Single long scleral tunnel technique for prevention of Ahmed valve tube exposure

Eslami, Yadollah; Azaripour, Ebrahim; Mohammadi, Masoud; Kiarudi, Mohammad Yaser; Fakhraie, Ghasem; Zarei, Reza; Alizadeh, Yousef; Moghimi, Sasan

doi:10.1177/1120672117753701

Cited by 12 publications

(21 citation statements)

References 16 publications

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“…6 Intrascleral tunnel techniques for AGV implantation have been previously described. [6][7][8][9][10][11][12][13] However, to our knowledge, the creation of a long intrascleral tunnel using a 23 G needle for AGV implantation in a cohort of vitrectomized eyes only, along with the related physical deductions and explanations, are new to the literature.…”

Section: Discussionmentioning

confidence: 99%

“…These include the realization of a scleral tunnel with a crescent knife or with a 23 G needle, and insertion of the valve tube in the AC through the tunnel. [6][7][8][9][10][11][12][13] Advantages of these techniques include a lower rate of valve tube exposure and postoperative hypotony complications, the absence of a covering patch with related aqueous leak, and being sutureless. However, there is a lack of reports describing the advantages of performing a 23 G needle tunnel in vitrectomized eyes.…”

Section: Introductionmentioning

confidence: 99%

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Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

Arpa

2021

European Journal of Ophthalmology

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Purpose: To describe the application of a modified Ahmed glaucoma valve (AGV) surgical implantation technique in vitrectomized eyes, in order to minimize the risk of early postoperative hypotony, which leads to hemorrhagic complications. Materials and methods: Data of patients implanted with AGV using the surgical technique described were retrospectively reviewed. Inclusion criterion: glaucomatous eyes with previous history of pars plana vitrectomy. Intraocular pressure (IOP) measurement and ophthalmic examination were performed preoperatively and postoperatively weekly for 1 month for the detection of early hypotony, choroidal effusion/detachment, intraocular hemorrhage. The surgical technique consisted in creating a 5 mm long scleral tunnel with a 23 G needle reaching the anterior chamber at the iridocorneal angle, in which the Ahmed glaucoma valve tube was inserted. Results: Ten eyes of 10 patients were included. Median preoperative IOP was 30.5 mmHg [interquartile range (IQR) 28.3–33.0]; median postoperative IOP was 12.0 mmHg (IQR 9.3–13.0) at 1 week, and 12.5 mmHg (IQR 11.0–15.0) at 1 month. In no cases postoperative IOP was <8 mmHg. On the first postoperative day, five (50%) eyes showed few blood clots in the anterior chamber. On the second-week appointment, moderate choroidal effusion was observed in two eyes (20%). No hemorrhagic complications were observed. Conclusions: The creation of a long intrascleral tunnel with a 23 G needle for AGV implantation in vitrectomized eyes could be effective in decreasing leakage through the space between the valve tube and the sclerocorneal tissue. This technique is safe, easy to perform, feasible and fast. Due to its advantages and good postoperative results, it could also be adopted in non-vitrectomized eyes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

Arpa

2021

European Journal of Ophthalmology

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“…Multiple studies have been carried out with promising results with many reporting no tube exposure during the reported follow-up period (from 6 months to about 10 years). [42][43][44][45][46][47][48] Kugu et al found the rate of tube exposure in patients who underwent surgery by long scleral tunnel technique to be significantly lower than those who underwent implantation by processed pericardium patch graft method alone, 2.5% (1 of 40 eyes) and 7.9% (3 of 38 eyes), respectively, over a mean follow-up duration of 46.7 ± 19.4 months. 49 In a study by Ollila et al comparing 332 eyes with simple scleral flap coverage and 92 eyes who had the addition of a 6-7 mm long scleral tunnel posterior to the scleral flap, erosion rate was 4.5% in the group with simple scleral flap (median follow-up 3.5 months [1-72 months]) while the other group had no erosions (median follow-up 22 months [10-39 months]) (p = 0.042).…”

Section: Methods Of Tube Coveragementioning

confidence: 99%

“…These techniques may be especially useful in countries that do not have access to patch grafts. Multiple studies have been carried out with promising results with many reporting no tube exposure during the reported follow‐up period (from 6 months to about 10 years) 42–48 . Kugu et al found the rate of tube exposure in patients who underwent surgery by long scleral tunnel technique to be significantly lower than those who underwent implantation by processed pericardium patch graft method alone, 2.5% (1 of 40 eyes) and 7.9% (3 of 38 eyes), respectively, over a mean follow‐up duration of 46.7 ± 19.4 months 49 .…”

Section: Risk Factors For Implant Exposurementioning

confidence: 99%

Glaucoma drainage implant exposure: A review of aetiology, risks and repair considerations

Lun

Chew

Lim

2022

Clinical Exper Ophthalmology

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In recent years, there has been a paradigm shift in glaucoma surgical procedures. Glaucoma drainage implant (GDI) surgeries are being performed much more commonly. Thus, it is important for surgeons to be cognisant of potential complications and their management. Exposure of a GDI is a well‐known complication, and prompt recognition and treatment are required to prevent endophthalmitis, a potentially blinding condition. In this review, we discuss the mechanisms and risk factors for GDI exposure, highlight important considerations for repair, and discuss repair techniques, with the aim of improving patient outcomes and minimising the risk of re‐exposure.

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“…2,14 Scleral tunnels have just been proposed to prevent tube erosion in primary tube surgery even if the tube was inserted into anterior chamber via a scleral flap. 15,16…”

Section: Introductionmentioning

confidence: 99%

Managing Ahmed Glaucoma Valve tube exposure: Surgical technique

Nardi

Maglionico

Posarelli

et al. 2020

European Journal of Ophthalmology

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Purpose: To describe a new surgical technique for managing Ahmed Glaucoma Valve tube exposure. The technique is simple, safe, easy to perform and may be an interesting alternative to conventional covering of the tube. This technique allows unlike the classical ones to act on the cause and not only on the complication of extrusion. Materials and Methods: This study was a retrospective case series that included four eyes of four patients who presented with an Ahmed Glaucoma Valve tube exposure. Results: Surgery was uneventful in all cases and we did not observe any intraoperative or postoperative complications. After at least 1-year follow-up, no case of tube re-exposure was detected. Conclusions: Many techniques have been proposed in order to cover the extruded tubes, and different materials may be used to reinforce the coverage, but re-exposure of the tube is a possible scenario. Indeed, our technique attempts not only to cover the exposed tube but also to solve the cause of the extrusion.

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Single long scleral tunnel technique for prevention of Ahmed valve tube exposure

Cited by 12 publications

References 16 publications

Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

Glaucoma drainage implant exposure: A review of aetiology, risks and repair considerations

Managing Ahmed Glaucoma Valve tube exposure: Surgical technique

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