Cauterized suture for complete tube occlusion of Ahmed glaucoma valve in hypotony maculopathy

Abstract

Purpose: To present our experience treating hypotony maculopathy with a simple, minimally invasive, and removable ab interno tube Ahmed glaucoma valve occlusion.

Methods: Under topical anesthesia a 5-0 polypropylene suture (Prolene; Ethicon) was inserted into the Ahmed glaucoma valve tube. The length of the tube was measured, and an external suture cauterization was performed to allow an easier and safer fixation in the tube. The suture was introduced into the tube itself with the viscoelastic 27-gauge cannula.

Results: This technique was performed in three cases of hypotony maculopathy with a complex history of medical treatments: a 4-year-old boy with Donnai-Barrow syndrome and previous pars plana vitrectomy that developed hypotony maculopathy the day after Ahmed glaucoma valve insertion and two male patients (69 and 49 years old) that underwent hypotony maculopathy after cyclophotocoagulation as a last option to reduce intraocular pressure. One of the men had three filtering surgeries, two 5-fluorouracil needlings and Ahmed glaucoma valve insertion. The other male patient had keratoplasty and posterior Ahmed glaucoma valve insertion. In the three cases, both hypotony and maculopathy were reversed within a week and a month, respectively, after Ahmed glaucoma valve occlusion with no complications. When hypotony maculopathy develops it seems suitable to occlude completely the Ahmed glaucoma valve tube to swiftly reverse clinical and anatomic changes.

Conclusion: Intraluminal Ahmed glaucoma valve occlusion with cauterized suture is a simple, quick, reversible, and effective technique that may offer a minimally invasive way to resolve hypotony maculopathy in complex cases and avoid severe loss of vision.

Keywords: Ahmed glaucoma valve; ab interno tube occlusion; hypotony maculopathy.