Combined Pars Plana Vitrectomy and Ahmed Implantation for Refractory Glaucoma

Kook, Michael S; Jeon, Seong Ki; Kim, Myung Joon; Yoon, Young Hee

Abstract

Eyes with neovascular glaucoma often times present with vitreous hemorrhage which makes subsequent panretinal photocoagulation difficult to impossible. These eyes can benefit from pars plana vitrectomy combined with glaucoma shunt procedure. Other candidates are those refractory galucomatous eyes with severe vitreoretinal diseases that require surgical intervention. We performed standard pars plana vitrectomies in combination with Ahmed Glaucoma Valve implant and analyzed the surgical outcome in 11 eyes of 11 patiens with severe refractory galucoma. With the surgical success defined as an achievement of intraocular pressure(IOP) less or equal to 21 mmHg with anatomical reattatchment of retina, nine eyes(81.8%) became qualified in the success group. Complications included hyphema and/or severe fibrinous reaction (3 eyes), temporary IOP increase (3 eyes), recurrent vitreous hemorrhage (1 eye) and loss of light perception (1 eye). No eye showed postoperative hypotony, choroidal effusion or hemorrhage. In conclusion, in those eyes with refractory glaucoma accompanied with severe vitreoretinal disease that do not respond to the conventional IOP lowering procedures, combined pars plana vitrectomy with Ahmed Glaucoma Valve implantation may serve as a useful surgical alternative.