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

Ranganath, Akshatha; Hashim, Adnan A

doi:10.1155/2011/183647

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…Zheng et al commented that only GDDs that were exposed were removed but did not specify if GDD exposure was the criteria for explantation [13]. Other authors successfully revised the eroded GDD without explantation [14]. Thus, management of the GDD during treatment of endophthalmitis lacks specific guidelines in the available literature.…”

Section: Discussionmentioning

confidence: 99%

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Islam

Blake

Gibran

2021

Eye

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Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/ enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05-1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04-1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.

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Section: Discussionmentioning

confidence: 99%

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Islam

Blake

Gibran

2021

Eye

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“…Glaucoma may present with aniridia and lens coloboma in pediatric ages. Glaucoma drainage implants have become a popular method of controlling intraocular pressure in pediatric glaucoma ( 1 , 2 ). Ahmed glaucoma valve implantation technique is effective to controlling the intraocular pressure ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…Glaucoma drainage implants have become a popular method of controlling intraocular pressure in pediatric glaucoma ( 1 , 2 ). Ahmed glaucoma valve implantation technique is effective to controlling the intraocular pressure ( 2 ). However, glaucoma drainage surgery in pediatric patients is associated with complications ( 1 - 3 ).…”

Section: Introductionmentioning

confidence: 99%

Novel use of double-layer amniotic membrane technique in tube erosion of pediatric case

Ulas¹

2021

Beyoglu Eye J

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This case report illustrates the successful use of the double-layer amniotic membrane technique in a child with glaucoma and aniridia. A 3.5-year-old girl with bilateral congenital glaucoma as well as aniridia, lens coloboma, nystagmus, and strabismus had been followed up since birth. Medical treatment did not result in the desired intraocular pressure improvement. An Ahmed glaucoma valve was implanted bilaterally. In a follow-up visit at 2 years of age, there were complaints of redness with watery discharge in the right eye. A biomicroscopic evaluation revealed tube erosion of the conjunctiva. The eroded area was dissected from the surrounding tissue and the area was closed using the new double-layer amnion membrane technique. After the surgery, the intraocular pressure was normal. Subsequent follow-up indicated that the erosion defect was closed and stabilized. The double-layer amniotic membrane technique can be used successfully in cases of conjunctival tube erosion. To the authors' knowledge, this is the first published pediatric case report of using the novel technique of amniotic membrane transplantation for tube erosion.

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“…The increasing use of glaucoma drainage implants, as a surgical modality for the treatment of glaucoma is not without its limitations. The extrusion or 'externernalization' of such tubes or plates through an eroded conjunctiva characterises by far the most significant complication of such devices due to its high-risk factor for subsequent endopthalmitis [1]. Although causes for conjunctival erosion have been postulated including dehiscence of the suture, erosion of the scleral/graft patch or even mechanical factors exacerbated by micro-motion and ocular movements the complex nature of aetiology requires the operating surgeon to adapt their technique to ensure best outcomes [2].…”

Section: Introductionmentioning

confidence: 99%

A Novel Surgical Technique for Closure of Dehiscence Conjunctiva Due to Glaucoma Drainage Device

Ansari¹,

Mathews²

2019

AJSCR

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Background: Step by step surgical technique for closure of dehisced conjunctiva in a patient with glaucoma drainage device (GDD). Purpose: To describe a step by step new surgical technique using combined tutoplast, conjunctival autograft and amniotic membrane to close dehisced conjunctiva in a patient with GDD. Case report: Patient with previous history of herpetic kerato uveitis and Baerveldt tube developed dehiscence of conjunctiva over the plate. He had previous surgical interventions on two occasions, which consisted of direct closure of the conjunctiva and conjunctival autograft, with no success. In order to close the persistent defect, he underwent additional surgery in the form of relieving conjunctival incisions, tutoplast, conjunctival autograft and amniotic membrane to ensure closure of defect and healing. Conclusions: Tube/plate erosions are a very challenging problem to manage, especially in eyes that have undergone several surgical interventions. As demonstrated here, tutoplast, conjunctival autograft and amniotic membrane can be used in conjunction, in situations where conjunctival scarring otherwise preclude successful repair.

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

Cited by 9 publications

References 12 publications

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Novel use of double-layer amniotic membrane technique in tube erosion of pediatric case

A Novel Surgical Technique for Closure of Dehiscence Conjunctiva Due to Glaucoma Drainage Device

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