Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.
Trabeculectomy still remains the standard procedure of choice for a patient with uncontrolled glaucoma on maximum tolerated medical therapy and/or after laser. Although it has a high success rate of its own, a small number of patients continue to have a failing or a failed bleb despite a good bleb management. Needling had been a well-known modality of bleb management described in literature which has refined itself through years. However, in most of the situations, this modality of treatment is least considered. In this review, we will go through the evolution of needling procedure and various related options, their success rates, complications and emerging trends.
A 65-year-old diabetic and hypertensive male presented with a sudden diminution of vision after sustaining a trivial fingernail injury to his only good-seeing (right) eye. The patient underwent phacotrabeculectomy with posterior chamber intraocular lens (PCIOL) implantation 22 years previously. In his right eye visual acuity at presentation was counting fingers at 1.5 m with an accurate projection of light. Intraocular pressure (IOP) was 4 mmHg. The anterior chamber was uniformly shallow with a peripheral iridocorneal touch. Angle details could not be visualized. The bleb was avascular, thin and cystic with a positive forced Seidel test. Fundus examination showed 360° choroidal detachments. B-scan ultrasound revealed massive choroidals. Revision of dysfunctional filtering bleb by conjunctival advancement with bleb preservation and anterior chamber reformation with healon was performed. Postoperatively, the first day visual acuity improved to 6/36, the anterior chamber was deep, bleb was well covered with conjunctiva, the IOP was 10 mmHg and fundus examination revealed resolving choroidals. At the final follow up at 4 months, the patient did not require medication and visual acuity was 6/12, the bleb was functioning well with an IOP of 14 mmHg. Examination of the fundus revealed a cup-to-disc ratio of 0.5 with moderate non-proliferative diabetic retinopathy changes. The patient has been advised to maintain a strict glycemic control and return for routine follow up after 3 months.
We report a rare case of a 11 year old boy who presented for a routine check up and was found to have moderate myopia, bilateral subluxation of lens, posterior subcapsular cataracts, lattice degeneration of retina and pigmentary glaucoma simulating Wagner syndrome. Wagner syndrome is an entity initially reported in Swiss families and has similar features to our patient. However, the association of pigmentary glaucoma is a new addition to the existing knowledge of Wagner syndrome. Glaucoma reported in Wagner syndrome till date has been open angle glaucoma due to anterior segment dysgenesis or neovascular glaucoma where the exact cause has not been elucidated. Patient was diagnosed to have pigmentary glaucoma on the basis of pigment dispersion over the corneal endothelium, increased trabecular pigmentation, midperipheral iris transillumination defects, pigment on the posterior capsule of the lens and raised intraocular pressure with disc changes.
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