and the treatment.METHODS:Thirty four eyes with glaucoma secondary to hypermature cataract in 34 patients were collected from August 2011 to August 2014 in the West China Hospital, Sichuan University. Analyze different treatment methods selected according to different clinical symptoms, and corresponding prognosis.RESULTS:Thirty four patients were hospitalized in emergency, all the eyes had visual acuity of finger counting or worse, intraocular pressure(IOPwas 35~75mmHg. All patients received comprehensive IOP-lowering therapy before the surgery. Twenty-eight patients underwent phacoemulsification, 6 patients underwent extra-capsular cataract extraction(ECCEand 19 patients underwent primary or secondary IOL implantation. All the patients experienced pain relief after surgery, 30 of them had well-controlled postoperative IOP. One case underwent Ahmed glaucoma valve implant surgery, 3 cases gave up the treatment. Seventeen cases who had IOL implanted got great visual acuity improvement, the best postoperative visual acuity was 0.7.CONCLUSION:As long as we have proper and prompt diagnosis and positive control of IOP and inflammation before surgery, precise surgery skills, close observation after surgery and positive anti-inflammation therapy, most of the glaucoma secondary to hypermature cataract get satisfactory outcomes.

  10. Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

    Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

    1987-01-01

    Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

  11. Effectiveness of multiple therapeutic strategies in neovascular glaucoma patients: A PRISMA-compliant network meta-analysis.

    Dong, Zixian; Gong, Jianyang; Liao, Rongfeng; Xu, Shaojun

    2018-04-01

    Neovascular glaucoma (NVG) is a severe secondary glaucoma with uncontrolled intraocular pressure that leads to serious eye pain and vision loss. Presently, the therapeutic strategies for NVG are diverse, but the therapeutic effects are still not ideal. We performed a network analysis to assess the effect of multiple therapeutic strategies on the treatment of NVG patients. We searched public electronic databases through April 2017 using the following keywords "neovascular glaucoma," "iris neovascularization," "hemorrhagic glaucoma," and "random" without language restrictions. The outcome considered in the present analysis was treatment success rate. A network meta-analysis and multilevel mixed-effects logistic regression were used to compare regimens. We included 27 articles assessing a total of 1884 NVG patients in our analysis. According to the network analysis, interferon and mitomycin plus trabeculectomy (94.9%), glaucoma valve implantation (86.9%), and iris photocoagulation plus trabeculectomy (81.9%) were the most likely to improve treatment success rate in NVG patients. The multilevel logistic regression analysis showed that glaucoma valve, bevacizumab, interferon, cyclophotocoagulation, trabeculectomy, iris photocoagulation, ranibizumab, and mitomycin had advantages in terms of improving treatment success rate in NVG patients. However, the application of retinal photocoagulation and vitrectomy reduced patient treatment success rate. The regimen including mitomycin, interferon, and trabeculectomy was the most likely to improve the treatment success rate in NVG patients. The application of glaucoma valve and bevacizumab were more beneficial for improving patient treatment success rate as a surgery and as an agent, respectively.

  12. Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery

    Masaki Tanito

    2018-01-01

    Full Text Available Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.

  13. [Ascites drainage at home

    Lutjeboer, J.; Erkel, A.R. van; Hoeven, J.J.M. van der; Meer, R.W. van der

    2015-01-01

    Ascites can lead to many symptoms, and often occurs in patients with an end-stage malignancy such as ovarian, pancreatic, colonic, or gastric cancer. Intermittent ascites drainage is applied in these patients as a palliative measure. As frequent drainage is necessary, a subcutaneously tunnelled

  14. Altered aquaporin expression in glaucoma eyes

    Tran, Thuy Linh; Bek, Toke; Cour, Morten la

    2014-01-01

    Aquaporins (AQP) are channels in the cell membrane that mainly facilitate a passive transport of water. In the eye, AQPs are expressed in the ciliary body and retina and may contribute to the pathogenesis of glaucoma and optic neuropathy. We investigated the expression of AQP1, AQP3, AQP4, AQP5......, AQP7 and AQP9 in human glaucoma eyes compared with normal eyes. Nine glaucoma eyes were examined. Of these, three eyes were diagnosed with primary open angle glaucoma; three eyes had neovascular glaucoma; and three eyes had chronic angle-closure glaucoma. Six eyes with normal intraocular pressure...... and without glaucoma were used as control. Immunohistochemistry was performed using antibodies against AQP1, AQP3, AQP4, AQP5, AQP7 and AQP9. For each specimen, optical densities of immunoprecipitates were measured using Photoshop and the staining intensities were calculated. Immunostaining showed labelling...

  15. Prevalence of glaucoma in a Nigerian hospital | Usifoh | Journal of ...

    Primary Open Angle Glaucoma (POAG) was the most common type of glaucoma (91.24%), followed by Normal Tension Glaucoma (NTG) with a prevalence of 3.23%. No significant association was found between age or sex and types of glaucoma. PACG and Juvenile glaucoma remains relatively rare accounting for only ...

  16. Reliable experimental setup to test the pressure modulation of Baerveldt Implant tubes for reducing post-operative hypotony

    Ramani, Ajay

    Glaucoma encompasses a group of conditions that result in damage to the optic nerve and can cause loss of vision and blindness. The nerve is damaged due to an increase in the eye's internal (intraocular) pressure (IOP) above the nominal range of 15 -- 20 mm Hg. There are many treatments available for this group of diseases depending on the complexity and stage of nerve degradation. In extreme cases where drugs or laser surgery do not create better conditions for the patient, ophthalmologists use glaucoma drainage devices to help alleviate the IOP. Many drainage implants have been developed over the years and are in use; but two popular implants are the Baerveldt Glaucoma Implant and the Ahmed Glaucoma Valve Implant. Baerveldt Implants are non-valved and provide low initial resistance to outflow of fluid, resulting in post-operative complications such as hypotony, where the IOP drops below 5 mm of Hg. Ahmed Glaucoma Valve Implants are valved implants which initially restrict the amount of fluid flowing out of the eye. The long term success rates of Baerveldt Implants surpass those of Ahmed Valve Implants because of post-surgical issues; but Baerveldt Implants' initial effectiveness is poor without proper flow restriction. This drives the need to develop new ways to improve the initial effectiveness of Baerveldt Implants. A possible solution proposed by our research team is to place an insert in the Baerveldt Implant tube of inner diameter 305 microns. The insert must be designed to provide flow resistance for the early time frame [e.g., first 30 -- 60 post-operative days] until sufficient scar tissue has formed on the implant. After that initial stage with the insert, the scar tissue will provide the necessary flow resistance to maintain the IOP above 5 mm Hg. The main objective of this project was to develop and validate an experimental apparatus to measure pressure drop across a Baerveldt Implant tube, with and without inserts. This setup will be used in the

  17. The analysis of clinical effect of phacoemulsification on primary angle-closure glaucoma with cataract

    Ling Zhao

    2013-07-01

    Full Text Available AIM:To evaluate the clinical outcomes and affected factors of prognosis of cataract extraction by phacoemulsification with intraocular lens implantation in eyes with primary angle-closure glaucoma(PACGand co-existing cataract.METHODS: Totally 60 cases(70 eyesof PACG with cataract, including 43 eyes with acute primary angle-closure glaucoma(APACG, 27 eyes of chronic primary angle-closure glaucoma(CPACG. The main outcome measures included: visual acuity, intraocular pressure, gonioscopy, depth of anterior chamber(ACD. Patients were examined 6 months after surgery.RESULTS: After phacoemulsification, visual acuity was improved(PPPPCONCLUSION:Phacoemulsification is more effective for acute APACG than for CPACG.

  18. Tenon advancement and duplication technique to prevent postoperative Ahmed valve tube exposure in patients with refractory glaucoma.

    Tamcelik, Nevbahar; Ozkok, Ahmet; Sarıcı, Ahmet Murat; Atalay, Eray; Yetik, Huseyin; Gungor, Kivanc

    2013-07-01

    To present and compare the long-term results of Dr. Tamcelik's previously described technique of Tenon advancement and duplication with the conventional Ahmed glaucoma valve (AGV) implantation technique in patients with refractory glaucoma. This study was a multicenter, retrospective case series that included 303 eyes of 276 patients with refractory glaucoma who underwent glaucoma valve implantation surgery. The patients were divided into three groups according to the surgical technique applied and the outcomes compared. In group 1, 96 eyes of 86 patients underwent AGV implant surgery without patch graft; in group 2, 78 eyes of 72 patients underwent AGV implant surgery with donor scleral patch; in group 3, 129 eyes of 118 patients underwent Ahmed valve implant surgery with "combined short scleral tunnel with Tenon advancement and duplication technique". The endpoint assessed was tube exposure through the conjunctiva. In group 1, conjunctival tube exposure was seen in 11 eyes (12.9 %) after a mean 9.2 ± 3.7 years of follow-up. In group 2, conjunctival tube exposure was seen in six eyes (2.2 %) after a mean 8.9 ± 3.3 years of follow-up. In group 3, there was no conjunctival exposure after a mean 7.8 ± 2.8 years of follow-up. The difference between the groups was statistically significant. (P = 0.0001, Chi-square test). This novel surgical technique combining a short scleral tunnel with Tenon advancement and duplication was found to be effective and safe to prevent conjunctival tube exposure after AGV implantation surgery in patients with refractory glaucoma.

  19. Port-wine vascular malformations and glaucoma risk in Sturge-Weber syndrome.

    Sharan, Sapna; Swamy, Brighu; Taranath, Deepa Ajay; Jamieson, Robyn; Yu, Tao; Wargon, Orli; Grigg, John R

    2009-08-01

    Treatment of the capillary vascular malformation (port-wine stain) in Sturge-Weber syndrome with the use of a laser is helpful cosmetically. However, concerns have been raised that laser obliteration of port-wine stains may result in ocular hypertension. The aim of this study was to review clinical features and management of ocular complications of SWS and assess the effects of dermatological laser treatment on the incidence of glaucoma or ocular hypertension. This retrospective cohort study was conducted in an institutional setting. All patients had involvement of the face. Patients who underwent skin laser to the port-wine vascular malformation were analyzed further. Ocular involvement, glaucoma, and skin laser treatment and the relationship to ocular hypertension/glaucoma were observed. Forty-one Sturge-Weber syndrome patients with port-wine vascular malformation were analyzed. Glaucoma was observed in 24 patients (58.5%) at mean age of 2.9 years (range, 0.0-16.5). Of these, 18 (75.0%) were treated with medical therapy, and 10 (41.7%) required trabeculectomy, with 2 of these requiring Seton implant. Of the 41 patients, 28 (68.3%) underwent laser to face/forehead. Mean age of laser commencement was 5 years (range, 0.4-16.5). Thirteen did not undergo laser treatment. Fourteen of the 28 and 10 of the 13 developed ocular hypertension/glaucoma. This retrospective review did not find evidence to suggest that laser treatment of port-wine vascular malformations causes glaucoma or that it can worsen a preexisting ocular hypertension or glaucoma. Statistical analysis was inconclusive.

  20. Percutaneous transhepatic biliary drainage

    Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

    1982-01-01

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  1. SQSTM1 Mutations and Glaucoma.

    Todd E Scheetz

    Full Text Available Glaucoma is the most common cause of irreversible blindness worldwide. One subset of glaucoma, normal tension glaucoma (NTG occurs in the absence of high intraocular pressure. Mutations in two genes, optineurin (OPTN and TANK binding kinase 1 (TBK1, cause familial NTG and have known roles in the catabolic cellular process autophagy. TKB1 encodes a kinase that phosphorylates OPTN, an autophagy receptor, which ultimately activates autophagy. The sequestosome (SQSTM1 gene also encodes an autophagy receptor and also is a target of TBK1 phosphorylation. Consequently, we hypothesized that mutations in SQSTM1 may also cause NTG. We tested this hypothesis by searching for glaucoma-causing mutations in a cohort of NTG patients (n = 308 and matched controls (n = 157 using Sanger sequencing. An additional 1098 population control samples were also analyzed using whole exome sequencing. A total of 17 non-synonymous mutations were detected which were not significantly skewed between cases and controls when analyzed separately, or as a group (p > 0.05. These data suggest that SQSTM1 mutations are not a common cause of NTG.

  2. PSEUDOEXFOLIATION SYNDROME IN ETHIOPIAN GLAUCOMA ...

    1999-05-05

    May 5, 1999 ... of a systemic disorder involving an aberrant connective- tissue metabolism ... were included in this study, except those secondary glaucoma cases due to trauma, ... a1(17), found the five and 10 year cumulative probabilities of ...

  3. [Perimetric changes in advanced glaucoma].

    Feraru, Crenguta Ioana; Pantalon, Anca

    2011-01-01

    The evaluation of various perimetric aspects in advanced glaucoma stages correlated to morpho-functional changes. MATHERIAL AND METHOD: Retrospective clinical trial over a 10 months time period that included patients with advanced glaucoma stages, for which there have been recorded several computerised visual field tests (central 24-2 strategy, 10-2 strategy with either III or V--Goldman stimulus spot size) along with other morpho-funtional ocular paramaters: VA, lOP optic disk analysis. We included in our study 56 eyes from 45 patients. In most cases 89% it was an open angle glaucoma (either primary or secondary) Mean visual acuity was 0.45 +/- 0.28. Regarding the perimetric deficit 83% had advanced deficit, 9% moderate and 8% early visual changes. As perimetric type of defect we found a majority with general reduction of sensitivity (33 eyes) + ring shape scotoma. In 6 eyes (10.7%) having left only a central isle of vision we performed the central 10-2 strategy with III or V Goldmann stimulus spot size. Statistic analysis showed scarce correlation between the visual acuity and the quantitative perimetric parameters (MD and PSD), and variance analysis found present a multiple correlation parameter p = 0.07 that proves there is no liniary correspondence between the morpho-functional parameters: VA-MD(PSD) and C/D ratio. In advanced glaucoma stages, the perimetric changes are mostly severe. Perimetric evaluation is essential in these stages and needs to be individualised.

  4. Ocular surface changes after combined surgery of glaucoma and cataract

    Zhe Yu

    2018-02-01

    Full Text Available AIM: To investigate the effect of phacoemulsification intraocular lens implantation combined with trabeculectomy on ocular surface in the treatment of glaucoma and cataract. METHODS: Totally 45 cases of patients with glaucoma and cataract in our hospital from February 2016 to February 2017 were enrolled. All the patients had unilateral disease, and the medical records of the patients were analyzed retrospectively. The sicked eyes were set as the observation group and contralateral eyes were set as the control group. The dry eye score, break-up time(BUT, corneal fluorescein staining score(FL, tear secretion test(SⅠtand conjunctival epithelium goblet cell density(CICwas compared between two groups before operation and at 1wk, 1 and 3mo after operation. RESULTS: The preoperative dry eye score of the observation group had no significant difference with that of the control group(P>0.05. At 1wk, 1mo after operation, data of the observation group was significantly higher than that of the control group and before operation, with statistical significance(PP>0.05. Preoperative BUT of the observation group had no significant difference with that of the control group(P>0.05; at 1 wk,1 and 3mo after operation, data of the observation group was significantly lower than that of the control group and before operation, with statistical significance(PPPP>0.05, and the postoperative SⅠt scores of the observation group at 1wk, 1 and 3mo postoperatively was evidently lower than that of the control group and before operation(PPCONCLUSION: Phacoemulsification intraocular lens implantation combined with trabeculectomy for treatment of glaucoma and cataract can aggravate dry eye symptoms, as well as reduce tear film stability and tear secretion, impair conjunctival epithelium goblet cell.

  5. Toric Intraocular Lens Outcomes in Patients With Glaucoma.

    Brown, Reay H; Zhong, Le; Bozeman, Caroline W; Lynch, Mary G

    2015-06-01

    To report the outcomes of toric intraocular lens implantation in patients with glaucoma and corneal astigmatism. One hundred twenty-six eyes of 87 patients with glaucoma and corneal astigmatism that underwent cataract surgery with an AcrySof toric intraocular lens (Alcon Laboratories, Inc., Fort Worth, TX) implant were selected for this single-center, retrospective case series. Corrected distance visual acuity, intraocular pressure, and refractive astigmatism were measured in each eye preoperatively and postoperatively. Uncorrected distance visual acuity and toric alignment were measured postoperatively. The uncorrected distance visual acuity was 0.04 ± 0.08 logMAR (20/22 Snellen) for all eyes. Ninety-eight percent of all eyes achieved an uncorrected distance visual acuity of 20/40 or better, with 76% achieving 20/25 or better and 47% achieving 20/20. The corrected distance visual acuity for all eyes was 0.01 ± 0.03 logMAR (20/20.5 Snellen) postoperatively. The refractive cylinder improved from 1.47 ± 1.10 diopters preoperatively to 0.31 ± 0.37 diopters postoperatively. The residual refractive cylinder was 1.00 diopter or less in 97% of eyes, 0.75 diopters or less in 90% of eyes, and 0.50 diopters or less in 83% of eyes. Mean misalignment was 4.4° ± 5.1°. Intraocular pressure decreased by a mean of 2.3 ± 3.3 mm Hg following the surgery. Toric intraocular lenses can reliably reduce astigmatism and improve uncorrected vision in eyes with cataract and glaucoma. Copyright 2015, SLACK Incorporated.

  6. Clinical observation of two operation methods for neovascular glaucoma

    Peng Zhang

    2013-11-01

    Full Text Available AIM: To evaluate the clinical effect of two different surgical treatments for neovascular glaucoma(NVG.METHODS: A total of 30 NVG inpatients(30 eyesat our hospital from April 2008 to December 2011 were reviewed. Patients were divided into two groups according to the different surgical treatments. In group A, 12 cases(12 eyeswere treated with Ahmed glaucoma valve(AGVimplantation and in group B, 18 cases(18 eyeswere treated with semiconductor diode laser photocoagulation transscleral cyclophotocoagulation(TSCPC. Intraocular pressure, visual acuity and complications were compared between two groups postoperatively.RESULTS: The postoperative IOP was significantly lower in each group(PPP>0.05in IOP 1 month after surgery. Visual acuity: in group A, the visual acuity was improved in 3 eyes, unchanged in 7 eyes and worsened in 2 eyes.; in group B, the visual acuity was improved in 3 eyes, unchanged in 12 eyes and worsened in 3 eyes. Postoperative complications: in group A, eyeball pain and corneal edema were found in 5 cases(41.7%, shallow anterior chamber in 3 cases(25%, anterior chamber fibroid exudation in 2 cases(16.7%, hyphema in 3 cases(25%; in group B, eyeball pain atearly stage after surgery were found in 10 cases(55.6% , corneal edema in 11 cases(61.1%, anterior chamber fibroid exudation in 5 cases(27.8%, hyphema in 6 cases(33.3%.CONCLUSION: AGV implantation and TSCPC are both effective surgical treatment methods for NVG. AGV implantation is a filtration surgery, which is relatively safe. TSCPC is more economical and suitable for glaucoma of advanced or absolute stage.

  7. Acid Mine Drainage Treatment

    Fripp, Jon

    2000-01-01

    .... Acid mine drainage (AMD) can have severe impacts to aquatic resources, can stunt terrestrial plant growth and harm wetlands, contaminate groundwater, raise water treatment costs, and damage concrete and metal structures...

  8. Agricultural Drainage Well Intakes

    Iowa State University GIS Support and Research Facility — Locations of surface intakes for registered agriculture drainage wells according to the database maintained by IDALS. Surface intakes were located from their...

  9. Surface Water & Surface Drainage

    Earth Data Analysis Center, University of New Mexico — This data set contains boundaries for all surface water and surface drainage for the state of New Mexico. It is in a vector digital data structure digitized from a...

  10. Progress of inflammatory cytokines in glaucoma

    Ping Hu

    2015-12-01

    Full Text Available Glaucomais a group of diseases characterized by optic nerve damage and visual field defect, and pathological high intraocular pressure is a risk factor for glaucoma. Glaucoma is affected by the interaction of multiple genes and environmental factors, and inflammation may be involved in the pathogenesis of glaucoma. A great deal of studies have confirmed that high expression of connective tissue growth factor(CTGF, tumor necrosis factor-α(TNF-α, interleukins(ILs, nuclear factor-kappa B(NF-κBand various cytokines in the aqueous humor of patients with glaucoma, which have a close correlation with pathogenesis of glaucoma.This article reviews the progress of inflammatory cytokines and their relationship with glaucoma.

  11. iStent as a Solo Procedure for Glaucoma Patients: A Systematic Review and Meta-Analysis.

    Malvankar-Mehta, Monali S; Chen, Yufeng Nancy; Iordanous, Yiannis; Wang, Wan Wendy; Costella, John; Hutnik, Cindy M L

    2015-01-01

    Glaucoma is a leading cause of irreversible blindness. It is firmly entrenched in the traditional treatment paradigm to start with pharmacotherapy. However, pharmacotherapy is not benign and has been well documented to have a number of significant challenges. Minimally invasive glaucoma surgery (MIGS) that targets the outflow pathway with minimal to no scleral dissection has resulted in the need to reconsider the glaucoma treatment paradigm. To perform a systematic review and meta-analysis to evaluate and quantify the effect on post-operative intraocular pressure (IOP) and number of topical glaucoma medications, in patients receiving the iStent MIGS device as the solo procedure without concurrent cataract surgery. A systematic review was conducted by searching various databases between January 1, 2000, and June 30, 2014. Studies reporting up to a maximum follow-up period of 24 months were retrieved and screened using the EPPI-Reviewer 4 gateway. Percentage reduction in IOP (IOPR%), and mean reduction in topical glaucoma medications after surgery were computed. Meta-analysis was performed using STATA v. 13.0. The standardized mean difference (SMD) was calculated as the effect size for continuous scale outcomes. Heterogeneity was determined using the I2 statistics, Z-value, and χ2 statistics. Fixed-effect and random-effect models were developed based on heterogeneity. Sub-group analysis was performed based on the number of iStents implanted and the follow-up period. The outcome measures were changes in the IOP and number of glaucoma medications. The search strategy identified 105 records from published literature and 9 records from the grey literature. Five studies with 248 subjects were included for quantitative synthesis. A 22% IOP reduction (IOPR%) from baseline occurred at 18-months after one iStent implant, 30% at 6-months after two iStents implantations, and 40% at 6-months after implantation of three iStents. A mean reduction of 1.2 bottles per patient of

  12. The Philadelphia Glaucoma Detection and Treatment Project

    Waisbourd, Michael; Pruzan, Noelle L.; Johnson, Deiana; Ugorets, Angela; Crews, John E.; Saaddine, Jinan B.; Henderer, Jeffery D.; Hark, Lisa A.; Katz, L. Jay

    2016-01-01

    Purpose To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. Design Retrospective analysis. Participants A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. Methods Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. Main Outcome Measures Detection rates of glaucoma-related diagnoses and types of treatments administered. Results Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT

  13. Malignant glaucoma after cataract surgery.

    Varma, Devesh K; Belovay, Graham W; Tam, Diamond Y; Ahmed, Iqbal Ike K

    2014-11-01

    To report a series of eyes that developed malignant glaucoma after cataract surgery. Private academic practice, Toronto, Ontario, Canada. Retrospective case series. Eyes that developed malignant glaucoma after cataract surgery were treated with medical therapy. This was followed by laser iridozonulohyaloidotomy, anterior chamber reformation and intraocular lens (IOL) pushback, and finally with surgical iridozonulohyaloidovitrectomy if all other measures were unsuccessful. Refraction, intraocular pressure (IOP), gonioscopy, and anterior chamber depth (ACD) by anterior segment optical coherence tomography were analyzed before treatment and after treatment. The study evaluated 20 eyes of 18 female patients aged 44 to 86 years. Preoperatively, the mean refraction was +3.11 diopters (D) ± 2.89 (SD), the mean axial length was 21.30 ± 1.40 mm, and all eyes had narrow or closed angles. Malignant glaucoma was diagnosed a mean of 5.8 ± 7.1 weeks postoperatively. At diagnosis, the mean refraction was -2.15 ± 2.95 D; the mean ACD, 2.49 ± 0.72 mm; and the mean IOP, 28.3 ± 10.8 mm Hg on a mean of 1.3 ± 1.6 medications. Two eyes responded to cycloplegia, 7 to laser iridozonulohyaloidotomy, and 6 to anterior chamber reformation-IOL pushback; 5 eyes required vitrectomy. Posttreatment, the mean refraction was -0.56 ± 1.07 D; the mean ACD, 3.30 ± 0.50 mm; and the mean IOP, 14.4 ± 4.60 mm Hg on a mean of 1.2 ± 1.4 medications. Cycloplegia was discontinued in 17 eyes. Malignant glaucoma can occur after phacoemulsification and presents with myopic surprise, anterior chamber shallowing and, possibly, elevated IOP. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  14. Update on normal tension glaucoma

    Jyotiranjan Mallick

    2016-01-01

    Full Text Available Normal tension glaucoma (NTG is labelled when typical glaucomatous disc changes, visual field defects and open anterior chamber angles are associated with intraocular pressure (IOP constantly below 21 mmHg. Chronic low vascular perfusion, Raynaud's phenomenon, migraine, nocturnal systemic hypotension and over-treated systemic hypertension are the main causes of normal tension glaucoma. Goldmann applanation tonometry, gonioscopy, slit lamp biomicroscopy, optical coherence tomography and visual field analysis are the main tools of investigation for the diagnosis of NTG. Management follows the same principles of treatment for other chronic glaucomas: To reduce IOP by a substantial amount, sufficient to prevent disabling visual loss. Treatment is generally aimed to lower IOP by 30% from pre-existing levels to 12-14 mmHg. Betaxolol, brimonidine, prostaglandin analogues, trabeculectomy (in refractory cases, systemic calcium channel blockers (such as nifedipine and 24-hour monitoring of blood pressure are considered in the management of NTG. The present review summarises risk factors, causes, pathogenesis, diagnosis and management of NTG.

  15. Clinical experience of phacoemulsification for cataract patients with angle-closure glaucoma in 29 cases

    Yong-Hui Gu

    2014-05-01

    Full Text Available AIM: To observe the clinical effect of phacoemulsification with foldable intraocular lens implantation on cataract with angle-closure glaucoma. METHODS: Twenty-nine cases(29 eyesof angle-closure glaucoma with cataract underwent phacoemulsification with foldable intraocular lens implantation, and the data of visual acuity, intraocular pressure, gonioscopy and complications after operation were statistically analyzed.RESULTS:Postoperatively, 28 eyes(96.5%visual acuity were improved. Intraocular pressure of 25 eyes(86.2%were maintained at a normal level without any IOP lowering drug, intraocular pressure of 3 eyes(10.3%were controlled by IOP lowering eye drops, intraocular pressure of 1 eye(3.5%returned to normal by trabeculectomy. The chamber depth of 29 eyes was increased. 8 eyes were suffered from mild corneal edema, and returned to normal after treatment. CONCLUSION: Characterized by decreasing intraocular pressure, opening anterior chamber, and raising visual acuity, phacoemulsification with foldable intraocular lens implantation is a good operative therapy for primary angle-closure glaucoma complicated with cataract with preoperative goniosynechia closed ≤270°.

  16. Electron microscopic evaluation of a gold glaucoma micro shunt after explantation.

    Berk, Thomas A; Tam, Diamond Y; Werner, Liliana; Mamalis, Nick; Ahmed, Iqbal Ike K

    2015-03-01

    We present a case of an explanted gold glaucoma micro shunt (GMS Plus) and the subsequent light and electron microscopic analyses. The shunt was implanted in a patient with medically refractive glaucoma. The intraocular pressure (IOP) was stable at 12 mm Hg 6 months postoperatively but spiked to 26 mm Hg 6 months later; membranous growth was visible on the implant gonioscopically. A second gold micro shunt was placed 2 years after the first. The IOP was 7 mm Hg 1 week postoperatively but increased to 23 mm Hg 3 weeks later; similar membranous growth was visible on this implant. One of the shunts was explanted, and light and scanning electron microscopic analyses revealed encapsulation around the shunt exterior and connective tissue invasion of the microstructure. This represents the first electron microscopic analysis of an explanted gold glaucoma micro shunt and the first unequivocal images of the fibrotic pseudo-capsule traversing its microchannels and fenestrations. Dr. Ahmed is a consultant to and has received research grants from Solx, Inc. No other author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  17. Glaucoma and dry eye disease: the role of preservatives in glaucoma medications

    Ratna Sitompul

    2011-11-01

    Full Text Available Glaucoma is a common cause of irreversible blindness with increasing prevalence. Some of glaucoma patients will also experience dry eye. Dry eye is the most frequent side effect related to benzalkonium chloride (BAC-containing eye drop  used for glaucoma patients. In addition, glaucoma and dry eyes have shared risk factors that are old age and female. Dry eye among glaucoma patients need to be treated promptly as it produces discomfort, reduces patients’ compliance and   decreases success rate of glaucoma therapy. Dry eye symptoms can be treated by applying preservative-free eye drop, giving combination of preservative containing and preservative-free eye drop to reduce BAC exposure, prescribing artificial tear and conducting surgery to minimize or eliminate the need of topical medication. (Med J Indones 2011; 20:302-5Keywords: benzalkonium chloride, dry eye, glaucoma

  18. Prevalence of open angle glaucoma in accompanying first degree relatives of patients with glaucoma

    Franciele Vegini

    2008-01-01

    Full Text Available OBJECTIVE: The aim of this study was to determine the prevalence of open angle glaucoma in first-degree relatives accompanying POAG patients during routine examination in a reference hospital. METHOD: First-degree relatives of primary open angle glaucoma patients who accompanied their relatives to the glaucoma service of a reference hospital were screened for glaucoma. RESULTS: One-hundred and one first-degree relatives were examined, of which 56.4% had never had their intraocular pressure measured. 10.9% had previously been diagnosed with glaucoma, and 5.9% were newly diagnosed during this study. CONCLUSIONS: The eye examination of first-degree relatives identified a significant percentage of individuals with glaucoma. Despite being first-degree relatives of glaucoma patients, 56.4% of the companions had never had their eye pressure measured, demonstrating a lack of awareness about this disease.

  19. Glaucoma and clinical characteristics in Vietnamese Americans.

    Peng, Pai-Huei; Manivanh, Richard; Nguyen, Ngoc; Weinreb, Robert N; Lin, Shan C

    2011-08-01

    To assess the proportions of glaucoma types and clinical characteristics in Vietnamese Americans in a single-center, retrospective study. Medical charts of Vietnamese-American patients who visited a single private practice in Northern California from 1998-2007 were reviewed. The main outcome measures included the distribution and characteristics of glaucoma types, and clinical parameters associated with the presence of various glaucomas. Data from 2247 patients aged 18-98 years were reviewed. Glaucoma was determined for 305 patients (13.6%). Among this group, 54.8% had primary open-angle glaucoma (POAG), 26.9% had primary angle-closure glaucoma (PACG), 13.4% had mixed mechanism glaucoma (MMG), and 4.9% had secondary glaucoma. In the MMG group (41 patients), 27 patients who initially had open angles developed narrow angles and underwent laser peripheral iridotomy (LPI) with a mean follow up of 6.4 years from the time of iridotomy. The other 13 patients had glaucoma progression with open angles after LPI. One POAG patient had neovascular glaucoma due to retinal vein occlusion several years later. Compared to the PACG group, the MMG group had significantly lower baseline intraocular pressure (25.0 vs. 20.2 mmHg, p = 0.007) but with no difference in biometry. POAG is the major type of glaucoma in this clinic-based Vietnamese population. However, Vietnamese appear to have a relatively higher proportion of PACG than Caucasians and those of African descent. It is recommended that gonioscopy be part of the regular eye check-up for adult Vietnamese patients.

  20. [Ascites drainage at home].

    Lutjeboer, Jacob; van Erkel, Arian R; van der Hoeven, J J M Koos; van der Meer, Rutger W

    2015-01-01

    Ascites can lead to many symptoms, and often occurs in patients with an end-stage malignancy such as ovarian, pancreatic, colonic, or gastric cancer. Intermittent ascites drainage is applied in these patients as a palliative measure. As frequent drainage is necessary, a subcutaneously tunnelled permanent ascites catheter is a good alternative for intermittent drainage. The patient can open - and then re-close - the catheter when abdominal pressure increases. We inserted 35 subcutaneously permanent ascites catheters in the course of the past 3.5 years in the Leiden University Medical Centre. The success rate was 100% and the complication risk was 2.9%. A subcutaneously tunnelled ascites catheter is an effective and safe palliative treatment for patients with end-stage malignant disease and suffering from ascites.

  1. Agricultural drainage water quality

    Madani, A.; Gordon, R.

    2002-01-01

    'Full text:' Agricultural drainage systems have been identified as potential contributors of non-point source pollution. Two of the major concerns have been with nitrate-nitrogen (NO3 - -N) concentrations and bacteria levels exceeding the Maximum Acceptable Concentration in drainage water. Heightened public awareness of environmental issues has led to greater pressure to maintain the environmental quality of water systems. In an ongoing field study, three experiment sites, each with own soil properties and characteristics, are divided into drainage plots and being monitored for NO3 - -N and fecal coliforms contamination. The first site is being used to determine the impact of the rate of manure application on subsurface drainage water quality. The second site is being used to determine the difference between hog manure and inorganic fertilizer in relation to fecal coliforms and NO3-N leaching losses under a carrot rotation system. The third site examines the effect of timing of manure application on water quality, and is the only site equipped with a surface drainage system, as well as a subsurface drainage system. Each of the drains from these fields lead to heated outflow buildings to allow for year-round measurements of flow rates and water samples. Tipping buckets wired to data-loggers record the outflow from each outlet pipe on an hourly basis. Water samples, collected from the flowing drains, are analyzed for NO3 - -N concentrations using the colorimetric method, and fecal coliforms using the Most Probable Number (MPN) method. Based on this information, we will be able better positioned to assess agricultural impacts on water resources which will help towards the development on industry accepted farming practices. (author)

  2. Clinical outcomes of Ahmed glaucoma valve in anterior chamber versus ciliary sulcus.

    Bayer, A; Önol, M

    2017-04-01

    PurposeTo evaluate the outcomes of Ahmed glaucoma valve (AGV) tube insertion through the anterior chamber angle (ACA) or through the ciliary sulcus (CS).Patients and methodsIn this case-control study, we retrospectively reviewed the charts of consecutive glaucoma patients who had undergone AGV implantation either through the ACA or the CS between March 2009 and December 2014. The main outcome measures were intraocular pressure (IOP), number of glaucoma medications prescribed, best corrected visual acuity (BCVA), glaucoma type, success rate, complications, and survival ratios. Statistical analysis was carried out using SPSS.ResultsThere were 68 eyes in the ACA group and 35 eyes in the CS group. There were no significant differences between the groups for age, sex, laterality, IOP, preoperative glaucoma medication number, BCVA or glaucoma type (P>0.05). The postoperative follow-up period was 27.2±16.5 months and 30.2±17.7 months for the ACA and the CS groups (P=0.28); IOP values were significantly reduced at the last visit to 16.4±7.2 mm Hg and 14.4±6.8 mm Hg. The difference in the last-visit IOP between the groups was not significant (P=0.06), but the IOP reduction ratio was higher in the CS group (P=0.03). There was no significant difference in the number of postoperative medications (P=0.18). Postoperative complications were similar, but the incidence of flat anterior chamber was higher in the ACA group (P=0.05).ConclusionsThe use of an AGV can control IOP in the majority of cases whether placed in the ACA or the CS. The IOP reduction ratio seemed to be higher in the CS group.

  3. Design of low cost glaucoma screening

    Niessen, A. G.; Langerhorst, C. T.; Geijssen, H. C.; Greve, E. L.

    1997-01-01

    In 1991 the Netherlands Glaucoma Patient Association organized a glaucoma screening survey. This survey was designed to evaluate the effectiveness of a low cost screening setting. During a screening period of 8 days, 1259 subjects over the age of 49 years were examined by a team of

  4. GLAUCOMA IN PSEUDOEXFOLIATION- CLINICAL PROSPECTIVE STUDY

    Balasubramanian M. Manickavelu

    2018-01-01

    Full Text Available BACKGROUND Pseudoexfoliation is one of the common cause of secondary open-angle glaucoma worldwide with a mean progression rate higher than primary open-angle glaucoma. In India, prevalence rate of pseudoexfoliation is around 2% (Hiller et al. In South India, the prevalence rate is 6% in >40 years of age as per Krishnadas et al in 2003. The aim of the study is to study the demographic aspects of pseudoexfoliation, the frequency of glaucoma in patients with pseudoexfoliation syndrome and to assess the treatment response in pseudoexfoliation syndrome. MATERIALS AND METHODS The study was conducted among 96 patients with pseudoexfoliation who attended OP Department of Ophthalmology, Government Tiruvannamalai Medical College and Hospital, Tiruvannamalai, from January 2017 to June 2017. Complete ocular examination with visual acuity, anterior segment examination, intraocular pressure, gonioscopy, fundus examination, central corneal thickness, visual field, ultrasound B scan and ultrasound biomicroscopy was done. RESULTS Incidence of glaucoma is more common in pseudoexfoliation and most of them have open angles. All patients with pseudoexfoliation should undergo complete glaucoma evaluation for early detection. Further ophthalmologist should focus on detection of pseudoexfoliation, since it is related to high risk of operative complication. CONCLUSION Incidence of glaucoma is more in pseudoexfoliation with most common bilateral presentation with open angles with recalcitrant intraocular pressure. Severity of optic nerve damage and with progression of field defects appeared to be more compared to primary open-angle glaucoma. Better response to combination drug therapy and surgical therapy than primary open-angle glaucoma.

  5. Determinants of glaucoma awareness in urban punjab

    Farooq, S.; Jaffar, S.; Kausar, A.

    2015-01-01

    To assess the awareness about glaucoma and the factors affecting it in urban Punjab population. Study Design: Cross-sectional study. Place and Duration of Study: Study was conducted in March-April 2011 in Rawalpindi District Punjab, Pakistan. Material and Methods: Glaucoma awareness study was conducted on urban population of Rawalpindi, Islamabad, Lahore and Taxila. Individuals belonging to medical profession (doctors, nurses and paramedics etc) were not included. Demographic details and educational status of all participants were documented. A brief structured close-ended study questionnaire was used to collect information about their awareness of risk factors, treatment aspects and complication of glaucoma. Results: There were 729 participants in the study. Majority were females (60.1%) and adults (76.1%). Literacy level of 40.2% was up to matriculate level. The study indicated that the awareness level about glaucoma was low especially about the recognition of high-risk groups and symptoms. Only one-third of respondents i.e. 32.6% had an idea about the symptoms of the disease and 27.4% participants had awareness of glaucoma as a blinding eye disease. Determinants of glaucoma awareness amongst study participants were gender, age, education level and occupation. Conclusion: Awareness of glaucoma was quite low among the urban population in Punjab. There is need of increased public health education to reduce glaucoma associated blindness and its burden on society. (author)

  6. Normal tension glaucoma and Alzheimer disease

    Bach-Holm, Daniella; Kessing, Svend Vedel; Mogensen, Ulla Brasch

    2012-01-01

    Purpose: To investigate whether normal tension glaucoma (NTG) is associated with increased risk of developing dementia/Alzheimer disease (AD). Methods: A total of 69 patients with NTG were identified in the case note files in the Glaucoma Clinic, University Hospital of Copenhagen (Rigshospitalet...

  7. New pharmacotherapy for the treatment of glaucoma.

    Schehlein, Emily M; Novack, Gary; Robin, Alan L

    2017-12-01

    Glaucoma is the second leading cause of blindness in the world and current pharmacotherapies for glaucoma have remained relatively unchanged (with the exception of fixed combinations of previously available medications) since the mid-1990s with the development of prostaglandin analogues. Now, with both new formulations and new classes of medications with novel mechanisms of action, the medical therapy of glaucoma may be heralding a new dawn in medical management. Areas covered: This review outlines new topical therapies for intraocular pressure (IOP) lowering treatment, in addition to new formulations, preservative-free options, and advances in glaucoma medical therapy delivery. We performed a comprehensive search for published studies for glaucoma medical therapy using the electronic database PubMed. A manual search for each therapy or delivery system was also performed. Expert commentary: These advances in glaucoma therapy have the potential to overcome many barriers to glaucoma's medical care, particularly in terms of adherence. However, both time and research are needed to prove the relative efficacy and safety of these new pharmacotherapies and products, helping us decide their role in the treatment of elevated intraocular pressure. We are hopeful that these new developments in therapy may bring more options for glaucoma medical therapy.

  8. Monitoring dynamics of aqueous humor in glaucoma

    Vyborny, P.; Hornova, J.

    1985-01-01

    Aqueous humor dynamics was observed in patients treated for glaucoma. Aqueous flow was measured using the radionuclide method of contact application of 22 NaCl and the detection of gamma radiation with external detectors. The sample of 184 eyes was divided into three groups: open-angle glaucoma with therapy, open-angle glaucoma without therapy and angle-closure glaucoma 47 eyes were used as controls. Changes were observed in 22 Na outflow half-time in dependence on the duration of the disease, therapy, intraocular pressUre and changes in the perimeter. The new technique has been fully proven in practice, is a contribution to the diagnosis of glaucoma and an indicator of the compensation of the disease. (author)

  9. Drainage Water Filtration

    Tile drainage discharge from managed turf is known to carry elevated concentrations of agronomic fertilizers and chemicals. One approach being considered to reduce the transport is end-of-tile-filters. Laboratory and field studies have been initiated to address the efficacy of this approach. Result...

  10. Driving patterns in older adults with glaucoma.

    van Landingham, Suzanne W; Hochberg, Chad; Massof, Robert W; Chan, Emilie; Friedman, David S; Ramulu, Pradeep Y

    2013-02-21

    The ability to drive is important for ensuring quality of life for many older adults. Glaucoma is prevalent in this age group and may affect driving. The purpose of this study is to determine if glaucoma and glaucomatous visual field (VF) loss are associated with driving cessation, limitations, and deference to another driver in older adults. Cross-sectional study. Eighty-one glaucoma subjects and 58 glaucoma suspect controls between age 60 and 80 reported if they had ceased driving, limited their driving in various ways, or preferred another to drive. Twenty-three percent of glaucoma subjects and 6.9% of suspects had ceased driving (p = 0.01). Glaucoma subjects also had more driving limitations than suspects (2.0 vs. 1.1, p = 0.007). In multivariable models, driving cessation was more likely for glaucoma subjects as compared to suspects (OR = 4.0; 95% CI = 1.1-14.7; p = 0.03). The odds of driving cessation doubled with each 5 decibel (dB) decrement in the better-eye VF mean deviation (MD) (OR = 2.0; 95% CI = 1.4-2.9; p driving limitations (OR = 4.7; 95% CI = 1.3-16.8; p = 0.02). The likelihood of reporting more limitations increased with the VF loss severity (OR = 1.6 per 5 dB decrement in the better-eye VF MD; 95% CI = 1.1-2.4; p = 0.02). Neither glaucoma nor VF MD was associated with other driver preference (p > 0.1 for both). Glaucoma and glaucomatous VF loss are associated with greater likelihood of driving cessation and greater limitation of driving in the elderly. Further prospective study is merited to assess when and why people with glaucoma change their driving habits, and to determine if their observed self-regulation of driving is adequate to ensure safety.

  11. Scanning the macula for detecting glaucoma

    Viquar U Begum

    2014-01-01

    Full Text Available Background: With the advent of spectral domain optical coherence tomography (SDOCT, there has been a renewed interest in macular region for detection of glaucoma. However, most macular SDOCT parameters currently are thickness parameters which evaluate thinning of the macular layers but do not quantify the extent of area over which the thinning has occurred. We therefore calculated a new macular parameter, "ganglion cell complex surface abnormality ratio (GCC SAR" that represented the surface area over which the macular thickness was decreased. Purpose: To evaluate the ability of SAR in detecting perimetric and preperimetric glaucoma. Design: Retrospective image analysis. Materials and Methods: 68 eyes with perimetric glaucoma, 62 eyes with preperimetric glaucoma and 165 control eyes underwent GCC imaging with SDOCT. SAR was calculated as the ratio of the abnormal to total area on the GCC significance map. Statistical Analysis: Diagnostic ability of SAR in glaucoma was compared against that of the standard parameters generated by the SDOCT software using area under receiver operating characteristic curves (AUC and sensitivities at fixed specificities. Results: AUC of SAR (0.91 was statistically significantly better than that of GCC average thickness (0.86, P = 0.001 and GCC global loss volume (GLV; 0.88, P = 0.01 in differentiating perimetric glaucoma from control eyes. In differentiating preperimetric glaucoma from control eyes, AUC of SAR (0.72 was comparable to that of GCC average thickness (0.70, P > 0.05 and GLV (0.72, P > 0.05. Sensitivities at specificities of 80% and 95% of SAR were comparable (P > 0.05 for all comparisons to that of GCC average thickness and GLV in diagnosing perimetric and preperimetric glaucoma. Conclusion: GCC SAR had a better ability to diagnose perimetric glaucoma compared to the SDOCT software provided global GCC parameters. However, in diagnosing preperimetric glaucoma, the ability of SAR was similar to that of

  12. Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

    Al-Omairi, Ahmed Mansour; Al Ameri, Aliah H; Al-Shahwan, Sami; Khan, Arif O; Al-Jadaan, Ibrahim; Mousa, Ahmed; Edward, Deepak P

    2017-11-01

    Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children. Retrospective cross-sectional study. A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of 6 months was conducted. Outcome measures included reduction in intraocular pressure from baseline, survival analysis, and reduction in the number of antiglaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mm Hg or less without medications, while qualified success was defined as having an IOP of 21 mm Hg or less with medications. A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly-associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range, 1.9-13 years) with a median follow-up of 12 months (range, 6-24 months). The IOP was reduced from a preoperative mean of 30.4 (± 10.3) to 24.9 (± 10.6) mm Hg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success rate at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at 1 year, and 5.5% at 2 years. Qualified success rate was 100% at 1 month followed by a 6-month and 1-year survival rate of approximately 50% and a 2-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other

  13. Wound Drainage Culture (For Parents)

    ... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Wound Drainage Culture KidsHealth / For Parents / Wound Drainage Culture What's in ...

  14. Predictors of visual outcomes following Boston type 1 keratoprosthesis implantation.

    Ahmad, Sumayya; Akpek, Esen K; Gehlbach, Peter L; Dunlap, Karen; Ramulu, Pradeep Y

    2015-04-01

    To identify predictors of visual outcomes following Boston type 1 Keratoprosthesis (KPro) implantation. Retrospective chart review. Data regarding preoperative clinical and demographic characteristics and postoperative course were collected. Fifty-nine eyes of 59 adult patients who underwent KPro implantation between January 2006 and March 2012 at a single tertiary care center. Preoperative factors associated with all-cause and glaucoma-related loss of visual acuity from the best postoperative visual acuity noted. Fifty-two of 59 eyes (88%) achieved improved vision post implantation, with 7 eyes failing to gain vision as a result of pre-existing glaucoma (n = 4) or retino-choroidal disease (n = 3). Twenty-one eyes (21/52, 40%) maintained their best-ever visual acuity at last visit (mean follow-up period was 37.8 months). The likelihood of maintaining best-ever vision was 71% at 1 year, 59% at 2 years, and 48% at 3 years. Primary KPro implantation was associated with a higher likelihood of losing best-ever vision as compared to KPro implantation as a repeat corneal procedure (hazard ratio [HR] = 3.06; P = 006). The main reasons for postimplantation vision loss was glaucoma (12/31, 39%), and the risk of glaucomatous visual acuity loss was 15% at 2 years and 27% at 3 years. Prior trabeculectomy was associated with a higher rate of vision loss from glaucoma (HR = 3.25, P = .04). Glaucoma is the primary reason for loss of visual acuity after KPro implantation. Conditions necessitating primary KPro surgery are associated with more frequent all-cause vision loss. Prospective trials are necessary to better determine which clinical features best predict KPro success. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Impact of same-session trabectome surgery on Ahmed glaucoma valve outcomes.

    Esfandiari, Hamed; Shazly, Tarek; Shah, Priyal; Hassanpour, Kiana; Torkian, Pooya; Yaseri, Mehdi; Loewen, Nils A

    2018-03-30

    To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was success defined as IOP > 5 mmHg, ≤ 21 mmHg and ≥ 20% reduction of IOP from baseline at two consecutive visits after 3 months, and no need for glaucoma reoperation. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). The cumulative probability of success at 1 year was 70% in AT, and 65% in A (p = 0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p = 0.001). The corresponding numbers for A were 27.8 ± 10.2 and 16.7 ± 4.9, respectively (p = 0.001). The final IOP was significantly lower in AT (p = 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p = 0.851). Corresponding number at 1 year visit was 1.2 ± 2 in AT and 2.8 ± 1.8 in A (p = 0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p = 0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3 and 28.5%, respectively, p = 0.67). Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma

  16. Prevención y tratamiento actual del glaucoma

    DR. P. José Manuel Díaz

    2010-11-01

    Full Text Available El glaucoma es la principal causa de ceguera no reversible en el mundo, afectando al 2% de la población. Actualmente se considera una neuropatía óptica, donde la presión intraocular juega un rol fundamental en la patogenia y las características del daño óptico producido. Con el tratamiento actual, se busca prevenir el daño en la estructura del nervio óptico, para preservar el campo visual, persiguiendo mantener la calidad de vida del paciente. Existen nuevos métodos imaginológicos que junto al examen clínico y campo visual, predicen daño y avance de enfermedad. Se incluyen en la comprensión de la patología la apoptosis y el concepto de neuroprotección. Nuevos fármacos buscan mantener una adecuada reducción en la presión intraocular sin fluctuaciones, evitando efectos adversos y mejorando la adherencia al tratamiento. Nuevas herramientas terapéuticas como la trabeculoplastía selectiva láser y nuevas cirugías como el implante de tubos de drenaje, aumentan las posibilidades de evitar la ceguera por glaucoma.

  17. Endoscopic cyclophotocoagulation in refractory glaucoma after osteo-odonto-keratoprosthesis in Stevens-Johnson syndrome: a case report.

    Forlini, Matteo; Adabache-Guel, Tania; Bratu, Adriana; Rossini, Paolo; Mingaine, Mpekethu Sam; Cavallini, Gian Maria; Forlini, Cesare

    2014-01-01

    To report successful treatment of refractive glaucoma in a patient submitted to osteo-odonto-keratoprosthesis surgery for Stevens-Johnson syndrome. An interventional case report. The patient is a 62-year-old Indian man with known Stevens-Johnson syndrome since 1972 secondary to tetracycline therapy, with bilateral dry eye and corneal blindness. He underwent symblepharon release surgery with mucous membrane graft in both eyes. Osteo-odonto-keratoprosthesis surgery was later performed on the left eye. He was submitted to 2 Ahmed valve implants to control secondary glaucoma but visual fields continued to worsen; hence, he underwent endoscopic 140° cyclophotocoagulation with a good control of IOP. Endoscopic cyclophotocoagulation as alternative treatment provides good results in refractory glaucoma after osteo-odonto-keratoprosthesis surgery.

  18. Small-incision cataract extraction combined trabeculectomy for primary angle-closure glaucoma with cataract

    Yu-Feng Wu

    2014-09-01

    Full Text Available AIM: To observe the curative effect of treating small-incision cataract extraction by intraocular lens implantation combined with trabeculectomy for primary angle-closure glaucoma with cataract. METHODS: Totally 44 cases(52 eyesof primary angle-closure glaucoma combined with cataract were selected to undergo the combined surgery, in order to observe the patients' pre- and postoperative eyesights, intraocular pressures and the postoperative complications.RESULTS: The postoperative eyesight was improved significantly as compared with the preoperative eyesight. The intraocular pressure was declined dramatically. The result was of statistical significance(P0.05. All the 52 cases' surgeries were performed by the same surgeon. The surgeries were processed smoothly, with 6 postoperative eyes of anterior chamber inflammation cell response, 3 eyes of anterior chamber fibrinoid exudate, 2 eyes of shallow anterior chamber through mydriasis and treatment with glucocorticoids and non-steroidal eyedrops before absorption, and no complications like malignant glaucoma, cyclodialysis, etc. were reported through mydriasis and pressure bandaging before recovery.CONCLUSION: Treating the primary angle-closure glaucoma combined with cataract through the combined surgery has high reliability and desirable curative effect. The surgical method is simple to learn and applicable for promotion on the basic level.

  19. Ion implantation

    Dearnaley, Geoffrey

    1975-01-01

    First, ion implantation in semiconductors is discussed: ion penetration, annealing of damage, gettering, ion implanted semiconductor devices, equipement requirements for ion implantation. The importance of channeling for ion implantation is studied. Then, some applications of ion implantation in metals are presented: study of the corrosion of metals and alloys; influence or ion implantation on the surface-friction and wear properties of metals; hyperfine interactions in implanted metals

  20. Relation between Glaucoma and Sensorineural Hearing Loss

    A Mollasadeghi

    2008-01-01

    Full Text Available Introduction: Glaucoma is one of the leading causes of blindness throughout the world. Some studies have suggested a relationship between glaucoma and sensorineural hearing loss, while others have found no evidence of an association. We performed a study to determine whether there is a significant difference in hearing of patients with glaucoma and a match control population. Methods: In this cross-sectional study, from February, 2005 till April, 2006, 44 patients with glaucoma were studied. The age range was between 15 to 60 years. After taking a complete medical history, those suffering from presbycusis, history of exposure to ototoxic drugs and substances and history of ear surgery were excluded from the study. All of the patients were cases of open-angle glaucoma, and were surveyed separately for normal-pressure glaucoma. Then complete audiometric tests (PTA, SDS, SRT, Impedance were conducted for all of them, and the results compared with a control group. Results: There was no statistically significant difference between the case group and control group in PTA, SDS, and SRT, except for Normal Tension Glaucoma (NTG. There wasn't any statistically significant difference between two groups with respect to age, gender, and history of diseases. In the NTG group, significant difference was seen only in high frequencies. Conclusion: As mentioned, there was a statistically significant difference between NTG group and control group. It is therefore recommended to conduct complete audiometric tests and histopathologic examinations in this group for early detection of hearing loss and application of rehabilitative measures.

  1. Glaucoma as a Metabolic Optic Neuropathy: Making the Case for Nicotinamide Treatment in Glaucoma.

    Williams, Pete A; Harder, Jeffrey M; John, Simon W M

    2017-12-01

    Mitochondrial dysfunction may be an important, if not essential, component of human glaucoma. Using transcriptomics followed by molecular and neurobiological techniques, we have recently demonstrated that mitochondrial dysfunction within retinal ganglion cells is an early feature in the DBA/2J mouse model of inherited glaucoma. Guided by these findings, we discovered that the retinal level of nicotinamide adenine dinucleotide (NAD, a key molecule for mitochondrial health) declines in an age-dependent manner. We hypothesized that this decline in NAD renders retinal ganglion cells susceptible to damage during periods of elevated intraocular pressure. To replete NAD levels in this glaucoma, we administered nicotinamide (the amide of vitamin B3). At the lowest dose tested, nicotinamide robustly protected from glaucoma (~70% of eyes had no detectable glaucomatous neurodegeneration). At this dose, nicotinamide had no influence on intraocular pressure and so its effect was neuroprotective. At the highest dose tested, 93% of eyes had no detectable glaucoma. This represents a ~10-fold decrease in the risk of developing glaucoma. At this dose, intraocular pressure still became elevated but there was a reduction in the degree of elevation showing an additional benefit. Thus, nicotinamide is unexpectedly potent at preventing this glaucoma and is an attractive option for glaucoma therapeutics. Our findings demonstrate the promise for both preventing and treating glaucoma by interventions that bolster metabolism during increasing age and during periods of elevated intraocular pressure. Nicotinamide prevents age-related declines in NAD (a decline that occurs in different genetic contexts and species). NAD precursors are reported to protect from a variety of neurodegenerative conditions. Thus, nicotinamide may provide a much needed neuroprotective treatment against human glaucoma. This manuscript summarizes human data implicating mitochondria in glaucoma, and argues for studies to

  2. Percutaneous drainage of lung abscesses

    van Sonnenberg, E.; D'Agostino, H.; Casola, G.; Vatney, R.R.; Wittich, G.R.; Harker, C.

    1989-01-01

    The authors performed percutaneous drainage of lung abscesses in 12 patients. Indications for drainage were septicemia and persistence or worsening of radiographic findings. These lung abscesses were refractory to intravenous antibiotics and to bronchial toilet. Etiology of the abscesses included pneumonia (most frequently), trauma, postoperative development, infected necrotic neoplasm, and infected sequestration. Guidelines for drainage included passage of the catheter through contiguously abnormal lung and pleura, inability of the patient to cough, and/or bronchial obstruction precluding bronchial drainage. Cure was achieved in 11 of 12 patients. Catheters were removed on an average of 16 days after insertion. Antibiotics were administered an average of 18 days before drainage. No major complications occurred

  3. Glaucoma evolution in patients with diabetes.

    Apreutesei, Nicoleta Anton; Chiselita, D; Motas, O I

    2014-01-01

    Glaucoma and diabetes are two chronic diseases with a long suspected pathogenic relationship. Screening for glaucoma in patients with diabetes. A retrospective study on 92 eyes from 46 patients with primitive open angle glaucoma (POAG) (normal and hypertensive) and intraocular hypertension (OHT) receiving medication and/or surgery associated with diabetes mellitus (DM) (type I, type II, mixed) is presented. Participants were divided into two groups as following: 16 eyes with glaucoma and diabetic retinopathy changes (group 1) and 76 eyes with glaucoma and without diabetic retinopathy changes (group 2). The following parameters were analysed: ocular pressure (Goldmann aplanotonometry), perimeter development (computerized perimetry) and fundus condition (absence, presence or progression of diabetic retinopathy). In patients with glaucoma and diabetic retinopathy (8 patients) we found a mean difference between treated intraocular pressure (IOP) and IOP last untreated control of 4.95 mmHg; a depreciation of the MD by 4.18 dB and an average number of glaucoma medications used of 0.889 +/- 1.054. Predominant changes in proliferative diabetic retinopathy were mild. In patients with glaucoma in the absence of diabetic retinopathy, the average difference between untreated IOP and IOP under treatment at the last check-up was 1.63 mmHg, the MD depreciation was by 0.65 dB and the average number of glaucoma medications used was 0.795 +/- 0.978. No statistically significant differences in terms of initial and final pressure were found. No statistically significant differences in the evolution of changes in perimeter between the two groups were observed. The presence of non-proliferating diabetic retinopathy influenced (only marginally statistically) the glaucomatous disease progression. Large comparative prospective studies are needed for the long-term follow up.

  4. Acid mine drainage

    Bigham, Jerry M.; Cravotta, Charles A.

    2016-01-01

    Acid mine drainage (AMD) consists of metal-laden solutions produced by the oxidative dissolution of iron sulfide minerals exposed to air, moisture, and acidophilic microbes during the mining of coal and metal deposits. The pH of AMD is usually in the range of 2–6, but mine-impacted waters at circumneutral pH (5–8) are also common. Mine drainage usually contains elevated concentrations of sulfate, iron, aluminum, and other potentially toxic metals leached from rock that hydrolyze and coprecipitate to form rust-colored encrustations or sediments. When AMD is discharged into surface waters or groundwaters, degradation of water quality, injury to aquatic life, and corrosion or encrustation of engineered structures can occur for substantial distances. Prevention and remediation strategies should consider the biogeochemical complexity of the system, the longevity of AMD pollution, the predictive power of geochemical modeling, and the full range of available field technologies for problem mitigation.

  5. Treatment of malignant glaucoma with minimal invasive vitrectomy surgery

    Li Meng

    2015-09-01

    Full Text Available AIM:To evaluate the efficacy of 25G vitrectomy surgery for malignant glaucoma. METHODS: Thirteen eyes of 11 patients with malignant glaucoma who had a history of primary angle-closure glaucoma were analyzed retrospectively from September 2012 to October 2013 in our hospital. All patients had undergone a prior surgery of trebeculectomy combined with iridectomy. The pre-operative mean best corrected visual acuity(BCVAin LogMAR was 0.70±0.13 and the mean intraocular pressure(IOPwas 41.3±12.7mmHg. Corneal edema, ciliary body edema and very shallow anterior chamber with a mean value of 0.69±0.17mm were showed by ultrasound biomicroscopy(UBM. Anterior vitrectomy and posterior capsulotomy were performed with 25G vitrectomy system in all eyes. Seven phakic eyes underwent phacoimulsification combined IOL implantation surgery during vitrectomy.RESULTS: The patients were followed up for 6~18mo with an average of 11.7±5.4mo. BCVA at the last follow-up improved to 0.29±0.08 and the mean IOP was 18.6±3.9mmHg. UBM results showed that ciliary body edema was eliminated, the iris was flattened and the anterior chamber was deepened with a mean depth of 2.48±0.31mm at 1mo after surgery. Postoperative complications included corneal edma, Descemet membrane folds, anterior chamber inflammation, fibrotic exudation, local iris posterior synechia and hypotony(IOP≤5mmHg. One eye had high IOP of 26.4mmHg and required long-term topical antiglaucoma medication to control the IOP≤21mmHg. No complications such as corneal endothelium decompensation, IOL capture, intraocular hemorrhage, infection and uncontrolled IOP were observed. CONCLUSION: 25G vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications associated with traditional vitrectomy. Combined vitrectomy with phacoemulsification may improve the success rate and visual function.

  6. Importance of intraocular pressure in glaucoma

    Joos, Karen M.

    1999-06-01

    Glaucoma results in permanent vision loss and affects the peripheral vision initially. It is presented in 22.5 million people worldwide and is the 3rd cause of blindness. Present tonometers are not ideal for intraocular pressure measurements in all eyes. Of concern, PRK and LASIK may result in lower intraocular pressure readings. A challenges now exists for the development of a tonometer which can easily compensate for corneas with many parameters to avoid a future increase in normal-tension glaucoma or glaucoma which is advanced.

  7. Coincidence of retinitis pigmentosa and pseudoexfoliative glaucoma

    Božić Marija

    2017-01-01

    Full Text Available Introduction. This is an observational case report presenting retinitis pigmentosa associated with pseudoexfoliative glaucoma. Case outline. A 69-year-old man presented with retinitis pigmentosa. On examination, pseudoexfoliative material was detected on anterior segment structures, and intraocular pressure was 26 mmHg in the right and 24 mmHg in the left eye. The patient was commenced on topical antiglaucomatous therapy (timolol + dorzolamide twice daily, latanoprost once in the evening to both eyes. Conclusion. To the best of our knowledge, this is the first reported case of retinitis pigmentosa associated with pseudoexfoliative glaucoma. Although rare, retinitis pigmentosa and glaucoma can occur in the same eye.

  8. High Prevalence of Narrow Angles among Chinese-American Glaucoma and Glaucoma Suspect Patients

    Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

    2009-01-01

    Purpose To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Patients and Methods Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data was collected for gender, age, race (self-declared), refraction (spherical equivalent), intraocular pressure (IOP), gonioscopy and vertical cup-to-disk ratio (CDR). Results Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade ≤2 in three or more quadrants). Those with narrow angles were significantly older (P=0.004) than their open angle counterparts, but the two groups did not differ in terms of gender, refraction, IOP or CDR (all, P≥0.071). In a multivariate model including age, gender and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). Conclusions A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of gender or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed. PMID:19826385

  9. High prevalence of narrow angles among Chinese-American glaucoma and glaucoma suspect patients.

    Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

    2009-01-01

    To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data were collected for sex, age, race (self-declared), refraction (spherical equivalent), intraocular pressure, gonioscopy, and vertical cup-to-disk ratio. Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade or = 0.071). In a multivariate model including age, sex, and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of sex or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed.

  10. Evaluation of ExPress glaucoma filtration device in Indian patients with advanced glaucoma

    Angmo, Dewang; Sharma, Reetika; Temkar, Shreyas; Dada, Tanuj

    2015-01-01

    ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medicat...

  11. A case involving an Ahmed™ glaucoma valve transferred from the vitreous into the anterior chamber of the eye with a silicone oil tamponade for the treatment of neovascular glaucoma

    Miki M

    2013-02-01

    Full Text Available Michiko Miki, Mari Ueki, Tetsuya Sugiyama, Shota Kojima, Tsunehiko IkedaDepartment of Ophthalmology, Osaka Medical College, Takatsuki, JapanPurpose: To report the short-term efficacy and safety of the transfer of an Ahmed™ glaucoma valve (AGV™ tube from the vitreous into the anterior chamber, in a patient with neovascular glaucoma who had undergone pars plana AGV™ implantation and ultimately needed a silicone oil tamponade.Case: A 41-year-old male with proliferative diabetic retinopathy in both eyes was referred to us for treatment in December 2009. Although the patient previously underwent several surgeries, he ultimately lost vision in his right eye. His left eye suffered from neovascular glaucoma after undergoing a pars plana vitrectomy for tractional retinal detachment. After several vitreous and glaucoma surgeries, the patient underwent implantation of a pars plana AGV™. Postoperatively, although his intraocular pressure was stabilized at approximately 10 mmHg, he had repeated vitreous hemorrhage and hyphema without improvement. He ultimately underwent PPV with a silicone oil tamponade and at the same time, the AGV™ tube was pulled out from the vitreous and inserted into the anterior chamber in order to avoid complications caused by the silicone oil.Results: At 19 months postoperative, the patient’s intraocular pressure had stabilized at 10 mmHg with no recurrence of vitreous hemorrhage and hyphema. Eventually, he lost vision in his left eye because of cerebral hemorrhage.Conclusion: The findings show that insertion of a pars plana AGV™ tube into the anterior chamber in a patient undergoing a silicone oil tamponade is both effective and safe in the short-term.Keyword: tube implantation, glaucoma surgery, tube transfer, pars plana, proliferative diabetic retinopathy, intraocular pressure

  12. Comparison of efficacy of procedures in the treatment of acute angle-closure glaucoma

    Lian-Rong Su

    2013-06-01

    Full Text Available AIM: To observe the clinical effects of 3 different surgery treatments for acute angle-closure glaucoma. METHODS: Totally 60 cases of acute angle-closure glaucoma were randomly divided into 3 groups. Iris root excision or laser iridotomy was applied to group A, cataract phacoemulsification with artificial lens implantation and goniosynechialysis for group B, crabeculectomy for group C. The changes of vision, intraocular pressure, chamber angle, anterior chamber depth before and after operation were observed, while the postoperative complications and following operations were analyzed. The period of follow-up was one week, one month, three months and six months.RESULTS: No statistical significance was found for treatments of group A and C(P>0.05. For group C the treatment was statistically significant(PPPCONCLUSION: Cataract phacoemulsification with artificial lens implantation and goniosynechialysis is a safe and effective surgery for treatment of acute angle-closure glaucoma, which can effectively improve vision, decrease intraocular pressure, open anterior chamber angle.

  13. Neovascular Glaucoma Induced by Peripheral Retinal Ischemia in Neurofibromatosis Type 1: Management and Imaging Features

    Francesco Pichi

    2013-04-01

    Full Text Available Purpose: To report the case of a young patient affected by neurofibromatosis 1 (NF-1 with peripheral retinal ischemia-induced neovascular glaucoma and the peculiar spectral-domain optical coherence tomography (SD-OCT features. Material and Methods: A 13-year-old boy affected by NF-1, as diagnosed according to established criteria, was referred with a diagnosis of hypertensive uveitis in his left eye. He underwent a complete ophthalmic examination and comprehensive blood work with viral and immunological tests. The case was documented with fluorescein angiography (FA and SD-OCT. When the intraocular pressure (IOP of the left eye decreased and the cornea cleared, FA revealed retinal ischemia and leakage from pathologic retinal vessels. SD-OCT revealed foveal hypoplasia secondary to the complete absence of the retinal nerve fiber layer. Results: Peripheral retinal ischemia-induced neovascular glaucoma was diagnosed. The patient underwent Ahmed valve implantation to control his IOP, and subsequent retinal photocoagulation by argon laser and intravitreal bevacizumab injection were performed to control neovascularization. Discussion: Retinal ischemia in NF-1 might lead to neovascular glaucoma: lowering of the IOP with surgical implantation of an Ahmed valve, regression of neovascularization by argon laser panretinal photocoagulation and intravitreal injection of bevacizumab can be a helpful way to control such a complication.

  14. GENDER AND AGE FEATURES OF GLAUCOMA

    O. V. Makarenk

    2014-02-01

    Full Text Available Today, the definition “glaucoma” combines a number of eye pathologies that lead to irreversible blindness, and therefore is difficult disabling disease. Glaucoma occurs in people of working age, so this problem is not only medical, but also social, because it causes disability in substantial economic costs not only for individual patients, but also for the whole country – patients become unable to work. Gender features of glaucoma are also contradictory. In European literature the basic idea is that men are more likely to suffer from glaucoma than women. Such studies have not been conducted in the Podillya region of Ukraine, that makes impossible to design a reliable global data to estimate the prevalence of glaucoma in different age groups for persons living in Vinnitsa region. Therefore, the aim of the study was a retrospective analysis of medical records of patients in Eye Microsurgery Department of Vinnitsa Regional Clinical Hospital for the period 2008-2012 years for determining the gender and age characteristics. Materials and methods 1418 patients with primary open-angle glaucoma (841 men and 577 women aged 14 to 92 years (mean age 67,12 ± 7,64, which were treated in the Eye Microsurgery Department, took part in the study. For the purpose of the study they were divided into two groups: I – male patients with glaucoma, II – female patients with glaucoma. Each group was divided into 7 subgroups according to the ontogenesis scheme: A – teens, B – youth, C – I adulthood age, D – II adulthood age, E – elderly age, F – senily age and G – centenarians. Thus was allocated 12 research groups. Results The structure of the incidence of glaucoma is 59.31% in men and 40.69% in women. Incidence of glaucoma is highest in the IE group and is 34.98%. The group IIE incidence is lower – 35.32%. In the group D the incidence of glaucoma among men and women was very different (13.89% and 2.89%, respectively. It should also be noted

  15. Ex-PRESS glaucoma filter: an MRI compatible metallic orbital foreign body imaged at 1.5 and 3 T

    Mabray, M.C.; Uzelac, A.; Talbott, J.F.; Lin, S.C.; Gean, A.D.

    2015-01-01

    Aim: To report on the MRI compatibility of the Ex-PRESS glaucoma filtration device, a tiny metallic implant placed into the anterior chamber of the eye that is much smaller than traditional glaucoma shunts, and to educate the radiology community regarding its appearance. Materials and methods: Seven patients with Ex-PRESS glaucoma filtration devices were identified that had undergone MRI at San Francisco General Hospital/University of California San Francisco Medical Center by searching and cross-referencing the radiology reporting system and the electronic medical record. MRI images were reviewed for artefact interfering with interpretation. Ophthalmology examinations were reviewed for evidence of complications. Results: Eighteen individual MRI examinations were performed during 12 unique MRI events on these 7 patients. 13/18 individual MRI examinations and 7/12 MRI events were performed at 3 T with the others performed at 1.5 T. Mean time from Ex-PRESS implantation to MRI was 17.5 months. Mean time from MRI to first ophthalmology examination was 1.1 months and from MRI to latest ophthalmology examination was 6.6 months. Susceptibility artefact did not interfere with image interpretation and no complications related to MRI were encountered. Conclusion: The Ex-PRESS glaucoma filtration device appears to be safe for MRI at 1.5 and 3 T and does not produce significant susceptibility artefact to affect diagnostic interpretation adversely. - Highlights: • The Ex-PRESS glaucoma filtration device is a tiny metallic orbital implant. • It can simulate a metallic orbital foreign body on imaging. • There is little information in the literature about it's MRI safety. • We report 18 MRIs performed on 7 patients including the first at 3 T. • Imaging appears to be safe at 1.5 and 3 T in patients with this device

  16. Ex-PRESS glaucoma filter: an MRI compatible metallic orbital foreign body imaged at 1.5 and 3T.

    Mabray, M C; Uzelac, A; Talbott, J F; Lin, S C; Gean, A D

    2015-05-01

    To report on the MRI compatibility of the Ex-PRESS glaucoma filtration device, a tiny metallic implant placed into the anterior chamber of the eye that is much smaller than traditional glaucoma shunts, and to educate the radiology community regarding its appearance. Seven patients with Ex-PRESS glaucoma filtration devices were identified that had undergone MRI at San Francisco General Hospital/University of California San Francisco Medical Center by searching and cross-referencing the radiology reporting system and the electronic medical record. MRI images were reviewed for artefact interfering with interpretation. Ophthalmology examinations were reviewed for evidence of complications. Eighteen individual MRI examinations were performed during 12 unique MRI events on these 7 patients. 13/18 individual MRI examinations and 7/12 MRI events were performed at 3 T with the others performed at 1.5 T. Mean time from Ex-PRESS implantation to MRI was 17.5 months. Mean time from MRI to first ophthalmology examination was 1.1 months and from MRI to latest ophthalmology examination was 6.6 months. Susceptibility artefact did not interfere with image interpretation and no complications related to MRI were encountered. The Ex-PRESS glaucoma filtration device appears to be safe for MRI at 1.5 and 3 T and does not produce significant susceptibility artefact to affect diagnostic interpretation adversely. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. Dry Eyes and Glaucoma: Double Trouble

    ... Involved News About Us Donate In This Section Dry Eyes and Glaucoma: Double Trouble email Send this article ... eye disease bothers the patient more. What Causes Dry Eye Syndrome? Dry eye can be caused by many ...

  18. Management of exfoliative glaucoma: challenges and solutions.

    Holló, Gábor; Katsanos, Andreas; Konstas, Anastasios Gp

    2015-01-01

    Exfoliative glaucoma is the most common type of secondary open-angle glaucoma worldwide. It is characterized by high intraocular pressure (IOP) and worse 24-hour IOP characteristics. In order to minimize progression, treatment of exfoliative glaucoma has to provide a low long-term mean IOP and good 24-hour IOP control. To achieve these goals, fixed-dose combination eye drops, argon and selective laser trabeculoplasty, and various forms of surgery (trabeculectomy, deep sclerectomy, viscocanalostomy, ab interno trabeculotomy, trabecular aspiration, and cataract surgery) all need to be considered during the long-term management of the disease. Since exfoliative glaucoma is a disease of the elderly, and is frequently associated with systemic vascular disease, interdisciplinary consultations are of great clinical importance. These management aspects and the current medical, laser, and surgical results are covered in this review, with a special focus on the needs of the general ophthalmologist.

  19. The interrelation between hypothyroidism and glaucoma

    Thvilum, Marianne; Hjelm Brandt Kristensen, Frans; Brix, Thomas Heiberg

    2017-01-01

    Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms......: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case-control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search......, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757...

  20. Glaucoma detection with damato multifixation campimetry online

    Olsen, Ane Sophie; Alberti, M.; Serup, L.

    2016-01-01

    to define abnormality, and these were evaluated using the Glaucoma Staging System as gold standard. Receiver operating characteristic (ROC) curves and area under the ROC (AUC) were calculated. Results AUCs from 15 algorithms ranged from 0.79 to 0.90. The most promising algorithm combined results from two...... successive DMCO STANDARD tests. The sensitivity was highly dependent on the severity of glaucoma. Hence, for eyes with mild, moderate, advanced, and severe glaucoma, the DMCO test demonstrated a sensitivity of 11.8, 71.4, 100, and 100%, respectively. The specificity was as high as 98.1%. Median duration per...... eye to complete the DMCO STANDARD test was 86 s for the control group and 125 s in participants with glaucoma. Conclusions DMCO shows promise as a free-of-charge online tool to identify glaucomatous visual field defects in a preselected population. Ongoing studies are evaluating the use of DMCO...

  1. Antihypertensive medication postpones the onset of glaucoma

    Horwitz, Anna; Klemp, Marc; Jeppesen, Jørgen

    2017-01-01

    The aim was to investigate the impact of antihypertensive medication on the onset of glaucoma. Data from the complete Danish population between 40 and 95 years of age were used in the period from 1996 to 2012, covering >2.6 million individuals. The National Danish Registry of Medicinal Products...... Statistics was used to identify all claimed prescriptions for glaucoma medication and antihypertensive drugs. We first investigated basic correlations in the data and found that patients treated with antihypertensive medication, at any time during the study period, had a significantly higher overall relative...... risk (RR) of glaucoma, even when controlling for age and sex (with a RR of 1.31 and Pglaucoma. To investigate the causal effect of antihypertensive treatment on the onset of treatment for glaucoma, we used...

  2. The role of inflammation in the pathogenesis of glaucoma

    Vohra, Rupali; Tsai, James C; Kolko, Miriam

    2013-01-01

    Glaucoma is an ocular disorder characterized by the progressive loss of retinal ganglion cells (RGC) and their axons. There are various hypotheses concerning the cause of RGC death. Previously, glaucoma was defined by high intraocular pressure (IOP); during the past decade, however, glaucoma...... specialists have acknowledged that elevated IOP is the most important risk factor for glaucoma, but does not define the disease. Other factors such as genetics, blood flow, and excitotoxicity are suggested as potential causal factors for progressive RGC death observed in glaucoma. We review recent studies...... elucidating a possible role of low-grade inflammation as a causal factor in the pathogenesis of glaucoma....

  3. A Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade.

    Davo-Cabrera, Juan Maria; Lanzagorta-Aresti, Aitor; Alcocer Yuste, Pablo

    2017-10-01

    The purpose of the study is to describe a novel technique to implant Ahmed valves in patients with refractory glaucoma because of silicone oil (SO) endotamponade PATIENTS:: Three patients with glaucoma without SO removal were used as an example for this technique. Technique report. We introduce a standard technique modification for Ahmed valves in patients with SO. This modification consists on locating the Ahmed valve more tangential to the limbus curvature instead of the usual perpendicular position and inserting the tube in the posterior chamber. The tube can be longer and run parallel to pupil. This technique allows use superotemporal quadrant (fewer complications), avoid corneal touch and decrease SO loss through the tube to subconjunctival space.

  4. The optic nerve head in glaucoma

    Rupert RA Bourne

    2006-09-01

    Full Text Available ll types of glaucoma involve glaucomatous optic neuropathy. The key to detection and management of glaucoma is understanding how to examine the optic nerve head (ONH. This pictorial glossary addresses the following issues: how to examine the ONH; normal characteristics of the ONH; characteristics of a glaucomatous ONH; how to tell if the glaucomatous optic neuropathy is getting worse;‘pitfalls and pearls’.

  5. Contact lens assisted imaging with integrated flexible handheld probe for glaucoma diagnosis

    Hong, Xun Jie Jeesmond; V. K., Shinoj; Murukeshan, V. M.; Baskaran, M.; Aung, Tin

    2017-06-01

    Angle closure glaucoma accounts for majority of the bilateral blindness in Asian countries such as Singapore, China, and India. Abnormalities in the optic nerve and aqueous outflow system are the most indicative clinical hallmarks for glaucoma of this clinical subtype. Traditional photographic imaging techniques to assess the drainage angle are contact based, and may expose patients to risk of corneal abrasion and infections. In addition, these procedures require the use of viscous ophthalmic gels as coupling medium to overcome the phenomenon of total internal reflection at the tear-air interface. In this paper, we propose an integrated flexible handheld probe consisting of a micro color CCD video camera and white light LEDs. The handheld probe is able to capture images of the fundus and opposite iridocorneal angle when placed at the central cornea or limbus respectively. Here, we propose the use of hydrogel contact lens as an index matching medium and better protective barrier, as an alternative to conventional ophthalmic gels. The proposed imaging system and methodology has been successfully tested on porcine eye samples, ex vivo. With its high repeatability, reproducibility, and a good safety profile, it is believed that the proposed imaging system and methodology will complement existing imaging modalities in the diagnosis and management of glaucoma.

  6. Macular thickness after glaucoma filtration surgery.

    Sesar, Antonio; Cavar, Ivan; Sesar, Anita Pusić; Geber, Mia Zorić; Sesar, Irena; Laus, Katia Novak; Vatavuk, Zoran; Mandić, Zdravko

    2013-09-01

    The aim of present study was to analyze early postoperative changes in the macular area using optical coherence tomography (OCT) after uncomplicated glaucoma filtration surgery. This prospective study included 32 patients (34 eyes) with open-angle glaucoma, which underwent trabeculectomy with or without use of mitomycin C. Exclusion criteria were macular edema, uveitis, age-related macular degeneration, blurred optical media, secondary glaucoma and angle-closure glaucoma. All standard clinical examinations were made before surgery, at the 2nd day, 1 week and 1 month after surgery. Tomography of the macula was performed during every examination using Cirrus HD OCT for the analysis of central subfield thickness. Results show that thickening of the macula was slightly higher 1 week and 1 month after operation in comparison with baseline end 2nd day postoperativelly. There was no significant difference in the change of macular thickness in patients who have used topical prostaglandins compared with those who have used other topical medications. Also, there was no difference in macular changes between patients treated with or without mitomycin C. In conclusion, we found a slight subclinical increase in macular thickness after uncomplicated trabeculectomy, for which we considered that was the result in reduction of intraocular pressure after glaucoma surgery. Macular thickening after glaucoma filtering surgery could be a physiological reaction to the stress of the retina caused by a sudden reduction of intraocular pressure and it is the consequence of altered relationship between capillary pressure and interstitial fluid pressure.

  7. Intravitreal Bevacizumab injection combined duplex technique in treatment of neovascular glaucoma

    Zheng-Jun Hu

    2015-05-01

    Full Text Available AIM: To observe the clinical curative effect of intravitreal Bevacizumab injection combined duplex technique in treatment of neovascular glaucoma(NVG.METHODS:Totally 25 eyes of 25 patients with NVG who underwent intravitreal Bevacizumab injection of 1.0mg(0.05mL, after the regression of iris neovascularization, 5 eyes with anterior chamber paracentesis fluid auxiliary controlled intraocular pressure. After 2wk, patients were treated by trabeculectomy and phacomulsification(9 eyes were implanted intraocular lens. The changes and complications of intraocular pressure, visual acuity, corneas and neovessels were observed after surgery, and followed up 12mo.RESULTS:After injection Bevacizumab in 25 eyes, iris neovascularization of 20 eyes subsided in 3~5d, and 5 eyes subsided in 7d. After controlling intraocular pressure, count of the corneal endothelial cell were 1 629±226mm2, and none suffered decompensation of corneal endothelium after two-surgery of trabeculectomy and phacomulsification. After followed up 12mo, intraocular pressure of 20 eyes were controlled in normal range; 2 eyes could control in normal range after treated by a kind of anti-glaucoma medicine and 3 eyes was 34~38mmHg after treated by anti-glaucoma medicine. 9 eyes had improved vision after implanted intraocular lens.CONCLUSION:Intravitreal Bevacizumab injection can subside iris and anterior chamber angle neovascularization effectively in a short time and reduce intraocular pressure. It can also reduce the risk of bleeding during operation or after operation. Intravitreal Bevacizumab injection combined with two-surgery of trabeculectomy and phacomulsification can treat neovascular glaucoma effectively.

  8. Cyclodialysis ab interno as a surgical approach to intractable glaucoma.

    Jordan, Jens F; Dietlein, Thomas S; Dinslage, Sven; Lüke, Christoph; Konen, Walter; Krieglstein, Günter K

    2007-08-01

    In glaucoma filtration surgery, the problem of subconjunctival scarring has still not been satisfactorily solved. Suprachoroidal drainage of aqueous humour offers a promising, alternative option for intractable glaucoma. We here present a clinical study on the surgical approach of gonioscopic cyclodialysis ab interno. Twenty-eight eyes of 20 patients with intractable glaucoma were included in this prospective, consecutive, case-control study. The eyes had had a mean of 4.4 +/- 2.4 previous antiglaucomatous interventions. Baseline intraocular pressure (IOP) was 34.3 +/- 10.5 mmHg despite maximum therapy. Under gonioscopic control, cyclodialysis ab interno was performed over two clock times to gain access to the suprachoroidal space. No additional trabecular meshwork surgery was performed. Success was defined as a lowering of IOP to below 21 mmHg without the need for further medication or intervention. Mean postoperative IOP was 14.6 +/- 12.4 mmHg. Mean follow-up (FU) for all eyes was 121.8 days. After a mean of 60 days, 21 eyes (75%) needed further surgical intervention. Qualified success was seen in four eyes (14.3%), with a mean FU of 383.6 days. Three eyes (10.7%) showed absolute success after a mean FU period of 202.7 days. In our series, we obtained the best results for phakic eyes, followed by pseudophakic and aphakic eyes. The results of this study do not provide convincing evidence of the functional efficacy of cyclodialysis ab interno. Nevertheless, the technique is easy to perform and offers safe and atraumatic access to the resorptive capability of the choroid. Conjunctival manipulation is avoided. Contrary to reports in the current literature, in our series, the best results were obtained for phakic eyes, though the small number of eyes included does not allow reliable statistics. Further studies will need to focus on the use of different space-retaining substances or a widening of the cyclodialysis cleft to improve surgical outcome.

  9. Glaucoma screening during regular optician visits : can the population at risk of developing glaucoma be reached?

    Stoutenbeek, R.; Jansonius, N. M.

    2006-01-01

    Aim: To determine the percentage of the population at risk of developing glaucoma, which can potentially be reached by conducting glaucoma screening during regular optician visits. Methods: 1200 inhabitants aged > 40 years were randomly selected from Dutch community population databases. A

  10. The glaucoma research foundation patient survey: patient understanding of glaucoma and its treatment.

    Herndon, Leon W; Brunner, Thomas M; Rollins, Jane Neff

    2006-01-01

    Determine patients' understanding of glaucoma and its treatment, their sources of information about glaucoma, their preferences for treatment, their experience with medication side effects, and their reasons for changing eye doctors. Prospective, nonrandomized patient survey study. A questionnaire was developed and sent to the 22,000 subscribers of the Gleams newsletter who have glaucoma. Questionnaires were returned by 4310 glaucoma patients. Most respondents received glaucoma information from their eye doctor. Only 28% of respondents reported having changed eye doctors for reasons related to their glaucoma. Of those who had, 60% cited poor communication as the reason. When queried about specific side effects associated with their medication, over 85% of responding patients were never or rarely bothered by headaches and eyelid darkening. Most respondents (67% and 55%, respectively) were rarely or never disturbed by red eye or burning and stinging. Most respondents understood the importance of intraocular pressure (IOP) lowering in glaucoma, and of those patients who expressed a preference, 92% reported that they would prefer the medication that lowers IOP the most, even if it caused red eye for a few weeks, over a medication that caused no red eye but did not get IOP as low. Patients who subscribe to Gleams and responded to the survey rely most on their doctors for information about glaucoma and its treatment. Most understand the importance of maintaining low IOP to decrease the risk of vision loss, and most will tolerate temporary ocular side effects to achieve low IOP.

  11. Oculoplastic technique of connecting a glaucoma valve shunt to extraorbital locations in cases of severe glaucoma.

    Rubin, Peter A D; Chang, Eli; Bernardino, Carlo Roberto; Hatton, Mark P; Dohlman, Claes H

    2004-09-01

    To describe a technique for inserting glaucoma shunts to the sinuses or the lacrimal sac as a means of lowering intraocular pressure in patients with refractory glaucoma associated with severe ocular surface disease. Nineteen patients with severe ocular surface disease necessitating a keratoprosthesis and with intractable glaucoma underwent placement of a modified Ahmed shunt to direct aqueous in the maxillary or ethmoid sinus or lacrimal sac. Intraocular pressure is presently well controlled without glaucoma medications in two thirds of patients. None of the patients had endophthalmitis. Established oculoplastic surgery techniques may be used to redirect aqueous to extraorbital locations and effectively lower intraocular pressure in patients with severe ocular surface disease and refractory glaucoma. This procedure has not been associated with endophthalmitis.

  12. Experimental Contact Lens to Prevent Glaucoma-Induced Blindness

    ... An Experimental Contact Lens to Prevent Glaucoma-Induced Blindness By Sharon Reynolds Posted January 23, 2014 An ... group of conditions that can result in irreversible blindness. This vision loss can be reduced if glaucoma ...

  13. Ocular hemodynamics and glaucoma: the role of mathematical modeling.

    Harris, Alon; Guidoboni, Giovanna; Arciero, Julia C; Amireskandari, Annahita; Tobe, Leslie A; Siesky, Brent A

    2013-01-01

    To discuss the role of mathematical modeling in studying ocular hemodynamics, with a focus on glaucoma. We reviewed recent literature on glaucoma, ocular blood flow, autoregulation, the optic nerve head, and the use of mathematical modeling in ocular circulation. Many studies suggest that alterations in ocular hemodynamics play a significant role in the development, progression, and incidence of glaucoma. Although there is currently a limited number of studies involving mathematical modeling of ocular blood flow, regulation, and diseases (such as glaucoma), preliminary modeling work shows the potential of mathematical models to elucidate the mechanisms that contribute most significantly to glaucoma progression. Mathematical modeling is a useful tool when used synergistically with clinical and laboratory data in the study of ocular blood flow and glaucoma. The development of models to investigate the relationship between ocular hemodynamic alterations and glaucoma progression will provide a unique and useful method for studying the pathophysiology of glaucoma.

  14. awareness and knowledge of glaucoma among adult patients

    PATIENTS AT THE EYE CLINIC OF A TEACHING HOSPITAL. G. NKUM1, S. LARTEY2, ... Background: Primary open angle glaucoma (POAG) is an irreversible .... If patients are aware of the risk factors and presentation of glaucoma, there will ...

  15. Potential applications of optical coherence tomography angiography in glaucoma.

    Dastiridou, Anna; Chopra, Vikas

    2018-05-01

    Optical coherence tomography angiography (OCTA) is a novel, noninvasive imaging modality that allows assessment of the retinal and choroidal vasculature. The scope of this review is to summarize recent studies using OCTA in glaucoma and highlight potential applications of this new technology in the field of glaucoma. OCTA studies have shown that retinal vascular changes may not develop solely as a result of advanced glaucoma damage. OCTA-derived measurements have provided evidence for lower retinal vascular densities at the optic nerve head, peripapillary and macula in preperimetric-glaucoma and early-glaucoma, as well as, in more advanced glaucoma, in comparison to with normal eyes. OCTA is a novel imaging modality that has already started to expand our knowledge base regarding the role of ocular blood flow in glaucoma. Future studies will better elucidate the role of OCTA-derived measurements in clinical practice, research, and clinical trials in glaucoma.

  16. Glaucoma: Eye-to-Eye with Dr. Rachel Bishop

    ... of this page please turn JavaScript on. Feature: Glaucoma Eye-to-Eye with Dr. Rachel Bishop Past ... nerves are pale and cupped—signs of advanced glaucoma. Yet the patient wasn't aware of any ...

  17. Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study

    2017-05-02

    Glaucoma; Glaucoma Suspect; Diabetic Retinopathy; Ocular Hypertension; Cataract; Branch Retinal Vein Occlusion; Branch Retinal Arterial Occlusion; Central Retinal Vein Occlusion; Central Retinal Artery Occlusion; Epi-retinal Membrane; Macular Degeneration; Drusen; Loss of Vision

  18. Transconjunctival drainage of serous and hemorrhagic choroidal detachment.

    Rezende, Flávio A; Kickinger, Mônica C; Li, Gisèle; Prado, Renata F; Regis, Luiz Gustavo T

    2012-02-01

    To describe a novel surgical technique for drainage of bullous serous and hemorrhagic choroidal detachments. A prospective, consecutive case series of 6 eyes with serous and/or hemorrhagic choroidal detachments secondary to intraocular surgery was documented to evaluate the feasibility of using the 25-gauge and 20-gauge transconjunctival trocar/cannula systems to drain choroidal detachments. Two eyes had expulsive hemorrhagic choroidal detachments and 4 eyes had serous choroidal detachments after glaucoma surgeries. A 25-gauge infusion line was placed in the anterior chamber. A 20-gauge (in eyes with hemorrhagic choroidal detachments) or a 25-gauge (in eyes with serous detachments) trocar/cannula system was inserted into the suprachoroidal space 7.0 mm from limbus. After drainage, the cannulas were removed and no sutures were placed. Pars plana vitrectomy was performed only in eyes with concomitant pathology that demanded the additional procedure. The primary outcome measure was presence of choroidal detachment at 1 week, 2 weeks, and 1 month postoperatively. Secondary outcome measures were visual acuity at 6 months and intraocular pressure at 1 week and 1, 3, and 6 months postoperatively. Drainage of hemorrhagic choroidal detachments resulted in resolution of the detachments by 1 month postoperatively. In eyes with serous detachments, resolution was achieved by 1 week postdrainage. In both groups, intraocular pressure increased to at least 10 mmHg by postoperative Week 1. The visual acuity improved in all eyes. No complications related to the transconjunctival technique were noted. Transconjunctival drainage of serous and hemorrhagic choroidal detachments seems to be a feasible and simple surgical option with minimal scleral and conjunctival damage. Pars plana vitrectomy may not be necessary when draining choroidal detachments in this manner.

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    Full Text Available ... NEI Intranet (Employees Only) *PDF files require the free Adobe® Reader® software for viewing. This website is maintained by the NEI Office of Science Communications, Public Liaison, and Education. Technical questions about this website can be addressed ...

  15. Glaucoma

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  16. Glaucoma

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  17. Glaucoma

    Full Text Available ... to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health problems and requirements of ... Pressroom Contacts Dustin Hays - Chief, Science Communication dustin.hays@nih.gov Kathryn DeMott, Media Relations ...

  18. Glaucoma

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  19. Glaucoma

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  20. Glaucoma

    Full Text Available ... Accomplishments Budget and Congress About the NEI Director History of the NEI NEI 50th Anniversary NEI Women Scientists Advisory Committee (WSAC) Board of Scientific Counselors ...

  1. Glaucoma

    Full Text Available ... of visual function, preservation of sight, and the special health problems and requirements of the blind.” News & ... Emily Y. Chew, M.D., Deputy Clinical Director Education Programs National Eye Health Education Program (NEHEP) Diabetic ...

  2. Glaucoma

    Full Text Available ... 5248 Health Information Frequently asked questions Clinical Studies Publications Catalog Photos and Images Spanish Language Information Grants ... Emily Y. Chew, M.D., Deputy Clinical Director Education Programs National Eye Health Education Program (NEHEP) Diabetic ...

  3. Glaucoma

    Full Text Available ... programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health ... Pressroom Contacts Dustin Hays - Chief, Science Communication dustin.hays@nih.gov Kathryn DeMott, Media Relations ...

  4. Glaucoma

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  5. Glaucoma

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  6. Glaucoma

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  7. Glaucoma

    Full Text Available ... blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health problems and requirements of the blind.” ... DeMott, Media Relations Kathryn.DeMott@nih.gov NEI Office of Communications ( ...

  8. Glaucoma

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  9. Glaucoma

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  10. Glaucoma

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  11. Glaucoma

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  12. Glaucoma

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  13. Glaucoma

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  14. Glaucoma

    Full Text Available ... History of the NEI NEI 50th Anniversary NEI Women Scientists Advisory Committee (WSAC) Board of Scientific Counselors ... Emily Y. Chew, M.D., Deputy Clinical Director Education Programs National Eye Health Education Program (NEHEP) Diabetic ...

  15. Glaucoma

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  16. Determinants of glaucoma awareness and knowledge in urban Chennai

    Sathyamangalam Ramesh

    2009-01-01

    Full Text Available Aim: To assess the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai in south India. Materials and Methods: Chennai glaucoma study (CGS was a population based prevalence study to estimate the prevalence of glaucoma in a rural and urban south Indian population. A total of 3850 subjects aged 40 years or above participated in the urban arm of CGS. A systematic random sample of 1926 (50.0% subjects completed a questionnaire that assesses their awareness and knowledge level of glaucoma. Respondents "having heard of glaucoma" even before they were contacted/recruited for the study were defined as "aware" and respondents having some understanding of the eye disease were defined as "knowledgeable". Results: Overall 13.5% were aware of glaucoma, the age-gender adjusted rate for awareness was 13.3% (95% CI: 11.57 to 15.03. Two clinicians graded knowledge on glaucoma, based on the subject′s knowledge of risk factors, definitions and treatment aspects of glaucoma. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. We observed a very good agreement between the clinicians in grading knowledge (k =0.92. Determinants of glaucoma awareness and knowledge were higher levels of education, females, age, religion and family history of glaucoma. Conclusion: Awareness and knowledge about glaucoma was very low among the urban population of Chennai. We have found that younger subjects and men were less aware of glaucoma. Subjects with lower levels of education were less aware and knew less about glaucoma than their counterparts. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.

  17. Demographic features of subjects with congenital glaucoma

    Tamçelik, Nevbahar; Atalay, Eray; Bolukbasi, Selim; Çapar, Olgu; Ozkok, Ahmet

    2014-01-01

    Context: Congenital glaucoma is a potentially blinding ocular disease of the childhood. Identification of the possible associated risk factors and may be helpful for prevention or early detection of this public health problem. Aims: To demonstrate the demographic features of congenital glaucoma subjects. Setting and Design: The charts of congenital glaucoma patients referred to Tamcelik Glaucoma Center were retrospectively reviewed through the dates of 2000 and 2013. Materials and Methods: Analyzed data included diagnosis, age at first presentation, symptoms at first presentation, laterality of the disease, sex, presence of consanguinity, family history of congenital glaucoma, maturity of the fetus at delivery, and maternal age at conception. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 19.0 by IBM (SPSS Inc, Chicago, Illinois, USA) was used to compare the mean of continuous variables with Student's t-test and analysis of variance (ANOVA) and χ2 test was used to test differences in proportions of categorical variables. Results: The data of 600 eyes of 311 patients were analyzed. The distribution of primary and secondary congenital glaucoma among the patients were 63.3% (n = 197) and 36.7% (n = 114), respectively. Of the 311 patients, 57.2% (n = 178) were male and 42.8% (n = 133) were female. The overall frequency of bilateral disease was 92.3% (n = 287). Overall rate of consanguinity and positive family history was 45.3% (n = 141) and 21.2% (n = 66), respectively. Conclusions: Bilateral disease in this study was more common than previously reported studies. Positive family history was more frequent in primary congenital glaucoma although not statistically significant. PMID:24881602

  18. ASSOCIATION BETWEEN GLAUCOMA AND BLOOD GROUPS

    F. Ghannadi R. Varmazyar

    2006-09-01

    Full Text Available There are reports from different countries that some types of glaucoma are associated with blood groups. This cross-sectional study was performed on 400 glaucomatous patients [100 patients in each group of Primary open angle glaucoma (POAG, chronic angle closure glaucoma (CACG, pseudoexfoliative glaucoma (PEXG and primary congenital glaucoma (PCG] and 400 blood donors as control group to assess the association between blood groups and glaucoma. All patients underwent ABO and Rh blood group testing. The prevalence of blood group A was 30% in the control group, 27% in POAG, 33% in CACA, 38% in PEXG and 36% in PCG. The prevalence of blood group B was 24% in the control group, 19% in POAG, 20% in CACG, 15% in PEXG and 34% in PCG (P < 0.025. The prevalence of blood group AB was 8% in the control group, 9% in POAG, 5% in CACG, 12% in PEXG, and 8% in PCG. The prevalence of blood group O was 38% in the control group, 45% in POAC, 42% in CACG, 35% in PEXG and 22% in PCG (P < 0.001. The prevalence of Rh+ was 88% in the control group, 84% in POAG, 87% in CACG, 86% in PEXG and 87% in PCG. Compared to control group, blood group B was more prevalent and blood group O was less prevalent in PCG. There was no association between other types of blood groups (ABO and Rh and PCG. There was no association between blood groups (ABO and Rh and other types of glaucoma.

  19. The medical management of glaucoma | Marais | South African ...

    Glaucoma is one of the leading causes of blindness worldwide. The main characteristic features include optic disc cupping, visual field loss, and in most instances a raised intraocular pressure. Primary open angle glaucoma accounts for nearly two thirds of all cases, while angle closure glaucoma contributes the majority of ...

  20. Goniodysgenesis in familial primary open-angle glaucoma

    Verbraak, F. D.; vd Berg, W.; Delleman, J. W.; Greve, E. L.

    1994-01-01

    Results of a pilot study to evaluate goniodysgenesis as a cause of familial open-angle glaucoma are reported. Patients with a familial high tension open-angle glaucoma and a goniodysgenetic chamber angle (n = 11), a number of their relatives with glaucoma (n = 12), and their relatives without