| 본문 : Introduction: A late hypotony after glaucoma drainage device implantation would be a delicate matter. A 45-year-old female with unilateral uveitic glaucoma eye admitted to emergency room for her left eye pain. Her best corrected visual acuities were 20/20 and finger count 2m. Intraocular pressure (IOP)s were 11 and 32 mmHg c GAT (OD and OS, respectively). She had cataract surgery 19 months ago and had a gradual IOP elevation to 26 mmHg c GAT for several months despite laser peripheral iridectomy (which kept the IOP stable for a year) on her left eye, so Ahmed glaucoma valve (AGV) was implanted 1 month ago. Collapsed anterior chamber and incarcerated iris into tube were noted. Iris was pulled out in the operation room and Argon laser iridoplasty around the tube was performed, but same situation happened after 5 days.
Methods and Results: Partial vitrectomy was performed under general anesthesia to mitigate the pressure from the posterior part of the globe. And tube of the AGV was plugged with 3-0 Prolene thread to maintain the anterior chamber because her uveal (iris-cilicary body-choroid) tissue seems so weak to endure the anterior-posterior pressure gradient. Although IOP was stable for 2 months, chamber collapse with IOP spike recurred. Total vitrectomy with larger size surgical iridectomy was performed. The IOP has been stable for 2 months.
Conclusions: Proper IOP control of Uveitic glaucoma cases with shallow window for managing aqueous humor production seems extremely difficult. Surgeons may get such troubles of deciding whether to pull the tube or not. However once you pull out the tube permanently, anterior chamber cannot be reformed due to the anterior-posterior pressure gradient. So partial obstruction by plugging 3-0 Prolene could be an option for the case. |