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Management of bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma.

Goel R, Thangkhiew L, Yadava U, Kumar S - Indian J Ophthalmol (2010 Sep-Oct)

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Dear Editor, We read the article by Parihar et al. and agree with their conclusions and would like to share the course of a uveitic glaucoma with intercalary staphyloma which was managed well with phacoaspiration, posterior chamber intraocular lens (PCIOL), and Ahmed glaucoma valve (AGV) implantation... Uveitic glaucoma is challenging due to the early onset and the numerous mechanisms of pathogenesis including steroid-induced intraocular pressure (IOP) elevation... Medical and surgical interventions though initially successful eventually fail due to fibrosis... We planned phacoaspiration with PCIOL and AGV implantation as a single-stage procedure in the left eye under cover of oral prednisolone (1 mg/kg) tapered in 4 weeks... On the first postoperative day, left eye IOP was 17 mmHg and vision was 20/200... However, on the second day, there were a severe anterior chamber reaction, an exudative membrane over the IOL and iridectomy with an IOP of 22 mmHg and vision of finger counting at 1 m... We performed YAG membranectomy and pigment sweeping of the IOL on the fifth postoperative day... By the seventh day the IOP was 14 mmHg and vision improved to 20/63 and has remained in the lower teens in 2-year follow-up [Figs. 2 and 3]... We would like to conclude that glaucoma drainage device implantation is an appropriate primary surgical procedure in patients with refractory glaucoma with intercalary staphyloma and can be safely combined with phacoaspiration with PCIOL implantation.

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Cadaveric scleral graft covering the tube of the Ahmed glaucoma valve
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Figure 0003: Cadaveric scleral graft covering the tube of the Ahmed glaucoma valve

Mentions: We diagnosed this patient as bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma. We planned phacoaspiration with PCIOL and AGV implantation as a single-stage procedure in the left eye under cover of oral prednisolone (1 mg/kg) tapered in 4 weeks. The plate of AGV was placed in the superotemporal quadrant and the tube was covered with the cadaveric scleral graft. Fixing the AGV tube and plate was an extremely uphill task due to thinness of sclera. Using iris retraction hooks, temporal phacoaspiration was performed and a multipiece acrylic foldable PCIOL was implanted in the bag. On the first postoperative day, left eye IOP was 17 mmHg and vision was 20/200. However, on the second day, there were a severe anterior chamber reaction, an exudative membrane over the IOL and iridectomy with an IOP of 22 mmHg and vision of finger counting at 1 m. We performed YAG membranectomy and pigment sweeping of the IOL on the fifth postoperative day. By the seventh day the IOP was 14 mmHg and vision improved to 20/63 and has remained in the lower teens in 2-year follow-up [Figs. 2 and 3].


Management of bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma.

Goel R, Thangkhiew L, Yadava U, Kumar S - Indian J Ophthalmol (2010 Sep-Oct)

Cadaveric scleral graft covering the tube of the Ahmed glaucoma valve
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992929&req=5

Figure 0003: Cadaveric scleral graft covering the tube of the Ahmed glaucoma valve
Mentions: We diagnosed this patient as bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma. We planned phacoaspiration with PCIOL and AGV implantation as a single-stage procedure in the left eye under cover of oral prednisolone (1 mg/kg) tapered in 4 weeks. The plate of AGV was placed in the superotemporal quadrant and the tube was covered with the cadaveric scleral graft. Fixing the AGV tube and plate was an extremely uphill task due to thinness of sclera. Using iris retraction hooks, temporal phacoaspiration was performed and a multipiece acrylic foldable PCIOL was implanted in the bag. On the first postoperative day, left eye IOP was 17 mmHg and vision was 20/200. However, on the second day, there were a severe anterior chamber reaction, an exudative membrane over the IOL and iridectomy with an IOP of 22 mmHg and vision of finger counting at 1 m. We performed YAG membranectomy and pigment sweeping of the IOL on the fifth postoperative day. By the seventh day the IOP was 14 mmHg and vision improved to 20/63 and has remained in the lower teens in 2-year follow-up [Figs. 2 and 3].

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, We read the article by Parihar et al. and agree with their conclusions and would like to share the course of a uveitic glaucoma with intercalary staphyloma which was managed well with phacoaspiration, posterior chamber intraocular lens (PCIOL), and Ahmed glaucoma valve (AGV) implantation... Uveitic glaucoma is challenging due to the early onset and the numerous mechanisms of pathogenesis including steroid-induced intraocular pressure (IOP) elevation... Medical and surgical interventions though initially successful eventually fail due to fibrosis... We planned phacoaspiration with PCIOL and AGV implantation as a single-stage procedure in the left eye under cover of oral prednisolone (1 mg/kg) tapered in 4 weeks... On the first postoperative day, left eye IOP was 17 mmHg and vision was 20/200... However, on the second day, there were a severe anterior chamber reaction, an exudative membrane over the IOL and iridectomy with an IOP of 22 mmHg and vision of finger counting at 1 m... We performed YAG membranectomy and pigment sweeping of the IOL on the fifth postoperative day... By the seventh day the IOP was 14 mmHg and vision improved to 20/63 and has remained in the lower teens in 2-year follow-up [Figs. 2 and 3]... We would like to conclude that glaucoma drainage device implantation is an appropriate primary surgical procedure in patients with refractory glaucoma with intercalary staphyloma and can be safely combined with phacoaspiration with PCIOL implantation.

Show MeSH
Related in: MedlinePlus