J Korean Ophthalmol Soc.  2015 Apr;56(4):643-649. 10.3341/jkos.2015.56.4.643.

Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis

• Lee JA
• Cho YK
• La TY
• Choi JA

• KMID: 2215720
• DOI: http://doi.org/10.3341/jkos.2015.56.4.643

Abstract

PURPOSE
To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs' heterochromic iridocyclitis.
CASE SUMMARY
A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed.
CONCLUSIONS
Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs' heterochromic iridocyclitis-induced glaucoma.

Keyword

Ahmed glaucoma valve surgery; Corneal endothelial cell density; Corneal failure; Fuchs' heterochromic iridocyclitis; Uveitic glaucoma

MeSH Terms

Cataract
Cell Count
Cornea
Corneal Edema
Corneal Endothelial Cell Loss*
Endothelial Cells
Endothelium
Follow-Up Studies
Glaucoma
Humans
Intraocular Pressure
Iridocyclitis*
Iris
Keratoplasty, Penetrating
Male
Middle Aged
Visual Acuity

Figure

• 

  Figure 1. Preoperative images: The slit lamp exam shows (A) fine round or stellate keratic precipitates and fine filaments on the endothelium between the keratic precipitates (B) patchy loss of the iris pigment epithelium. (C) The funduscopy shows swol-len optic disc.

• 

  Figure 2. After the Ahmed valve implantation: (A) the valve tip was well positioned at superotemporal side (POD 1 day) (B) the slit lamp shows depigmented atrophic iris and posterior syn-echiae (POD 8 months) (C) before PPKP: Severely edematous cornea and corneal haziness are shown. POD = Postop date; PPKP = penetrating keratoplasty.

• 

  Figure 3. Remarkable changes of corneal endothelial cell density: (A) before Ahmed valve implantation (A-1: right eye, A-2: left eye) (B) POD 7 months after Ahmed valve implantation (C) POD 13 months after Ahmed valve implantation (D) before cataract surgery. POD = Postop date.

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