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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 3  |  Page : 259-260
 

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractive glaucoma in Indian eyes


Swamy Eye Clinic, 11 South Mada Street, Villivakkam, Chennai-600 049, India

Date of Web Publication21-Apr-2010

Correspondence Address:
Ariga Murali
Swamy Eye Clinic, 11 South Mada Street, Villivakkam, Chennai 600049
India
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DOI: 10.4103/0301-4738.62667

PMID: 20413941

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How to cite this article:
Murali A. The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractive glaucoma in Indian eyes. Indian J Ophthalmol 2010;58:259-60

How to cite this URL:
Murali A. The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractive glaucoma in Indian eyes. Indian J Ophthalmol [serial online] 2010 [cited 2014 Nov 23];58:259-60. Available from: http://www.ijo.in/text.asp?2010/58/3/259/62667


Dear Editor

We read with interest the article by Parihar et al. [1] We congratulate the authors for their study and wish to make a few observations. While the authors have mentioned that tube insertion into the anterior chamber (AC) is done through a paracentesis track made with a 22-G needle and also that the use of viscoelastic through this needle track assists tube insertion there is no mention of the use of a special tube inserter forceps which we find greatly facilitates insertion of the Ahmed glaucoma valve (AGV) tube in to the AC. The tube inserter (New World Meditec Inc, CA) is a stainless steel forceps with a serrated grip and notched tip [Figure 1] which provides rigidity to the AGV tube for easy insertion into the anterior or posterior chamber unlike any other serrated or tying forceps which may kink or damage the tube.

In situations where there is extensive conjunctival scarring and in revision surgeries the use of preserved scleral allograft obtained from an eye bank is suitable for covering the tube. It is biocompatible and can be trimmed to any size or shape. Ethanol-preserved sclera should be soaked in balanced salt solution for about 20 min before use. The use of such allografts has not been discussed by the authors.

The authors have enlisted many complications noted in their study following the use of the AGV in refractive glaucoma. Tube retraction is another complication which has been encountered by us in some cases. Tube retraction [Figure 2]a refers to the retraction of the tube from the AC either into the scleral tunnel which had been fashioned for tube placement or into the subconjunctival space. This results in failure of aqueous drainage and resultant elevation in IOP. When this occurs and the tube is too short to be re-inserted the options for management include replacement with another AGV, reinsertion of the tube into pars plana (a pars plana clip may be used) or a tube extender [2] can be used to lengthen the tube. The tube extender (New World Meditec Inc, CA) is made of medical grade silicone with a length of about 24 mm and outer diameter of 0.635 mm. The proximal end can be attached to the existing AGV tube after removing it from the AC while the distal end can be inserted into the AC through a new paracentesis opening made with a 22-G needle. The tube extender is then sutured to the underlying sclera. We have used a tube extender in such situations [Figure 2]b and c with good results.

 
   References Top

1.Parihar JK, Vats DP, Maggon R, Mathur V, Singh A, Mishra SK. The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractive glaucoma in Indian eyes. Indian J Ophthalmol 2009;57:345-50.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Sarkisian SR, Netland PA. Tube extender for revision of glaucoma drainage implants. J Glaucoma 2007;16:637-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  


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This article has been cited by
1 Analysis of Ahmed glaucoma valve implantation for silicone oil-induced secondary glaucoma
Gao, W.-Q., Ye, B.
International Journal of Ophthalmology. 2011; 11(3): 479-481
[Pubmed]
2 Authorsę reply
Parihar, J.K.S., Vats, D.P., Maggon, R., Mathur, V., Singh, A., Mishra, S.K.
Indian Journal of Ophthalmology. 2010; 58(3): 260-261
[Pubmed]



 

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