1
|
Nilforushan N, Abolfathzadeh N, Miraftabi A, Banifatemi M. Outcomes of Trabeculectomy and Ahmed Glaucoma Valve Implantation in Patients With Iridocorneal Endothelial Syndrome. J Glaucoma 2024; 33:e35-e42. [PMID: 38506803 DOI: 10.1097/ijg.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024]
Abstract
PRCIS Our study highlights the long-term success of trabeculectomy or Ahmed glaucoma valve (AGV) surgery in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. However, many ICE syndrome cases may need multiple glaucoma surgeries to achieve controlled intraocular pressure (IOP), with/without concomitant corneal graft surgery. OBJECTIVE To evaluate the long-term outcome of trabeculectomy and AGV implantation in ICE syndrome. METHODS Patients with glaucoma secondary to ICE syndrome who underwent either trabeculectomy or AGV surgery with intraoperative adjunctive mitomycin-C from 2009 to 2020 were included in this study. All patients were followed for at least 6 months after initial surgery. The main outcome measures were IOP, number of IOP-lowering medications, and surgical success. Surgical success was defined as complete according to the levels of IOP ( < 18) and at least 20% reduction from preoperative IOP without medications and qualified as a complete success but with medications, where the number of medications was less than preoperative numbers. Cumulative success was the sum of the qualified and complete success. RESULTS Twenty-nine eyes of 29 patients were included. Trabeculectomy was done in 13 patients (group A, 44.8%) and 16 patients underwent AGV surgery (group B, 55.2%). The median age was 50 (42-56.50) and 47 (36.75-52.75) years in groups A and B, respectively ( P = 0.10). All patients completed at least 2 years of follow-up. Mean IOP was not significantly different between groups preoperatively ( P = 0.70) and the effect of the type of surgery on IOP was not statistically significant at multiple follow-up time points (repeated measures analysis of variance, P = 0.44). The mean IOP decreased from 35.76 ± 6.36 mm Hg preoperatively to 16.00 ± 3.10 in group A and from 36.12 ± 8.11 mm Hg to 17.00 ± 3.75 in group B ( P = 0.449) at year 2 of follow-up. The effect of the type of surgery was not significant on the total number of IOP-lowering medications used throughout the study (repeated measures analysis of variance, P = 0.81). Kaplan-Meier analysis shows complete success in 14 patients (48.3%), 11 patients (37.9%), and 7 patients (24.1%) at 6-month, 1-year, and 2-year follow-up, respectively. The cumulative success rate was 95% at 2 years follow-up for all patients. CONCLUSIONS In 2-year follow-up, trabeculectomy or AGV significantly reduced the IOP in glaucoma patients secondary to ICE syndrome.
Collapse
Affiliation(s)
- Naveed Nilforushan
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
2
|
Ruparelia S, Darwich R, Eadie BD. PreserFlo Microshunt for the management of intraocular pressure elevation in iridocorneal endothelial syndrome. Am J Ophthalmol Case Rep 2023; 32:101932. [PMID: 37800094 PMCID: PMC10550507 DOI: 10.1016/j.ajoc.2023.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose To report on a case of angle-closure glaucoma secondary to iridocorneal endothelial (ICE) syndrome effectively managed with the PreserFlo Microshunt. Observations We report successful implantation of a PreserFlo Microshunt in a 57-year-old patient with secondary angle-closure glaucoma in the context of ICE syndrome. Following failure of medical therapy to adequately control intraocular pressure (IOP), the patient was consented for surgical intervention and underwent combined cataract surgery and PreserFlo Microshunt implantation. IOP at the last post-operative follow-up (5 months) was 12 mmHg with the patient on brinzolamide/timolol maleate (Azarga®). We report no complications in the post-operative period. Conclusions and importance The PreserFlo Microshunt may be a promising option for patients with ICE syndrome who fail medical therapy. Implantation of this device was well tolerated in the presented case.
Collapse
Affiliation(s)
- Sunil Ruparelia
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rami Darwich
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brennan D. Eadie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
3
|
Wajima R, Higashide T, Sugiyama K. Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome. Am J Ophthalmol Case Rep 2023; 32:101887. [PMID: 38161521 PMCID: PMC10757185 DOI: 10.1016/j.ajoc.2023.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter. Methods Three patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone. Results No intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively. Conclusions and importance Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.
Collapse
Affiliation(s)
- Ryotaro Wajima
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| |
Collapse
|
4
|
Tian X, Guo J, Liao J, He M, Shi Y, Tang L. Penetrating canaloplasty in angle-closure glaucoma secondary to iridocorneal endothelial syndrome following multiple failed filtering surgeries: A case report. Medicine (Baltimore) 2023; 102:e32950. [PMID: 36827050 PMCID: PMC11309658 DOI: 10.1097/md.0000000000032950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
RATIONALE Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient. PATIENT CONCERNS A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye. DIAGNOSES The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations. INTERVENTIONS Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye. OUTCOMES The patient's visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed. LESSONS Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.
Collapse
Affiliation(s)
- Xuelian Tian
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Juan Guo
- Department of Ophthalmology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jinying Liao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng He
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yinwen Shi
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
5
|
Senthilkumar VA, Puthuran GV, Tara TD, Nagdev N, Ramesh S, Mani I, Krishnadas SR, Gedde SJ. Outcomes of the Aurolab aqueous drainage implant and trabeculectomy with mitomycin C in iridocorneal endothelial syndrome. Graefes Arch Clin Exp Ophthalmol 2023; 261:545-554. [PMID: 36038686 DOI: 10.1007/s00417-022-05811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/24/2022] [Accepted: 08/16/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. MATERIALS AND METHODS This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31-83%) and 24% in the AADI group (95%CI = 11-48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16-1.40). CONCLUSION AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.
Collapse
Affiliation(s)
| | - George Varghese Puthuran
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.
| | - Techi Dodum Tara
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.,Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Tirunelveli, India
| | - Nimrita Nagdev
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Sujitha Ramesh
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Iswarya Mani
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | | | - Steven Jon Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Deng Y, Zhang S, Ye W, Gu J, Lin H, Cheng H, Xie Y, Le R, Tao Y, Zhang W, Chen W, Tham CC, He M, Wang N, Liang Y. Achieving inner aqueous drain in glaucoma secondary to iridocorneal endothelial syndrome: One year results of penetrating canaloplasty. Am J Ophthalmol 2022; 243:83-90. [PMID: 35870489 DOI: 10.1016/j.ajo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSES To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE). DESIGN Prospective, non-comparative clinical study. METHODS Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled IOP between January 2018 and April 2020. Patients were followed up at one week, month 1, 3, 6, 12 postoperatively, and semi-annually thereafter. Intraocular pressure (IOP), number of anti-glaucoma medication and surgery-related complications were recorded. Surgical success was defined as IOP ≥5 and ≤21mmHg without (complete success) or with/without (qualified success) IOP-lowering medications. RESULTS A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5±11.8 mmHg on 2.9±1.0 medications before surgery to 16.6±5.3 mmHg (P<0.001) on 0.2±0.6 medications (P<0.001) at 12 months post-operation, respectively. Hyphema (37.9%), transient hypotony (34.5%) and transient post-operative IOP elevation (≥30mmHg, 17.9%) were the most commonly observed early complications at the one week and one month visits. From one month and beyond, all treated eyes showed no obvious bleb at the operation quadrant. CONCLUSIONS Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated quite acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.
Collapse
Affiliation(s)
- Yuxuan Deng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Shaodan Zhang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wenqing Ye
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Juan Gu
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Haishuang Lin
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Huanhuan Cheng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Wuhu First People's Hospital, Wuhu, Anhui, China
| | - Yanqian Xie
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Rongrong Le
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Yan Tao
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wei Zhang
- Biomedical Informatics and Statistics Center, School of Public Health, Fudan University, Shanghai, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mingguang He
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China.
| |
Collapse
|
7
|
D'cruz RP, Rao A. 'Progressive peripheral anterior synechiae in iridocorneoendothelial syndrome- a crawling disaster'. Eur J Ophthalmol 2021; 33:NP40-NP44. [PMID: 34964381 DOI: 10.1177/11206721211070095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Iridocorneal endothelial (ICE) syndrome is well known to cause refractory glaucoma in young adults. Commonly acclaimed mechanism for trabeculectomy failure in these cases include accelerated subconjunctival fibrosis, abnormal endothelial proliferation, and closure of ostium. In the following article, we present a case of Iridocorneal endothelial syndrome that presented with refractory glaucoma after trabeculectomy due to rapidly progressive peripheral anterior synechiae causing angle closure and corneal decompensation that mandated a tailored surgical approach of management. Methods: This is a descriptive case report based on electronic medical records, patient observation, surgical intervention, and follow-ups. Case description: A thirty-eight-year-old-male presented to us with signs suggestive of iridocorneal endothelial syndrome with gonioscopy revealing peripheral anterior synechiae (PAS) over four clock-hours temporally. Uncontrolled intraocular pressure (IOP) despite maximal medical therapy mandated augmented trabeculectomy with anti-fibrotics. The bleb failed within 3 weeks of trabeculectomy, with evidence of progressive crawling PAS causing endothelial decompensation and raised IOP. He underwent Ahmed glaucoma valve (AGV) implant surgery with viscosynechiolysis and sectoral iridectomy under antiviral cover. This helped control IOP and retain corneal clarity, with no recurrence of PAS in the affected area. Conclusion: Progressive peripheral synechiae in ICE syndrome can cause early bleb failure and refractory glaucoma. Careful viscosynechiolysis and sectoral iridectomy alongside a second implant surgery can help salvage visual functions and preserve corneal clarity while preventing further progression of PAS in these eyes.
Collapse
Affiliation(s)
- Rakhi P D'cruz
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, India
| | - Aparna Rao
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, India
| |
Collapse
|
8
|
Abstract
PRéCIS:: This case series reports safe, effective implantation of XEN gel stents to treat iridocorneal endothelial (ICE) syndrome. The stents continue to function well and have not been occluded by membranes or peripheral anterior synechiae, but continued follow-up is necessary. PURPOSE ICE syndrome-related glaucoma is often refractory to medical treatment, and traditional surgical treatment has lower success rates than typical for other types of glaucoma. We present a series of patients who were treated with XEN gel stent implantation. PATIENTS AND METHODS Retrospective case series of 4 patients with ICE syndrome who underwent XEN with subconjunctival mitomycin C injection. RESULTS Average preoperative intraocular pressure was 28.5 mm Hg on 3.8 glaucoma medications, and average postoperative intraocular pressure was 10.5 mm Hg on 1.0 medication. No patients required return to the operating room for additional procedures over an average of 6.9 months of follow-up. One patient had shallow anterior chamber that resolved with conservative management. Another had shallow anterior chamber that resolved with anterior chamber reformation with viscoelastic and developed nonappositional choroidal effusions that had resolved at most recent follow-up of 7 months after surgery. No XEN implants have been occluded by membrane formation or peripheral anterior synechiae. CONCLUSIONS XEN is a safe and effective option for surgical management of ICE syndrome-related glaucoma. Further follow-up surveillance is necessary.
Collapse
|
9
|
Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome. Eye (Lond) 2020; 35:608-615. [PMID: 32367005 DOI: 10.1038/s41433-020-0912-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. METHODS Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. RESULTS The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = -3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. CONCLUSIONS Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.
Collapse
|
10
|
Outcomes of Ahmed Glaucoma Drainage Implant in Eyes With Glaucoma Secondary to Iridocorneal Endothelial Syndrome. J Glaucoma 2020; 29:567-571. [DOI: 10.1097/ijg.0000000000001504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Pathak Ray V, Rao DP, Gulati I. Primary implantation of non-valved glaucoma-drainage-device in sulcus in iridocorneal endothelial syndrome. Int J Ophthalmol 2019; 12:1809-1811. [PMID: 31741874 DOI: 10.18240/ijo.2019.11.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Divya P Rao
- L V Prasad Eye Institute, Banjara Hills, Hyderabad 500034, India
| | - Isha Gulati
- L V Prasad Eye Institute, Banjara Hills, Hyderabad 500034, India
| |
Collapse
|
12
|
De Maria M, Iannetta D, Moramarco A, Fontana L. Iridocorneal endothelial syndrome in a patient with keratoconus - a case report. BMC Ophthalmol 2019; 19:221. [PMID: 31711443 PMCID: PMC6849214 DOI: 10.1186/s12886-019-1215-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/25/2019] [Indexed: 11/20/2022] Open
Abstract
Background To describe a case of a rare association of bilateral keratoconus and unilateral essential iris atrophy and to conduct a literature review of the current strategies of treatment of the corneal disease and glaucoma in patients with Iridocorneal Endothelial Syndrome (ICE). Case presentation We report a rare association of bilateral keratoconus and unilateral essential iris atrophy in a 38-year-old man. Diagnosis of bilateral keratoconus was confirmed by corneal topography. Slit-lamp examination showed extensive iris atrophy with corectopia and policoria in one eye. Corneal specular microscopy revealed an abnormal endothelium morphology in the same eye with extensive peripheral anterior synechiae and closure of the drainage angle at gonioscopy. Intraocular pressure was 26 mmHg, despite maximal topical therapy. Optic disc examination showed severe glaucomatous cupping. Surgery by glaucoma drainage device implantation was performed. Conclusion Essential iris atrophy is a rare clinical variant of ICE syndrome characterized by profound anatomical alterations of the anterior segment associated with corneal edema and secondary glaucoma. In these patients, selective keratoplasties have replaced penetrating keratoplasty to treat corneal decompensation and glaucoma drainage devices are preferred to conventional trabeculectomy for the treatment of secondary glaucoma.
Collapse
Affiliation(s)
- Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine Ph.D. program, University of Modena and Reggio Emilia, Modena, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Fontana
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.
| |
Collapse
|
13
|
Colás-Tomás T, López Tizón E. Ex-PRESS mini-shunt implanted in a pregnant patient with iridocorneal endothelial syndrome. Eur J Ophthalmol 2019; 30:NP25-NP28. [DOI: 10.1177/1120672118820508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The failure rate of both filtration surgery and of aqueous shunt implantation is higher for iridocorneal endothelial syndrome than in other scenarios, due to the continuous proliferation of abnormal endothelial cells over the trabecular meshwork and the filtration area and also due to the more pronounced cicatrizing response shown by these young patients. We present the first case ever described in the literature of a pregnant patient with iridocorneal endothelial syndrome and uncontrolled ocular hypertension who was implanted an Ex-PRESS mini-shunt. Clinical case: A 35-year-old female presented with diminution of vision in the left eye for 2 months. She was 20 weeks pregnant. Her visual acuity was 20/20 in right eye and 20/25 in left eye, and intraocular pressure was 11 mmHg in right eye and 34 mmHg in left eye. Slit lamp biomicroscopic examination revealed no alterations in right eye, whereas left eye showed corectopia and uveal ectropion, stroma of iris’ sectoral atrophy and moderate corneal epithelial edema. Gonioscopy showed some anterior iris synechiae in left eye. Fundus evaluation was normal. Based on clinical features and examination, the diagnosis of left eye iridocorneal endothelial syndrome with decompensated intraocular pressure was made. She was prescribed topical timolol (0.5%) and dorzolamide. As a result of uncontrolled intraocular pressure and the impossibility to prescribe other hypotensive treatment available due to her being pregnant, it was decided to perform surgery in left eye using an Ex-PRESS mini-shunt and Ologen®; 6 months post surgery, intraocular pressure was 9 mmHg with no need for hypotensive treatment. The cornea was transparent, and the patient maintained her left eye visual acuity. Conclusions: Ex-PRESS mini-shunt can be considered a surgical option for iridocorneal endothelial syndrome. Its composition allows the ostium to remain open and the device triggers a milder postoperative inflammatory response. In our particular case, taking into account that the subject was a young, phakic, pregnant woman, whose intraocular pressure had to be closely controlled and we had to ensure that her postoperative care included as few drugs and as few reoperations as possible, we thought that using this device was the most appropriate option.
Collapse
|
14
|
Silva L, Najafi A, Suwan Y, Teekhasaenee C, Ritch R. The iridocorneal endothelial syndrome. Surv Ophthalmol 2018; 63:665-676. [DOI: 10.1016/j.survophthal.2018.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 12/19/2017] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
|
15
|
Abstract
This article aims to review the clinical management strategies available for the rare iridocorneal endothelial syndrome. The different clinical variations as well as the imaging techniques available to aid diagnosis are discussed. We then present the evidence available to help the reader to understand how the condition can be managed medically and also the important surgical aspects of treatment. This involves raised intraocular pressure management in addition to the visual management options of partial or full thickness keratoplasty. We hope that this review provides an exhaustive but also succinct review of the literature available on what is a rare and difficult condition to treat.
Collapse
Affiliation(s)
- Andrew Walkden
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Leon Au
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
16
|
Pilat AV, Sheth V, Purohit R, Proudlock FA, Anwar S, Gottlob I. Hand-held optical coherence tomography imaging in children with anterior segment dysgenesis. Acta Ophthalmol 2017; 95:537-541. [PMID: 27130748 PMCID: PMC5516133 DOI: 10.1111/aos.13053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Anastasia V. Pilat
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Viral Sheth
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Ravi Purohit
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Frank A. Proudlock
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Samira Anwar
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Irene Gottlob
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| |
Collapse
|
17
|
Chandran P, Rao HL, Mandal AK, Choudhari NS, Garudadri CS, Senthil S. Glaucoma associated with iridocorneal endothelial syndrome in 203 Indian subjects. PLoS One 2017; 12:e0171884. [PMID: 28282413 PMCID: PMC5345787 DOI: 10.1371/journal.pone.0171884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/28/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose To report the demographic profile, clinical features, and prevalence of glaucoma and its management in patients with Iridocorneal endothelial (ICE) syndrome. Methods Retrospective review of 203 consecutive subjects with ICE syndrome at a tertiary eye care centre between January 1988 and June 2013. Results ICE syndrome was present in 223 eyes of 203 subjects, 124 (61%) were female and 79 (39%) were male. The median age at presentation was 43 years (1st (Q1) and 3rd (Q3) quartile; 34, 51 years). ICE syndrome was unilateral in 183 (90%) subjects, and bilateral in 20 (10%) subjects. The most common clinical variant was progressive iris atrophy (PIA, 115; 52% eyes), followed by Chandler syndrome (CS, 87; 39% eyes) and Cogan-Reese syndrome (CRS, 21; 9% eyes). Glaucoma was found in 156 eyes (70%) at presentation and the median (Q1, Q3) intraocular pressure in eyes with glaucoma was 24 (16, 38) mm Hg. Seven eyes developed glaucoma during the follow-up period, increasing the percentage of eyes with glaucoma to 73%. Intraocular pressure was managed medically in 81 eyes (50%) and the other 82 eyes (50%) required surgical intervention. Corneal edema was present in 124 eyes (56%) of which, 32 eyes (14%) required keratoplasty. Conclusions In our study on ICE syndrome in Indian population, the presentation was predominantly uniocular and more common in middle aged women. Progressive iris atrophy was the most common clinical variant. ICE syndrome was associated with glaucoma in over 70% of the eyes and half of the eyes had corneal edema.
Collapse
Affiliation(s)
- Premanand Chandran
- VST Glaucoma Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Harsha L. Rao
- VST Glaucoma Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anil K. Mandal
- VST Glaucoma Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | - Sirisha Senthil
- VST Glaucoma Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- * E-mail: ,
| |
Collapse
|
18
|
Surgical outcomes of patients with iridocorneal endothelial syndrome: a case series. Int Ophthalmol 2016; 37:607-613. [DOI: 10.1007/s10792-016-0317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
|
19
|
Jain VK, Sharma R, Ojha S, Tandon A, Babber M, Jain G, Sami I. Trabeculectomy with Mitomycin-C in Patients with Iridocorneal Endothelial Syndrome: A Case Series. J Clin Diagn Res 2016; 10:NR05-6. [PMID: 27437260 DOI: 10.7860/jcdr/2016/16506.7782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
Iridocorneal Endothelial syndrome (ICE) is a rare ocular disorder characterized by abnormal endothelization of angle structure and iris producing characteristic manifestations including secondary angle closure glaucoma. We describe the clinical course of three patients with secondary glaucoma due to ICE syndrome who underwent trabeculectomy with mitomycin-C. At last follow-up, all patients had controlled IOP (<18 mm Hg) off drug. Early postoperative period was accompanied by shallowing of anterior chamber, diffuse vascularisation of bleb, frequent episodes of high IOP which were managed successfully. Trabeculectomy with MMC offers a good treatment choice for the management of secondary glaucoma associated with ICE syndrome.
Collapse
Affiliation(s)
- Vaibhav Kumar Jain
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Reena Sharma
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Sushil Ojha
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Anupama Tandon
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Meenu Babber
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Gunjan Jain
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| | - Ifsa Sami
- Assistant Professor, Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences & Research (UPRIMS & R) , Saifai, Etawah, India
| |
Collapse
|