Ahmed Glaucoma Valves versus EX-PRESS Devices in Glaucoma Secondary to Silicone Oil Emulsification

Abstract

Objective To evaluate and compare the clinical effects of Ahmed glaucoma valves (AGVs) and EX-PRESS implants on glaucoma secondary to silicone oil (SO) emulsification. Methods A retrospective case-series study was designed. A total of 23 eyes with late intraocular pressure (IOP) elevation secondary to SO emulsification were included in the study. Antiglaucoma surgery with implantation of AGVs or EX-PRESS devices was performed. Pre- and postoperative ocular parameters were recorded at each visit during a 1-year follow-up period. The rates of complete success (IOP < 21 mmHg without medication) and qualified success (IOP < 21 mmHg with ≤3 glaucoma medications) were analyzed. Results A total of 14 eyes underwent AGV implantation, and 9 underwent EX-PRESS implantation. The mean IOP and number of medications used at the last follow-up decreased significantly compared with that before surgery (P < 0.001). The total success rate for all eyes including complete success (7/23) and qualified success (7/23) was 60.9% (14/23) at 1 year. The total success rate in the AGV group was 78.6% (11/14), whereas it was 33.3% (3/9) in the EX-PRESS group; the difference between the 2 groups was significant (P < 0.05). Conclusion For glaucoma secondary to SO emulsification, glaucoma implants could be effective at lowering IOP, and AGVs might produce better outcomes than EX-PRESS devices.

Efficacy and Safety of Micropulse Transscleral Laser Therapy in Silicone Oil-induced Glaucoma

“…2,18,19 Trabeculectomy in SOG has poor outcomes due to high inflammation related to SO emulsification in the subconjunctival space and the absence of naive conjunctiva due to scarring resulting from previous vitreoretinal surgery. 2,12,13,23 Drainage devices were suggested as a better solution. However, complications rate remains remarkable such tubes exposure, endophthalmitis, and failure due to SO migration into tubes.…”

“…However, complications rate remains remarkable such tubes exposure, endophthalmitis, and failure due to SO migration into tubes. 2,12,18,23 Finally, transscleral cyclodestructive techniques such as cyclocryotherapy and conventional laser cyclophotocoagulation were suggested as a final efficient technique but exposing to a high risk of complications. 4,24 Cyclocryotherapy is not any more commonly used nowadays due to the high risk of complications particularly inflammation, hypotony, and globe phthisis.…”

“…Invasive techniques are often needed 2,18,19. Trabeculectomy in SOG has poor outcomes due to high inflammation related to SO emulsification in the subconjunctival space and the absence of naive conjunctiva due to scarring resulting from previous vitreoretinal surgery 2,12,13,23. Drainage devices were suggested as a better solution.…”

“…Drainage devices were suggested as a better solution. However, complications rate remains remarkable such tubes exposure, endophthalmitis, and failure due to SO migration into tubes 2,12,18,23. Finally, transscleral cyclodestructive techniques such as cyclocryotherapy and conventional laser cyclophotocoagulation were suggested as a final efficient technique but exposing to a high risk of complications 4,24.…”

Hyperoleon in filtering bleb

“…Trabeculectomy has a lower success rate in such eyes, due to pre-existing conjunctival fibrosis and the presence of hyperoleon which can migrate through the trabeculectomy ostium into the filtering bleb causing inflammation and obstruction to the aqueous outflow. Ahmed glaucoma valve surgery has shown to have a better success rate compared with trabeculectomy in these eyes 3 4. Hyperoleon in filtering bleb can mimic blebitis, air bubbles postcataract surgery or an encysted bleb.…”