Jose Vicente Piá-Ludeña

Introduction: To present a novel surgical technique for the treatment of a steep-walled filtering bleb following an Ahmed glaucoma valve implant. The primary aim was to alleviate the patient's discomfort and address associated corneal thinning, complications that can arise from this condition. Methods: Case report and surgical technique. This case report describes a 29-year-old female who developed a dysesthesic filtering bleb following the implantation of a glaucoma drainage device. The employed surgical technique to address this complication involved the drainage of aqueous from the bleb using a 30-G needle, which effectively reduced its height. Subsequently, a compression suture was applied to maintain an appropriate bleb size. Results: With the presented surgical technique, the ultimate control of an overhigh filtering bleb associated to a glaucoma drainage device was possible. Following the procedure, the patient's symptoms and the corneal thinning linked to the bleb's excessive size were successfully managed. Furthermore, the anatomy of the filtering bleb was preserved, and an optimal intraocular pressure outcome was achieved. Conclusions: The removal of aqueous and the application of a compression suture are two surgical techniques traditionally used for managing the hypertensive phase of glaucoma drainage devices and for alleviating discomfort from blebs after classical filtering surgery, respectively. In the case presented, the combination of these two techniques effectively reduced the size of an excessively high filtering bleb associated with a glaucoma drainage device. This approach successfully resolved the patient's discomfort and corneal issues related to this complication.

Purpose: To describe an alternative technique used in massive post-traumatic cyclodialysis. Classic techniques such as direct cyclopexy are performed ab externo and entail a higher risk of endophthalmitis or ciliary body hemorrhage. Therefore we present a case report using combined sewing machine technique cyclopexy with transscleral diode cyclophotocoagulation for complete post-traumatic cyclodialysis. Patients: Our patient is a 43-year-old woman who suffered a blunt trauma 9 months ago from an air-bag blunt in a car accident. Methods: Technique report. Results: Two weeks post-surgery, there has been an elevation in intraocular pressure (IOP), and the cyclodialysis has been resolved. Additionally, signs of macular hypotony, such as optic nerve head edema and vascular tortuosity, have disappeared. As anticipated, the disappearance of chorioretinal folds occurred later but has also been observed. Furthermore, the best corrected visual acuity has been improved and the induced hyperopia has been corrected from +5 (−1.75 × 20°) to +1.5 (−1.75 × 20°). Conclusions: Combined sewing machine technique cyclopexy with transscleral diode cyclophotocoagulation for complete post-traumatic cyclodialysis could be an alternative surgical improvement to both direct and indirect cyclopexy. It entails fewer complications, such as endophthalmitis, and offers favorable aesthetic outcomes along with enhanced intraoperative visualization.

Purpose: As minimally invasive glaucoma surgery devices emerge, newer complications are reported. XEN gel stent is safer than classic glaucoma surgery but may also lead to severe adverse effects as hypotony. Compression conjunctival sutures are a useful treatment for overfiltration hypotony after XEN gel stent implantation, but might force bleb tearing by the implant as it gets tightly close to the sutured conjunctiva. This complication has not been previously reported. Methods: We report a patient with overfiltration hypotony after XEN gel implantation. Conjunctival compression sutures and implant relocation ab interno were performed obtaining a good outcome. As conjunctiva got tightly close to the stent, the device eroded the bleb so leakage and implant extrusion were found. Results: Bleb reconstruction by conjunctival autograft was performed in order to avoid hypotony due to continuous conjunctival leakage. Conclusion: Conjunctival compression sutures may be used for overfiltration control after XEN gel implantation but we must be aware of potential conjunctival damage due to implant erosion even if it is correctly positioned. Close follow-up and early suture release may be convenient in these patients.

Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure. A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation. Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference (p = 0.18). When we compare both groups, there was no difference at 1 month (p = 0.46) and 3 months (p = 0.21) after surgery. However, there was a statistically significant difference at month 6 (p = 0.0055) and 1 year (p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure p = 0.2). For intraocular pressure p = 0.06), and for intraocular pressure p = 0.02). Hypotony (p = 0.01) and vision loss of two lines (p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group. This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.