Journal of Ophthalmology & Clinical Research Category: Clinical Type: Case Report
Ahmed Glaucoma Valve Implantation in the Surgical Treatment of Traumatic Glaucoma - Case Report
- Malgorzata Mrugacz1*, Anna Bry2
- 1 Department Of Pediatric Ophthalmology, Department Of Eye Rehabilitation, Medical University Of Bialystok, 17 Washington Str, 15-274 Bialystok, Poland
- 2 Department Of Pediatric Ophthalmology, Department Of Eye Rehabilitation , Medical University Of Bialystok, Bialystok, Poland
*Corresponding Author:Malgorzata Mrugacz
Department Of Pediatric Ophthalmology, Department Of Eye Rehabilitation, Medical University Of Bialystok, 17 Washington Str, 15-274 Bialystok, Poland
Tel:+48 85 7450862,
Received Date: Aug 27, 2014 Accepted Date: Jan 08, 2015 Published Date: Jan 22, 2015
This case report describes the safety and efficacy of Ahmed Glaucoma Valve implantation for the management of traumatic glaucoma.
The postoperative regimen included a topical antibiotic and a cycloplegic for 2 to 4 weeks, and topical steroids for approximately 2 months. Anti-glaucoma medication was added as required to improve IOP reduction for the first week. Patient was examined 1 day, 7 days, 14 days, 1 month, 2 months, 3 months, 6 months (Figure 1) and 12 months after surgery. Surgical success was defined as postoperative IOP level between 10 and 21 mmHg.
On ocular examination, visual acuity was RE: 20/20 and LE: no light perception. Mean postoperative IOP in left eye was 35 mmHg during the first week and 16 mmHg at 12 months. We observed hyphema on the first postoperative day and hypotony 3 weeks after surgery. Hypotony was defined as an IOP less than 5 mmHg or shallowing of the anterior chamber without evidence of aqueous misdirection. This resolved within 1 month. Tube exposure and fibrotic reaction around the valve occurred 3 months postoperatively. The tube was repositioned surgically and fibrotic reaction resolved within 3 weeks.
The reported success rate of drainage implants in children varies from 44% to 95%. Coleman et al.,  reported an overall success rate of 77% and 60.6%, Englert et al.,  reported a success rate of 90.6% and 58.3% at 12 and 24 months, respectively, and Djodeyre et al.,  reported an overall success rate of 70% to 63% at 12 and 24 months, respectively in pediatric patients with Ahmed Glaucoma Valve implants. Recently, Morad et al.,  reported a success rate of 71% to46% after 36 and 48 months, respectively, and Ozdal et al.,  reported a success rate of 94.4% at 1 year and 60% at 2 years. Hamush et al.,  reported a 79% and 30% success rate in controlling IOP at 12 and 60 months, respectively, and Morad et al.,  reported an overall success rate of 100% to 85% at 1 year and 5 years, respectively in the population of patients with Sturge-Weber glaucoma.
A period of transient elevation of intraocular pressure, known as hypertensive phase, has been described after glaucoma drainage implant surgery, appearing approximately 4 weeks after surgery and lasting at least 12 to 16 weeks . In our patient the intraocular pressure was greater than 21 mmHg during the first week after surgery. Coleman et al.,  found a moderately higher intraocular pressure during postoperative months 4 to 6 with Ahmed glaucoma Valve implants in adults.
Postoperative hypotony which appears in our patient 3 weeks after surgery can be a major problem with all aqueous drainage implants affecting surgical outcome. The study by Francis et al.,  have shown that the Ahmed glaucoma Valve, as opposed to the Optimed or Krupin implants, has the best flow-restricting function and closely regulates pressure within a desired range. Initial reports with the Ahmed valve in children reported this complication from 11% to 14% [7,8]. In the larger series reported by Djodeyre et al., , the hypotony rate was 25%, similar to the results of 23% according to the study by Morad et al., .
In our patient we found hyphema on the first postoperative day. According to the studies by Ayyala et al., , Wu et al., , and Montanez et al.,  hyphema is the most common early postoperative complication in complicated glaucoma with the Ahmed glaucoma valve.
Several clinical studies have identified as late complication tube malposition [5-8] which occurred in our patient. This complication can be related to an inadequate surgical process or perivalvular fibrous tissue contracture. In a buphthalmic eye, there is relative elastic recoil that occurs when the intraocular pressure is normalized. Most probably, tube rotation occurs around the scleral spur, and the drainage tube ends up in a far more anterior position closer to the corneal endothelium surface. Placing these tubes close to the iris as possible may compensate for the expected anterior rotation after surgery in these eyes.
This case report confirmed that the Ahmed Glaucoma Valve may be safe and effective treatment for traumatic glaucoma in children, despite its postoperative complications. This procedure may be used to treat complicated glaucoma in eyes with previous failed filtering procedures.
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Citation: Malgorzata M, Anna B (2015) Ahmed Glaucoma Valve Implantation in the Surgical Treatment of Traumatic Glaucoma - Case Report. J Ophthalmic Clin Res 2: 004.
Copyright: © 2015 Malgorzata Mrugacz, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.