J Korean Ophthalmol Soc.  2015 May;56(5):794-798. 10.3341/jkos.2015.56.5.794.

A Case of Persistent Shallow Anterior Chamber in Glaucoma Drainage Device Implantation Recovered by Fibrin Glue

• Wi YJ
• Lee KY
• Yoo YC

• KMID: 2121183
• DOI: http://doi.org/10.3341/jkos.2015.56.5.794

Abstract

PURPOSE
To report a case of persistent shallow anterior chamber after silicone tube intubation, recovered by fibrin glue in glaucoma drainage device implantation (GDI).
CASE SUMMARY
A 42-year-old female, diagnosed with neovascular glaucoma at a local clinic visited our clinic for uncontrolled intraocular pressure (IOP) in her right eye. We performed GDI on her right eye. Scleral flap and paracentesis of the anterior chamber were performed. Then, a silicone tube was inserted into the anterior chamber. Despite repetitive infusion of balanced salt solution (BSS), the anterior chamber became persistently shallow due to peritubular leakage. After dropping the fibrin glue in the peritubular space and beneath the scleral flap, attachment occurred. No additional leakage was observed near the scleral flap and after infusion of BSS, a deep anterior chamber was maintained. One day after surgery, IOP in the right eye was 3 mm Hg, deep anterior chamber was maintained, and no leakage of aqueous humor into the conjunctiva occurred. Two months after surgery, IOP was 16 mm Hg and a deep anterior chamber was maintained.
CONCLUSIONS
In cases of persistent shallow anterior chamber after silicone tube intubation in intraoperative GDI, the best methods to maintain the anterior chamber is by suture ligation of the peritubular loosened site or infusion of viscoelastic agent to anterior chamber. In the present case, applying the fibrin glue beneath the scleral flap apparently obstructed the peritubular infiltration.

Keyword

Aqueous leak; Fibrin glue; Glaucoma drainage device implantation; Peritubular infiltration; Silicone tube

MeSH Terms

Adult
Ambulatory Care
Anterior Chamber*
Aqueous Humor
Conjunctiva
Drainage*
Female
Fibrin Tissue Adhesive*
Glaucoma*
Glaucoma, Neovascular
Humans
Intraocular Pressure
Intubation
Ligation
Paracentesis
Silicones
Sutures
Fibrin Tissue Adhesive
Silicones

Figure

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  Figure 1. Intraoperative anterior segment photographs. (A) Surgical spear was approximated to suspicious leaking site beneath the scleral flap. (B) Surgical spear expanded due to peritubular leak. (C) Fibrin glue was applied in the peritublar space and beneath the scleral flap. (D) Scleral flap was attached to the lower sclera.

• 

  Figure 2. Postoperative (2 months) anterior segment photographs. (A) Anterior chamber was kept deep. (B) There were no signs of inflammation in the conjunctiva. (C, D) Peritubular space, which was not wanted, was seen in gonio-scopic findings (arrow).

Reference

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