Nitta Keisuke, Akiyama Hideo
Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, JPN.
Cureus. 2023 Feb 11;15(2):e34854. doi: 10.7759/cureus.34854. eCollection 2023 Feb.
We present a new technique for inserting the tube of the Ahmed glaucoma valve (AGV) (model FP7; Rancho Cucamonga, CA: New World Medical) implant into the ciliary sulcus, easily and precisely, using a 4-0 nylon thread as a guide. An 88-year-old woman received AGV implantation for secondary angle recession glaucoma with underlying pseudoexfoliation syndrome in her left eye. She had a history of trauma with mild intraocular lens (IOL) oscillation and poor mydriasis, with maximum pupil diameter of 3.5 mm. Ciliary sulcus tube insertion in such patients sometimes becomes difficult, however, using a 4-0 nylon thread as a guide, precise insertion was achieved easily in the following way. A 4-0 nylon thread was placed into the anterior chamber through a 1 mm incision opposite the site of the AGV implant. Subsequently, a 23G needle was inserted into the sclera 2 mm from the corneal limbus in the same quadrant as AGV implants. The tip of the 23G needle proceeded horizontally to the iris, through the sclera and ciliary body, and into the ciliary sulcus. At the center of the pupil, the 4-0 nylon thread was introduced into the lumen of the 23G needle. Subsequently, the 23G needle, together with the 4-0 nylon thread in the lumen was withdrawn out of the eye. The 4-0 nylon was then inserted into the tube lumen of the AGV implant. Finally, by using 4-0 nylon as a guide, the Ahmed tube was inserted into the ciliary sulcus precisely without much difficulty.
我们介绍一种新技术，使用4-0尼龙线作为引导，将艾哈迈德青光眼阀（AGV）（FP7型号；加利福尼亚州兰乔库卡蒙加：新世界医疗公司）植入物的导管轻松、精确地插入睫状沟。一名88岁女性因左眼继发性房角后退性青光眼合并潜在的剥脱综合征接受了AGV植入术。她有外伤史，伴有轻度人工晶状体（IOL）摆动和瞳孔散大不良，最大瞳孔直径为3.5mm。然而，在这类患者中，睫状沟导管插入有时会变得困难，不过，使用4-0尼龙线作为引导，通过以下方法可轻松实现精确插入。将一根4-0尼龙线通过与AGV植入部位相对的1mm切口放入前房。随后，将一根23G针头在与AGV植入物相同象限距角膜缘2mm处插入巩膜。23G针头的尖端水平穿过巩膜和睫状体，进入虹膜，再进入睫状沟。在瞳孔中心，将4-0尼龙线引入23G针头的管腔。随后，将23G针头连同管腔内的4-0尼龙线一起从眼内拔出。然后将4-0尼龙线插入AGV植入物的导管管腔。最后，以4-0尼龙线作为引导，将艾哈迈德导管轻松精确地插入睫状沟。
