Posters

Outcomes of a second Ahmed valve implantation in a non conventional position in two monophthalmic patients with refractory glaucoma

Poster Details

First Author: M.Belibou ROMANIA

Co Author(s):    D. Chiselita   C. Bogdanici   A. Alexa              

Abstract Details

Purpose:

Presenting the clinical features, preoperative evaluation, surgical approach, early postoperative evolution and complications in two monophthalmic patients with refractory glaucoma who benefited from a second Ahmed Valve implantation.

Setting:

Saint Spiridon University Hospital, Iasi, Romania

Methods:

The first case is a 35 years-old monophthalmic patient. She has had an operated congenital cataract– anterior chamber IOL implant and a history of secondary glaucoma with mixed mechanism (IOL and uveitis). As means of IOP reduction she had an Ahmed valve implanted in the uper nasal quadrant. She presents with decreased VA and high IOP (33 mmHg) under maximal therapy. The second case is a 29 years-old patient with advanced juvenile glaucoma, refractory to previous surgical approaches- phakotrabeculectomy and Ahmed valve implantation. The patient is monophthalmic with a BCVA= 0.12 and an IOP= 34 mmHg under maximal therapy.

Results:

In the first case slit lamp biomicroscopy reveals medium depth anterior chamber, non reflexive pupil with an AC-IOL. The implantation of a second Ahmed valve in the inferotemporal quadrant is performed.This ensures an IOP reduction (12 mmHg), but the patient complains of persistent ocular pain. In the second case slit lamp examination shows a transparent DSAEK graft, a narrow AC with irido-corneal peripheral contact. The 360˚ angle closure is confirmed by gonioscopy and AC OCT. The central corneal thickness is 632 µm, and endothelial cell count is 1292/mm2. A second Ahmed valve is placed in the upper nasal quadrant.

Conclusions:

The first case was complicated by secondary oculodynia from the mechanical compression of the valve tube on the iris. Surgery was performed to ensure an easier passage of the tube, with good outcomes. The surgical challenges of the second case were the narrow anterior chamber and the presence of a prior DSAEK transplant, but the postoperative evolution was favorable. Unique and challenging every time, the implantation of a second Ahmed valve in patients with refractory glaucoma and a previous glaucoma drainage device in place proves to be an efficient and elegant solution for IOP lowering.

Financial Disclosure:

None