Incidence and Management of Encapsulated Cysts Following Ahmed Glaucoma Valve Insertion

Eibschitz-Tsimhoni, Maya; Schertzer, Robert M.; Musch, David C.; Moroi, Sayoko E.

doi:10.1097/01.ijg.0000169391.94555.c1

Cited by 77 publications

(54 citation statements)

References 25 publications

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“…[48][49][50] Postoperative complications after AVI include hypotony (IOPp5 mm Hg) (11-42%), shallow anterior chamber (15 B26%), tube malposition (5B26%), tubecorneal touch (3B8%), tube occlusion (14%), tube exposure (6B12%), and other rare complications such as tenon encapsulated cyst (1B7%), postoperative cataract (0B2%), strabismus (0B3%), retinal or choroidal detachment (1B18%), endophthalmitis (1B5%), wound leak (3%), plate migration (2%), inflammation, hyphema, delayed retrobulbar haemorrhage. [28][29][30]33,39,51,52 In our study, overall rates of complications was lower than previously reported. Shallow anterior chamber (8.8%) was most commonly encountered, but found in a lower rate compared to other studies.…”

Section: Discussioncontrasting

confidence: 54%

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Yang

Park

2008

Eye

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Purpose To evaluate clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma. Methods A retrospective review was conducted on 34 eyes from 29 patients with refractory glaucoma, who were younger than 18 years of age and who underwent Ahmed valve implantation. The main outcome measures were intraocular pressures (IOPs) and the number of glaucoma medications used. Qualified success was defined as IOP p21 mm Hg regardless of the number of glaucoma medications. Complete success was defined as IOP p21 mm Hg without glaucoma medication.Results Mean age at operation was 5.5 years (range, 0-16). Fifteen eyes (44.1%) had undergone previous glaucoma surgery before Ahmed valve implantation. Mean follow-up time was 29.1 months (range, 3-31). IOP was reduced from a preoperative mean of 37.5 ± 7.3 to 18.4 ± 7.3 mm Hg at 6 months postoperatively (Po0.01). At 12 months after surgery, the success rates were 63.3% (qualified success) and 13.3% (complete success). The cumulative probabilities of qualified success at 6, 12, and 24 months after Ahmed valve implantation were 89.0, 68.6, and 45.7%, respectively. The median time of survival was 19.6 ± 0.9 months. Conclusions Ahmed valve implantation is effective in lowering IOP in refractory paediatric glaucoma, with limited survival after long-term follow-up. Addition of a second Ahmed valve may be effective in the management of failure after primary implantation.

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Section: Discussioncontrasting

confidence: 54%

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Yang

Park

2008

Eye

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“…4 The encapsulated bleb is impervious to the aqueous humor, which results in intraocular pressure elevation. 10,11 The incidence of bleb encapsulation is much higher with the AGV than the other glaucoma drainage implants and has been estimated to be between 40% and 80%, 12 which might be attributed to certain factors of the aqueous humor that stimulate a fibrotic response. Tsai et al 13 have suggested that immediate aqueous filtration with inflammatory factors may stimulate the fibrotic response in the subconjunctival space when the Ahmed implant is used, and delayed flow with a ligated, nonvalved implant may elicit a less fibrous reaction.…”

Section: Discussionmentioning

confidence: 99%

MR Imaging Features of Giant Reservoir Formation in the Orbit: An Unusual Complication of Ahmed Glaucoma Valve Implantation

Jeon¹,

Kim²,

Kim³

et al. 2007

American Journal of Neuroradiology

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SUMMARY:We report the MR imaging findings of an unusually large fluid collection, so-called giant reservoir, around an Ahmed glaucoma valve implant that caused progressive proptosis in a patient with posttraumatic glaucoma. Although other cystic lesions of the juxtalacrimal area of the orbit, such as dermoid cyst, can present similar imaging findings, the characteristic morphology and location should lead the radiologist to the correct nature of this cystic lesion. G laucoma drainage devices provide an alternative treatment in complicated and refractory glaucoma cases.

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“…However, glaucoma implants including AGVs stimulate a foreign body fibrotic response that encapsulates the glaucoma implant body and increases aqueous outflow resistance through the capsule. This can lead to elevated intraocular pressure (IOP) requiring further surgical intervention [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Tissue Response to Implanted Ahmed Glaucoma Valve with Adjunctive Amniotic Membrane in Rabbit Eyes

Lee¹,

Park²,

Kim³

et al. 2014

Ophthalmic Res

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Aims: To investigate the histopathology of the fibrous capsule around Ahmed glaucoma valves (AGVs) implanted with adjunctive amniotic membranes in rabbits. Methods: AGV implantation with or without adjunctive amniotic membrane was performed in a single eye of 20 albino rabbits. The upper surface of the AGV body was covered with amniotic membrane in the study group. After 2 months, histology was used to compare the thickness and characteristics of the fibrous capsule, transdifferentiation of myofibroblasts, and density of blood vessels and leukocytes between the study and control groups. Results: The fibrous capsule along the roof of the bleb was composed of compact collagen fibers with minimal vascularization in the control group. In contrast, in the study group, the fibrous capsule was looser and had a more disorganized collagen architecture. The thickness of the fibrous capsule and the myofibroblast layer was significantly thinner in the study group than in the control group (p < 0.001). The number of CD31-positive blood vessels did not differ between the two groups (p = 0.235). CD45-positive inflammatory cells were more frequently observed in the study group than the control group (p = 0.001). The groups did not differ in the thickness of the fibrous capsule or myofibroblast layer, or the density of blood vessels and leukocytes along the floor of the bleb. Conclusions: Adjunctive amniotic membranes could reduce the risk of encapsulation and aqueous outflow resistance by altering the tissue response to implanted AGVs and subsequent formation of a loose thin capsule.

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Incidence and Management of Encapsulated Cysts Following Ahmed Glaucoma Valve Insertion

Abstract: Encapsulated cysts associated with elevated intraocular pressure were commonly seen after Ahmed glaucoma valve implant insertion. Failing medical therapy, surgical excision of the cyst is effective in lowering intraocular pressure.

Cited by 77 publications

References 25 publications

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

MR Imaging Features of Giant Reservoir Formation in the Orbit: An Unusual Complication of Ahmed Glaucoma Valve Implantation

Tissue Response to Implanted Ahmed Glaucoma Valve with Adjunctive Amniotic Membrane in Rabbit Eyes

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