Intracameral air injection during Ahmed glaucoma valve implantation in neovascular glaucoma for the prevention of tube obstruction with blood clot

Abstract

Rationale:Glaucoma drainage implant surgery is a treatment option for the management of neovascular glaucoma. However, tube obstruction by blood clot after Ahmed glaucoma valve (AGV) implantation is an unpredictable clinically challenging situation.Patient concerns-diagnoses-interventions:We report 4 cases using intracameral air injection for the prevention of the tube obstruction of AGV by blood clot.Outcomes:The first case was a 57-year-old female suffering from ocular pain because of a tube obstruction with blood clot after AGV implantation in neovascular glaucoma. Surgical blood clot removal was performed. However, intractable bleeding was noted during the removal of the blood clot, and so intracameral air injection was performed to prevent a recurrent tube obstruction. After the procedure, although blood clots formed around the tube, the tube opening where air could touch remained patent. In 3 cases of neovascular glaucoma with preoperative severe intraocular hemorrhages, intracameral air injection and AGV implantation were performed simultaneously. In all 3 cases, tube openings were patent. It appears that air impeded the blood clots formation in front of the tube opening.Lessons:Intracameral air injection could be a feasible option to prevent tube obstruction of AGV implant with a blood clot in neovascular glaucoma with high risk of tube obstruction.

Recent Advancements in Glaucoma Surgery—A Review

“…Early GDD failure may occur because a blood clot obstructs the tube, particularly in eyes with neovascular or inflammatory glaucoma. At the end of surgery, Hwang et al [ 42 ] injected filtered air into the anterior chamber through a 30-gauge needle. The authors hypothesised that a large air bubble would keep blood from entering the tube opening and prevent an obstructive clot from forming.…”