BACKGROUND:Tube implants can lead to long-term decompensation of the cornea after decades, in particular in complicated childhood glaucoma, because of a variety of causes including contact between ...the tube tip and the corneal endothelium. The augmentation of a XEN implant with a Baerveldt (250) tube implant, introduced 2016 by Mermoud et al for refractory glaucoma in adult patients, may reduce this risk in children. In our retrospective study, we report on the XEN-augmented Baerveldt (250) tube implant in children.
PATIENTS AND METHODS:Ten consecutive patients with refractory childhood glaucoma who underwent XEN-augmented Baerveldt implantation by a single surgeon (F.G.) between January 2016 and August 2018 were retrospectively analyzed. In this technique, a XEN tube was inserted under a standard scleral flap from outside into the anterior chamber and its outer end was connected to the Baerveldt (250) tube. The follow-up consisted of regular anterior and posterior segment examination with intraocular pressure (IOP) measurements using a hand-held slit lamp and a Perkins applanation tonometer and/or rebound tonometer (Icare).
RESULTS:Ten cases (6 female individuals, 4 male individuals, median age 6 years) were operated using a XEN-augmented Baerveldt implant aphakic glaucoma, primary congenital glaucoma, secondary congenital glaucoma (Peters anomaly), ectropion uveae, and Stickler syndrome were 4, 3, 1, 1, and 1. Before surgery (XEN-augmented Baerveldt implantation), median IOP was 31 mm Hg. At the last postoperative follow-up, the mean IOP was 18.5 mm Hg with a median follow-up period of 13 months (range, 3 to 21 mo). No shallow or flat anterior chamber was observed. In all cases, this technique could be performed without intraoperative complications. In 3 cases, however, a surgical revision was necessary. There was no prolonged postoperative hypotony or short-term corneal alteration. By using an S-shaped loop the original Baerveldt tube length could be preserved for potential future use. In a total of 6 out of 10 cases, the procedure was a complete success (IOP, ≤20 mm Hg without additional medication).
CONCLUSIONS:XEN-augmented Baerveldt implantation was used for refractory pediatric glaucoma in which conventional surgery had already failed. A new additional modification using an S-shaped loop was introduced. Short-term IOP control seems promising, but long-term results are still pending and the long-term efficacy and safety must still be proven before this technique can be generally recommended.
Suprachoroidal Bleeding After XEN Gel Implantation Prokosch-Willing, Verena; Vossmerbaeumer, Urs; Hoffmann, Esther ...
Journal of glaucoma,
2017-December, 2017-Dec, 2017-12-00, 20171201, Letnik:
26, Številka:
12
Journal Article
Recenzirano
PURPOSE:To report for the first time a clinical case of suprachoroidal bleeding after XEN45 gel implantation.
OBSERVATIONS:A 84-year old female patient with pseudoexfoliation glaucoma with ...intraocular pressure (IOP) (20 mm Hg) above target despite maximal IOP-lowering therapy was scheduled for XEN45 gel implantation. The XEN45 gel implantation went without complications and was properly placed in the anterior chamber and beneath the conjunctiva. On the first postoperative day, the patient presented with an IOP of 4 mm Hg, a functioning bleb and a deep anterior chamber. On the second day she developed suprachoroidal bleeding. A wait and see strategy was followed and the patient monitored steadily. The bleeding resolved spontaneously after 6 weeks.
CONCLUSIONS AND IMPORTANCE:Minimally invasive glaucoma surgery is developed to provide a safer and less-invasive option to reduce IOP in glaucoma patients compared with trabeculectomy. Although the concept of the XEN45 gel stent seems to be a favorable to reach IOP-lowering results similar to those of trabeculectomy, complications may be similar, too. We have to keep this in mind when informing patients about surgical options.
PRéCIS:Treatment of leakage with ocular hypotony after trabeculectomy with MMC can be safely achieved through conjunctival patch alone or combined with donor scleral graft in cases of melted ...underlying sclera.
PURPOSE:To report outcomes of two surgical approaches for treating ocular hypotony in eyes with blebs with late-onset leakage after standard trabeculectomy with Mitomycin C (MMC).
METHODS:Thirty consecutive cases with bleb leakage and hypotony underwent bleb revision surgery between 2009 and 2014 by the same surgeon (JW) at the Department of Ophthalmology of the Mainz University Medical Center, Germany. In 18 patients an autologous conjunctival patch graft was applied. In 12 patients the underlying sclera was found melted and an additional scleral donor graft was sutured in place. We analyzed intraocular pressure (IOP), visual acuity and optical coherence tomography (OCT) of the macula preoperatively, at 1 day, 1 week, 4 weeks and 6 months after surgery.
RESULTS:Mean IOP was 6.2±3.5▒mmHg preoperatively and 21.7±16.4▒mmHg at 1 day, 13.7±6.7 at one week, 13.1±5.1▒mmHg at 4 weeks, and 12.1±4.7▒mmHg at 6 months after surgery. Visual acuity (logMar) increased from 0.57±0.49 preoperatively to 0.49±0.40 at 6 months. Optical coherence tomography (OCT) showed flattening of macular folds that were present before treatment. No serious adverse event was reported.
CONCLUSIONS:This revision technique with conjunctival patch and/or additional donor scleral graft is an effective and safe method for treating late bleb leakage and hypotony maculopathy following trabeculectomy with MMC.
A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study ...describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly.
The study included two groups of 23 patients with failing bleb following trabeculectomy: "Group 1" underwent simple needling revision of the filtering bleb and served as a control group, while "Group 2" received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure (IOP), postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests.
Adverse effects occurred with a higher frequency after sole needling of the bleb (5 cases of choroidal effusion and 1 case of choroidal hemorrhage) than after the combined method with additional scleral sutures (1 case of choroidal effusion). The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 (P = 0.01). Ten patients with ocular hypotony (IOD of 5 mmHg or lower) were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups (P>0.05).
This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
INTRODUCTION:Suprachoroidal hemorrhage (SCH) is a rare, but potentially vision-threatening event with poor long-term visual prognosis. At present, there is disagreement whether surgical intervention ...or conservative treatment is superior in the management. We report on a case of spontaneous resolution of severe SCH after needling procedure in the only eye of a young patient with congenital glaucoma.
CASE PRESENTATION:A 43-year-old woman with congenital glaucoma was scheduled for bleb needling in her only eye. Preoperative best-corrected visual acuity was 20/40 and intraocular pressure 20 mm Hg. On the third postoperative day, she developed a massive delayed SCH with appositional (kissing) choroidal bullae and visual acuity was hand motion. Scleral drainage was performed after 10 days, but did not show a significant decrease of the choroidal swelling and further conservative treatment was discussed. After 2 months, choroidal swelling had completely resolved, best-corrected visual acuity was 20/50, and intraocular pressure was 11 mm Hg.
DISCUSSION:Full functional recovery and decrease of choroidal swelling may be attained with a conservative treatment of massive delayed SCH after needling procedure in congenital glaucoma.
We report a case of a rare complication after trabeculotomy combined with a small trabeculectomy with mitomycin C in a young patient with juvenile glaucoma. The patient underwent uneventful surgery. ...However, postoperatively, he experienced a long-lasting hypotony with the need of 2 revision surgeries and 2 short episodes of high-intraocular pressure. He developed a fixed dilated pupil over time.
OBJECTIVES:The objective of this study is to investigate the results of an adaptive approach of bleb revision surgery for late onset hypotony after trabeculectomy with mitomycin C because of bleb ...leakage and/or scleral melting.
METHODS:A total of 29 eyes of 27 patients, aged 63.8±11.7 years with hypotony maculopathy intraocular pressure (IOP), ≤6 mm Hg because of late onset bleb leakage and/or scleral melting after trabeculectomy with mitomycin C in which minimally invasive transconjunctival suturing of the scleral flap was impossible were enrolled in this retrospective interventional case series. External bleb leakage was seen in 16 eyes, 11 eyes suffered from scleral melting. Because of the intraoperative findings regarding appearance of conjunctiva and sclera 4 different surgical approaches were used(1) bleb excision (in case of external leakage) and conjunctival reapproximation, (2) bleb excision and free conjunctival autografting, (3) human donor scleral patch grafting (in case of scleral flap defect) with conjunctiva reapproximation and (4) combined conjunctival and scleral patch grafting. Outcome measures were IOP and visual acuity (VA) development over time. Data analysis comparing changes in the parameters (IOP and VA) before and after bleb revision surgery was carried out using the paired t test.
RESULTS:Changes in IOP and VA were analyzed over 9.3±8.3 months (range, 1.1 to 36.5 mo). IOP increased from 4.0±1.8 mm Hg, (P<0.001) before revision surgery to 13.1±4.1 mm Hg at 3 months after revision and 12.6±3.8 mm Hg at last follow-up visit, showing no significant difference in IOP between 3 months post revision and at the last documented patients’ follow-up visit (P=0.28). The VA before revision surgery (0.42±0.28 logMAR) significantly increased (P=0.05) 3 months after revision (0.32±0.23 logMAR) and remained stable (P=0.65) until the last follow-up visit (9.3±8.3 mo; range, 1.1 to 36.5) (0.35±0.32 logMAR).
CONCLUSIONS:In patients with hypotony an adaptive approach of bleb management shows good results both in terms of IOP control and improvement in VA.
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