Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve

Nouri‐Mahdavi, Kouros; Caprioli, Joseph

doi:10.1016/s0002-9394(03)00630-5

Cited by 242 publications

(211 citation statements)

References 17 publications

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“…5 It has been theorized that HP develops in the setting of postoperative inflammation, leading to congestion and fibrosis of the conjunctiva around the AGV plate, restricting aqueous flow. 6 It is particularly important to control IOP elevation in HP in patients with severe glaucomatous optic nerve damage. 5,6 Although no studies have specifically examined the prevalence of HP in uveitic glaucoma patients after AGV implantation, it has been observed frequently, presumably from persistent inflammation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Purpose-To compare the intraocular pressure (IOP) outcomes of Ahmed glaucoma valve (AGV) surgery alone versus AGV with fluocinolone implant in uveitic glaucoma patients.Methods-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.Results-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 < 0.0001, P < 0.0001) and the AGV + fluocinolone group (P = 0.001, P < 0.0001). Compared to the AGV group, the AGV + fluocinolone group used fewer 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.Conclusions-In uveitic glaucoma, AGV with fluocinolone achieves a similar, desired IOP control but with fewer glaucoma medications than AGV alone.

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Section: Introductionmentioning

confidence: 99%

“…6 It is particularly important to control IOP elevation in HP in patients with severe glaucomatous optic nerve damage. 5,6 Although no studies have specifically examined the prevalence of HP in uveitic glaucoma patients after AGV implantation, it has been observed frequently, presumably from persistent inflammation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…PBS was then injected into the capsule through the valve and the pressure of capsule was adjusted accordingly. The design of valve resembles the glaucoma valves that function to adjust the IOP, 23 since high IOP often occurs after PPV surgery. This novel pressure-control device may help to maintain a safe intraocular pressure.…”

Section: Discussionmentioning

confidence: 99%

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve

Gao

et al. 2007

Eye

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Purpose The current vitreous substitutes such as silicone oil, heavy silicone oil, and polymeric gels that are directly injected into vitreous cavity frequently cause severe intraocular complications. There is a very urgent need to find a more suitable artificial vitreous substitute for pars plana vitrectomy (PPV) surgery. Methods We have devised a novel capsular artificial vitreous using tailor-made silicone rubber elastomer. The novel device was implanted into the vitreous cavity of rabbit after PPV and the eye was examined by ophthalmoscopy, fundus photography, and tonometry during an 8-week treatment period. B-scan ultrasonography, electroretinogram (ERG), and histological studies by light microscopy were also performed at the end of 8 weeks.Results The novel artificial vitreous body consists of a thin vitreous-like capsule with a silicone tube-valve system. The capsule can be folded and implanted into vitreous cavity through 1.5 mm incision on sclera. Physiological balanced solution (PBS) was then injected into the capsule and inflated to support retina and control intraocular pressure (IOP) through the tube-valve system subsequently fixed under the conjunctiva. Experiments using rabbits showed that the novel vitreous body could effectively support the retina and apparently induced no significant pathological changes in the eye over 8 weeks. Conclusion This approach may provide a new research strategy in the vitreous replacement technology. The novel artificial vitreous body device can effectively support retina, control IOP, and has good biocompatibility. It may be a good alternative to injecting artificial vitreous although its tamponade properties and usefulness still have to be proven in complex vitreoretinal diseases.

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“…Ennek az az oka, hogy az episcleralis hegesedés miatt a kivezetett csarnokvíz nem képes a subconjunctivába felszívódni, és felhalmozódik. A hipertenzív fázis mintegy 3-6 hónapon át tart [12,34]. Eközben természetesen átmeneti szemnyomáscsökkentő kezelésre van szükség a glaucomás progresszió megelőzése céljából.…”

Section: Csarnokvíz-elvezető Implantátumokunclassified

Current surgical methods for advanced glaucoma

Holló

2013

Orvosi Hetilap

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A szerző az előrehaladott glaucomás károsodás esetén hatékony műtéti eljárásokat tekinti át. Magas nyomású, előre-haladott glaucoma esetén alacsony szemnyomás elérése szükséges. Ezt az első műtétként, megfelelő pre-és posztoperatív gyulladásgátló kezelés mellett végzett, mitomycin C-alkalmazással kombinált trabeculectomia biztosítja a legeredményesebben. Sok esetben azonban a glaucomaellenes fi ltrációs műtét sikertelenné válik a fokozott episcleralis hegesedés miatt. Ilyenkor a hosszú elvezetőcsövű csarnokvíz-elvezető implantátum beültetése a választandó megoldás. Az Ahmed implantátummal Magyarországon több mint egy évtizedes kedvező tapasztalattal rendelkezünk a legkomplikáltabb, magas szemnyomású, előrehaladott glaucomás esetek megoldásában. Az előrehaladott glaucoma korszerű műtéti ellátásának lényegét a nem szemész orvosnak is célszerű ismernie, hiszen a kezelésre vonatkozó tanácsaival segítheti glaucomás betegei optimális ellátását. Orv. Hetil., 2013, 154(52), 2052-2058 Kulcsszavak: glaucoma, szemnyomás, trabeculectomia, csarnokvíz-elvezető implantátum Current surgical methods for advanced glaucomaThe author summarizes the most effective types of glaucoma surgery in advanced glaucoma. In high pressure advanced glaucoma a low target intraocular pressure is to be set. The most effective method of reaching this target pressure level is mitomycin C trabeculectomy combined with effective pre-and postoperative antiinfl ammatory treatment. However, in several cases glaucoma fi ltering surgery gradually fails due to increased episcleral fi brosis. In these cases use of long-tube glaucoma drainage devices is recommended. In Hungary use of the Ahmed implant has provided favourable clinical outcome even in the most complicated, high pressure, advanced glaucoma cases. Modern types of surgical treatment of advanced glaucoma need to be known by non-ophthalmologist physicians for more than a decade. This may help them to propose the optimal treatment modality to their glaucoma patients. A glaucoma olyan progresszív lefolyású, a retinalis ganglionsejtek kórosan fokozott ütemű apoptózisával járó betegségek csoportja, amelyekben a látásfunkciók súlyo-san és irreverzíbilisen károsodnak [1]. A 40 évesnél idő-sebb kaukázusi népességben a glaucoma prevalenciája legalább 2%. A betegség prevalenciája az életkor előre-haladásával fokozódik, a nyolcadik életévtizedre a betegek aránya 7% körülire nő [2]. A glaucoma népegészség-ügyi jelentősége éppen ezért világszerte és hazánkban is kiemelkedően nagy [1,3]. A glaucoma nem egyenlő az emelkedett intraocularis nyomással. A retinalis ganglionsejtek kórosan felgyorsult ütemű apoptózisát az emelkedett szembelnyomás mellett a látóidegfő (papilla nervi optici) visszatérő fokális ischaemia-reperfúzió káro-sodása (alacsony, illetve ingadozóan alacsony ocularis perfúziós nyomás) és genetikai eltérések is kiváltják. A klinikumban legtöbbször a fenti mechanizmusok kombinációival találkozunk [4,5]. Az intraocularis nyo-

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Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve

Cited by 242 publications

References 17 publications

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

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

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve

Current surgical methods for advanced glaucoma

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