J Korean Ophthalmol Soc.  2018 Sep;59(9):887-892. 10.3341/jkos.2018.59.9.887.

Conjunctival Necrosis following Ahmed Valve Implantation and Subtenon Triamcinolone Injection

• Park KS
• Kim KN
• Kim WJ
• Lee SB
• Kim CS

• KMID: 2420340
• DOI: http://doi.org/10.3341/jkos.2018.59.9.887

Abstract

PURPOSE
We report a case of conjunctival necrosis in a glaucoma patient who underwent Ahmed valve implantation and subtenon triamcinolone injection.
CASE SUMMARY
subconjunctival injections of mitomycin C in her right eye. Ahmed valve implantation and subtenon triamcinolone injection were performed in the right eye. Four weeks later, conjunctival necrosis was observed. After debridement of necrotic tissue, an additional conjunctival autograft was needed because of recurrence of the conjunctival necrosis. After amniotic membrane transplantation was performed for one more recurrent conjunctival necrosis, conjunctival epithelialization was completed.
CONCLUSIONS
Although conjunctival necrosis after periocular injection of triamcinolone is a rare complication, previous multiple usage of antimetabolites such as mitomycin C might be associated with a higher risk of developing conjunctival necrosis. In such cases, aggressive surgical intervention may be helpful in the reconstruction of the conjunctival epithelium.

Keyword

Ahmed valve; Conjunctival necrosis; Glaucoma; Mitomycin C; Triamcinolone

MeSH Terms

Amnion
Antimetabolites
Autografts
Debridement
Epithelium
Glaucoma
Humans
Injections, Intraocular
Mitomycin
Necrosis*
Recurrence
Triamcinolone*
Antimetabolites
Mitomycin
Triamcinolone

Figure

• 

  Figure 1. Anterior segment photography after Ahmed valve implantation with subtenon triamcinolone injection. (A) Conjunctival necrosis 4 weeks later. (B) Recurred and widened conjunctival necrosis 12 weeks later. The arrow denotes the tube of the Ahmed glaucoma drainage device inserted in the anterior chamber. The blank arrowhead denotes triamcinolone injected with Ahmed valve implantation. The arrowhead denotes the exposed margin of the half thickness scleral flap covering the tube of the Ahmed glaucoma drainage device. The dashed line denotes the boundary of the conjunctival necrosis.

• 

  Figure 2. Anterior segment photography after Ologen® insertion and placing a conjunctival autograft and an amniotic membrane patch. (A) The dashed line denotes the boundary of the Ologen®, and the arrow denotes the suture site of the conjunctival autograft 1 day later. (B) Fluorescein dye was applied. The continuous line denotes the boundary of the amniotic membrane patch 1 day later. (C) The amniotic membrane patch dropped. The conjunctival autograft was recovering 1 week later.

• 

  Figure 3. Anterior segment photography 2 weeks after Ologen® insertion and placing a conjunctival autograft and an amniotic membrane patch. (A) The two dashed ellipsoids denote the recurred conjunctival necrosis. (B) Debridement, amniotic membrane implantation, conjunctival suture, and amniotic membrane patch graft were sequentially conducted.

• 

  Figure 4. Anterior segment photography after debridement, amniotic membrane implantation, conjunctival suture, and amniotic membrane patch graft. (A, B) Nine weeks later. The conjunctival epithelialization was completed. (C) Twenty months later the conjunctival epithelium was intact.

Reference

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