Spontaneous glaucoma drainage device extrusion after early postoperative orbital cellulitis – Case report and literature review

Abstract

A 70-year-old glaucoma patient who underwent Ahmed Glaucoma Valve (AGV) implantation developed orbital cellulitis (OC) 5 days postoperatively. On presentation, the valve was not exposed and no intraocular involvement was noted. After successful treatment of OC with intravenous and oral antibiotics, the patient presented to the clinic with the AGV completely extruded from the eye. There are only 10 previous cases of OC reported in the literature following glaucoma drainage device (GDD) implantation and no previous reports of spontaneous AVG extrusion. Close observation and thorough evaluation of the tube and plate positions are warranted to achieve better outcomes.

Extrusão espontânea de válvula de Ahmed: relato de caso

“…A extrusão espontânea desse dispositivo é extremamente rara, havendo na base de dados MEDLINE ® somente dois relatos de caso. No primeiro, a extrusão ocorreu três meses após uma celulite orbitária pós-operatória tratada com sucesso 6 . No segundo, a válvula de Ahmed foi implantada para correção de glaucoma pós traumatismo ocular refratário a controle medicamentoso.…”

Delayed-Onset Retrobulbar Hemorrhage and Glaucoma Drainage Device Extrusion in a Patient on Anticoagulation: A Case Report

“…Considering the history of coughing after coronary artery bypass surgery, Valsalva maneuver might also contribute to a possible etiologic factor. Alternative explanations for the massive bleeding include trauma or initially improper plate fixation secondary to compromised scleral resistance, low scleral rigidity, or insufficient viscoelastic material utilized in the anterior chamber [8]. Although these explanations are plausible, a fibrous capsule usually forms near the GDD about 4-6 weeks after surgery and regulates flow.…”

“…Our case was notable for extrusion of the GDD body after delayed-onset retrobulbar hemorrhage following successful implantation of an AGV. We believe that massive bleeding around the plate and the secondary flap tear due to the volume effect of hemorrhage played a major role in tissue fragility and that loosening of the plate suture changed the position of the plate until complete extrusion occurred [6,8].…”