Glaucoma, LV Prasad Eye Institute, Vijayawada, India.
VST Center for Glaucoma Care, LV Prasad Eye Institute, Hyderabad, India.
BMJ Case Rep. 2020 May 13;13(5):e234454. doi: 10.1136/bcr-2020-234454.
A 5-year-old boy with failed combined trabeculotomy and trabeculectomy underwent Ahmed glaucoma valve (AGV) implantation and presented 5 weeks postoperatively, with sudden onset proptosis downward displacement of the globe, limited extraocular movements and displacement of tube from anterior chamber. CT scan of the orbits showed a large cystic bleb with posterior dislocation of the implant and was explanted. In vitro testing of implant for fluid flow characteristics revealed a dysfunctional valve with anterior leak, which could have possibly lead to anterior and inferior fluid accumulation resulting in displacement of implant, a probable cause for this rare complication. The case was successfully managed later with the Aurolab aqueous drainage device implantation. This case report cautions the surgeon for the possibility of a large cystic bleb following abnormal leak in AGV resulting in orbital complications like proptosis, motility limitation and impending optic nerve compression.
一位 5 岁男孩曾行联合小梁切开术和小梁切除术失败，后行 Ahmed 青光眼引流阀（AGV）植入术，术后 5 周出现眼球向下突出、眼球运动受限和引流管从前房脱出。眼眶 CT 扫描显示大的囊性隆起，植入物后脱位，遂将其取出。植入物的流体流动特性的体外测试显示阀门功能障碍，存在前漏，这可能导致前下方液体积聚，从而导致植入物移位，这可能是导致这种罕见并发症的原因。随后成功地使用 Aurolab 房水引流装置进行了治疗。本病例报告提醒外科医生注意 AGV 异常渗漏后形成大的囊性隆起的可能性，这可能导致眼球突出、运动受限和视神经受压等眼眶并发症。
