Korean J Ophthalmol.  2012 Apr;26(2):92-96. 10.3341/kjo.2012.26.2.92.

Pars Plana Ahmed Implantation Combined with 23-gauge Vitrectomy for Refractory Neovascular Glaucoma in Diabetic Retinopathy

• Jeong HS
• Nam DH
• Paik HJ
• Lee DY

• KMID: 1364861
• DOI: http://doi.org/10.3341/kjo.2012.26.2.92

Abstract

PURPOSE
To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR).
METHODS
The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up.
RESULTS
The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 +/- 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 +/- 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 +/- 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 +/- 0.61 to 0.96 +/- 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases.
CONCLUSIONS
We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.

Keyword

Diabetic retinopathy; Glaucoma drainage device; Neovascular glaucoma; Vitrectomy

MeSH Terms

Adult
Aged
Diabetic Retinopathy/*complications/pathology
Female
Follow-Up Studies
*Glaucoma Drainage Implants
Glaucoma, Neovascular/*complications/pathology/*surgery
Humans
Intraocular Pressure
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vitrectomy/*methods

Figure

• 

  Fig. 1 (A) Intraoperative photograph shows a 23-gauge sclerotomy 3.5 mm posterior to the limbus, and (B) Ahmed valve tube inserted through the cutter probe sclerotomy site and anchored to episclera with 9-0 nylon.

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  Fig. 2 Preoperative (Preop) and postoperative intraocular pressure (IOP) changes in all patients.

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