Simultaneous Bilateral Implantation of Ex-Press Glaucoma Shunt for Secondary Glaucoma Treatment Due to Axenfeld-Rieger Syndrome: A Case Report

Abstract

Background: Axenfeld-Rieger Syndrome is a rare genetic disease affecting multiple organ systems. In the eye, it can be manifested with varying degrees of anterior segment dysgenesis and it carries a high risk of glaucoma. Methods:We describe a case of 23 year old male patient with Axenfeld-Rieger syndrome who had bilateral cataract surgeries with IOL/iris diaphragm implantation prior to the referral. After those procedures he developed high and uncontrolled intraocular pressure (IOP) on both eyes. Since the patient was from the rural part of the country, we decided to perform same day bilateral glaucoma surgery with Ex-Press glaucoma shunt implantation. Both surgeries were done by the same surgeon.Results: At first postoperative day, both eyes had slight hypotony, so the additional viscoelastic has been instilled in the anterior chambers to maintain the pressure. There was no retinal, nor choroidal detachment. Throughout the follow up period, the IOP was stabile without any additional medications, visual acuity improved significantly and there were no other postoperative complications. Conclusion:Ex-Press glaucoma shunt can be very useful in treating secondary glaucoma due to rarely seen genetic diseases which can affect eyes, and it can be safely implanted as a same day bilateral procedure.

Síndrome de Axenfeld-Rieger: a importância do diagnóstico precoce e da avaliação oftalmológica

“…10 Quanto à conduta, quadros como esse são restritos a abordagens tópicas e cirurgias fistulizantes (como implantação de shunt para glaucoma e trabeculectomia clássica). 9,11 Observa-se na literatura que a indicação da TREC foi feita corretamente. A segurança e a efetividade da TREC foi confirmada para quadros de jovem com SAR e quadro glaucomatoso.…”

“…A segurança e a efetividade da TREC foi confirmada para quadros de jovem com SAR e quadro glaucomatoso. 8,11…”

“…1,2,3,5,6 Dessa forma, faz-se necessário o reconhecimento precoce da SAR a fim de proporcionar um manejo clínico e cirúrgico adequados, com intuito de preservar a função visual dos pacientes e evitar uma evolução desfavorável como no caso relatado. 7,9,10,11…”

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

“…Although not very common, some intraocular procedures, such as, simultaneous bilateral trabeculectomies and vitrectomies have been performed as and when indicated without any bilateral complications (49,(82)(83)(84)(85)(86)(87).…”