Objective: We reported a case of Descemet's membrane detachment (DMD) following ripcord removal of a Baerveldt shunt in a post-corneal transplant eye, and the interventions done. Method: This is a case report Results: A 65-year-old male with multiple surgeries (phacoemulsification, two corneal transplants, and Baerveldt shunt implantation) in the right eye developed increased intraocular pressures, prompting removal of the intraluminal stent (ripcord) of the shunt. This was complicated by hypotony and DMD. Ripcord reinsertion and viscoelastic injection were performed to reattach the Descemet's membrane (DM) but failed. 0.1mL of 14% perfluoropropane (C3F8) gas was injected into the anterior chamber that successfully reattached the DM with return to pre-operative best-corrected visual acuity after 1 week. Conclusion Injection of an expansive gas (C3F8) was effective in repairing a corneal graft DMD in an eye with a Baerveldt shunt.
Glaucoma Drainage Implants ; Corneal Transplantation

To assess the effects of topical cyclosporin A(Csa) on the function of fibrous capsule and fibroblast proliferation after glaucoma drainage implant surgery in rabbits, we compared intraocular pressure(IOP), outflow resistance through the capsule and fibroblast density in capsule and fibroblast density in capsule among three groups: group A(12 eyes) that received implant surgery only, group B(11eyes) trated with topical 2% CsA twice a day for 2 weeks after implant surgery, and group C(14 eyes) with intraoperative subcon-junctival soaking of 2% CsA for S minutes and postoperative topical 2% CsA twice a day for 2 weeks. There was significant postoperative IOP decreases at 2, 4 and 8 weeks in group B(7.3 +/- 2.0. 7.1 +/- 1.7, and 6.6 +/- 1.8 mmHg, respectively) and group C(7.8 +/- 2.6, 7.1 +/- 1.7, and 6.8 +/- 1.6 mmHg, respectively) compared with group A(5.1 +/- 1.7, 5.0 +/- 1.0, and 4.8 +/- 1.5 mmHg, respectively)(p<0.01 for each). Flow resistances at postoperative 8 weeks were significantly lower in group Band group C than in group A(n=3. p<0.01). There was no significant difference in postoperative IOP decrease and outflow resistance between group B and Group C(p>0.05 for each). Fibroblast density was not significantly lower in group B and Group C than in group A(n=3, p=0.08). These results suggest adjunctive topical CsA may enhance the effectiveness of glaucoma drainage implant surgery.
Cyclosporine* ; Fibroblasts ; Glaucoma Drainage Implants* ; Glaucoma* ; Intraocular Pressure ; Rabbits*

PURPOSE: To evaluate the flow resistance though the tube in a glaucoma drainage implant using various tube ligation methods. METHODS: To measure the flow resistance, the following tube ligation methods were designed and tested: Type 1: no ligation of Ahmed valve tube. Type 2: ligation of Ahmed valve tube with 8-0 Vicryl. Type 3: ligation of Molteno tube and a 6-0 Vicryl as an intra-luminal stent with 8-0 Vicryl. Type 4: ligation of Ahmed valve tube and three strands of 8-0 nylon as extra-luminal stents with 8-0 Vicryl. Type 5: ligation of Ahmed valve tube and a 6-0 Prolene as an extra-luminal stent with 8-0 Vicryl followed by removal of the Prolene for partial ligation. RESULTS: The pressure was maintained under 0.143 mm Hg in type 1. In type 2, the pressure increased to 6.688 mm Hg and dropped to approximately 6.384 mm Hg. In type 3, the pressure was maintained at 5.396 mm Hg which decreased to 3.572 mm Hg after stent removal. In type 4, the pressure was maintained at 5.700 mm Hg which dropped to 5.472 mm Hg after the 1st stent removal, to 5.016 mm Hg after the 2nd stent removal and to 4.180 mm Hg after the 3rd stent removal. In type 5, the pressure increased to 6.384 mm Hg and decreased to 5.624 mm Hg. CONCLUSIONS: The tube ligation along with extra-luminal stents followed by staged removal may provide prevention of hypotony and staged control of intraocular pressure after a glaucoma implant operation.
Drainage ; Glaucoma ; Glaucoma Drainage Implants ; Intraocular Pressure ; Ligation ; Nylons ; Polyglactin 910 ; Polypropylenes ; Stents

A new glaucoma drainage implant, expanded polytetrafluoroethylene(e-PTFE) membrane implant, and e-PTFE-silicone tube implant were used in 11 eyes of 11 patients with recalcitrant glaucomas including neovascular glaucoma. After an average follow-up of 13 months, intraocular pressures(IOPs) decreased to the level ranging from 10 to 20mmHg in all the eyes. Five patients were not on antiglaucoma medication. Four patients required one beta blocker and/or pilocarpine. The remaining two patients still required the maximum tolerated medical therapy and were considered to have a failed drainage surgery. A temporary obstruction of the drainage tube occurred in 2 eyes with neovascular glaucoma which developed a minimal hyphema and fibrinous aqueous after surgery. Postoperative hypotony and shallow anterior chamber developed in 4 eyes, but their situations were not dangerous. The patients each had a filtration bleb postequatorially after surgery. These blebs disappeared one to seven months later. In spite of the presence of a filtration bleb, 7 eyes developed an increased IOP temporarily. The required conjunctival incision for installation of an e-PTFE drainage implant was less than 90 degrees and the overall surgical procedures seemed to be simple.
Anterior Chamber ; Blister ; Drainage* ; Fibrin ; Filtration ; Follow-Up Studies ; Glaucoma Drainage Implants ; Glaucoma* ; Glaucoma, Neovascular ; Humans ; Hyphema ; Membranes* ; Pilocarpine

When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.
Blister* ; Catheters ; Filtering Surgery ; Glaucoma Drainage Implants* ; Glaucoma* ; Humans ; Intraocular Pressure ; Vitrectomy*

BACKGROUNDAhmed glaucoma valves (AGV) has been used for decades, but there is no detailed report about the efficacy of AGV in Chinese glaucoma patients. This study aimed to compare the intraocular pressure (IOP) lowering efficacy and side effects of S-2 polypropylene and PF-7 silicone AGV implantation in Chinese refractory glaucoma patients.

METHODSPatients were divided into S-2 model AGV group and FP-7 model AGV group. The complete and qualified surgical success rate, change of IOP, number of anti-glaucoma medications used and postoperative complications were recorded and analyzed.

RESULTSAverage follow-up time was comparable between two groups. IOP was reduced from (37.9 ± 12.7) mmHg preoperatively to (17.3 ± 5.3) mmHg at the last follow-up in S-2 group and reduced from (39.9 ± 14.4) mmHg to (17.7 ± 4.9) mmHg in FP-7 group. Anti-glaucoma medications were reduced from 3.8 ± 0.2 to 1.5 ± 0.2 in S-2 group, and 3.5 ± 0.2 to 0.7 ± 0.2 in FP-7 groups. The cumulative success rates were comparable in two groups, which were 61.2% and 72.1% in S-2 group and FP-7 group respectively. When IOP reduction criteria was used, complete success rates were 30.6% and 51.2% for S-2 and FP-7 groups, and qualified success rates were 86.1% and 92.7% separately. In both groups, the major complication was hypotony, and the previous trabeculectomy of patients was the major risk factor for surgery failure.

CONCLUSIONSIn this short-term retrospective study, S-2 AGV is showed at least as effective as FP-7 AGV in IOP reduction, but associated with higher rate of complications. Previous trabeculectomy is a principle risk factor for AGV implantation failure. These clinical outcomes are important for converting use of the FP-7 silicon AGV in Chinese refractory glaucoma patients.

Adult ; Female ; Glaucoma ; physiopathology ; therapy ; Glaucoma Drainage Implants ; Humans ; Intraocular Pressure ; physiology ; Male ; Retrospective Studies

The treatment of refractory Glaucoma is a difficult problem in clinical ophthalmology. For refractory glaucoma patients with hyphema, shallow anterior chamber, anterior conglutination of peripheral chamber angle, corneal endothelium dystrophy or decompensated, at present, there is no effective treatment. In order to solve this problem, a new type posterior integral glaucoma valve with IOP control device was designed using medical titanium alloy, and the valve model was established by Abaqus software, and the stiffness and preload of the valve were analyzed by finite element method. The results showed that the opening and closing of the valve were controlled automatically by the pressure difference between the front and back of the valve, and the opening and flow rate of the valve increase dynamically with the increase of intraocular pressure, and finally reached the set ideal IOP value of steady state.
Finite Element Analysis ; Follow-Up Studies ; Glaucoma ; Glaucoma Drainage Implants ; Humans ; Intraocular Pressure ; Treatment Outcome

New techniques of anterior chamber tube shunt to an encircling band (ACTESB) were used in 49 eyes of 47 patients with neovascular glaucoma and other types of refractory glaucoma. In 34 eyes of 33 patients (Group A), by using Isingle slit incision and end suturing technique at the distal portion of tube, intraocular bressure was controlled less than 21mmHg in 21 eyes (61.8%) with a follow-up of 6 months to 18 months (mean, 13 month). The mean intraocular pressure of 36.38mmHg was reduced. Visual acuity was maintained or improved in 61 %. In 15 eyes of 14 patients (Group B), by using multiple slit incision at the distal portion of tube and single slit incision of the tube beneath scleral flap and external occlusion of tube with 8-0 vicry1, successful outcome was obtained in 86.6% of eyes after average follow up of 6 months. The mean intraocular pressure of 41.47mmHg reduced. Visual acuity was maintained or improved in 86.8%. The incidence of flat anterior chamber was decreased markedly and hyphema was not found in group B. In 4 eyes, there was evidence of blockage of the distal end of tude. Thus we think that the pattern of one piece valved implant is better than the other technique.
Anterior Chamber* ; Follow-Up Studies ; Glaucoma Drainage Implants ; Glaucoma* ; Glaucoma, Neovascular ; Humans ; Hyphema ; Incidence ; Intraocular Pressure ; Visual Acuity

BACKGROUNDNeovascular 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.

METHODSThis 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.

RESULTSAll 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 < 0.05). There were significant differences in BCVA between the two groups at the 12-month follow-up (χ(2) = 9.86, P = 0.020). Cox proportional hazards regression showed NVG as a risk factor for surgical failure (RR = 15.08, P = 0.033). Postoperative complications were similar between the two groups.

CONCLUSIONSAGVI is a safe and effective procedure in refractory 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.

Adult ; Aged ; Female ; Glaucoma ; surgery ; Glaucoma Drainage Implants ; Glaucoma, Neovascular ; surgery ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies

As the anterior chamber tube shunt to an encircling band(ACTSEB) is a complicated procedure, extended polytetafluoroethylene(e-PTFE)-silicone tube implant is being attempated as a new glaucoma drainage implant in Korea. Anterior chamber tube shunt to a two-fold e-PTFE surgical membrane(ACTSSM) has better intraocular pressure(IOP) control than ACTSEB and kept the postoperative anterior chamber depth deep. ACTSEB and ACTSSM procedures were done in normal, colored rabbit eyes in order to compare the tissue response to each shunt. The rabbits were sacrificed 3 and 6 weeks later and the eyes were prepared for light microscopy. In general, foreign body responses were similar. Fibrous capsules lining the e-PTFE were thicker, less dense fibroblast, and less collagen than that lining the silicone encircling band. These findings seem to be related to the difference of the IOP lowering effect between ACTSEB and ACTSSM.
Anterior Chamber ; Capsules ; Collagen ; Fibroblasts ; Foreign Bodies ; Glaucoma Drainage Implants ; Korea ; Membranes* ; Microscopy ; Rabbits ; Silicones*