J Korean Ophthalmol Soc.  2011 Jun;52(6):746-752. 10.3341/jkos.2011.52.6.746.

A Case of Ahmed Glaucoma Valve Implantation without Removal of the Anterior Chamber Lens

• Lee E
• Park SJ
• Kwon JD

• KMID: 2214650
• DOI: http://doi.org/10.3341/jkos.2011.52.6.746

Abstract

PURPOSE
To report the results of performing an Ahmed glaucoma valve implantation without removing the anterior chamber lens to treat secondary glaucoma.
CASE SUMMARY
A 72-year-old male visited the hospital for imminent visual field loss in the left eye. At the time of the visit, he had a mild headache, and the intraocular pressure of the left eye was 38 mm Hg. The left eye had received anterior chamber lens insertion with iridectomy and the posterior capsule was ruptured. The vitreous protruded at the two o'clock site and adhered to the backside of the anterior chamber lens tilting it toward the temporal cornea. At the time of the visit, the maximum corrected vision of the left eye was 0.32. The patient was diagnosed with secondary glaucoma caused by the anterior chamber lens. Because the patient did not want to have the anterior chamber lens removed and the supporting area of the anterior chamber lens blocked the trabeculectomy and peripheral iridectomy sites, the authors performed an Ahmed glaucoma valve implantation instead. The outcome of Ahmed glaucoma valve implantation was evaluated through a preoperative and postoperative vision test and periodical corneal endothelial cell analysis. During the six months of postoperative follow-up, the vision was improved, intraocular pressure was stabilized, and corneal endothelial cells were maintained.
CONCLUSIONS
When a patient requires glaucoma surgery for secondary glaucoma caused by an anterior chamber lens, an Ahmed implantation without lens removal may be an option which may carefully be considered. However, because of the possibility of subsequent complications, a longer follow-up period is necessary.

Keyword

Ahmed glaucoma valve; Anterior chamber lens; Corneal endothelial cell; Intraocular pressure; Secondary glaucoma

MeSH Terms

Aged
Anterior Chamber
Cornea
Endothelial Cells
Eye
Follow-Up Studies
Glaucoma
Headache
Humans
Intraocular Pressure
Iridectomy
Male
Trabeculectomy
Vision Tests
Vision, Ocular
Visual Fields

Figure

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  Figure 1. Imminent visual field defect in Humphrey visual field test.

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  Figure 2. The left eye on the visit. The left eye had received anterior chamber lens insertion and iridectomy and the posterior capsule had already ruptured. In addition, the vitreous body escaped in the direction of two o'clock and stuck on the backside of the anterior chamber lens, and the anterior chamber lens was tilted toward the temporal cornea.

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  Figure 3. In the preoperative corneal endothelial cell analysis of the left eye, the corneal endothelial cell density was 579 cells/mm2.

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  Figure 4. After the operation, the Ahmed glaucoma valve was positioned properly over the anterior chamber lens and it did not contact the cornea or the iris in photograph (A) and gonioscope photograph (B).

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  Figure 5. In corneal endothelial cell analysis after 43 days (A) and 3 months (B) from the operation, the corneal endothelial cell density was 660 cells/mm2 and 586 cells/mm2, respectively, maintaining a favorable condition without a big difference from that before the operation.

Reference

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