Fibrovascular ingrowth as a cause of Ahmed glaucoma valve failure in children

Purpose The purpose of this study is to document the presence of fibrovascular ingrowth into the Ahmed glaucoma valve (AGV) as a cause of AGV failure in the pediatric population. Design Retrospective case series. Methods Retrospective study of six children with histologically documented fibrovascular ingrowth of their AGV, with review of relevant demographic, clinical, and surgical factors. Results Six patients, two males and four females, with a mean age at AGV placement of 27.5 months (range 1 to 122) were identified with AGV failure, AGV removal, and subsequent histology documenting fibrovascular ingrowth into the valve chamber. Etiology of glaucoma included: trauma, aphakia, angle-closure, aniridia, and infantile. Mean time from AGV implantation to explantation was 23 months (range 6 to 65). Mean intraocular pressure at AGV explantation was 35 mm Hg (range 27 to 48). Conclusions Fibrovascular ingrowth of both the pediatric and adult size AGV occurs in children and should be considered in the presence of AGV failure

Retinopathy in patients with diabetic ophthalmoplegia

To review the clinical characteristics, prevalence, and severity of retinopathy in diabetics with cranial nerve (CN) 3, 4, and/or 6 palsies, and to determine the relationship between type and duration of diabetes mellitus (DM), presence of retinopathy, and occurrence of CN palsy. Retrospective, comparative cohort study. Chart reviews of 2229 patients with CN 3, 4, and/or 6 palsies were performed at the Bascom Palmer Eye Institute (BPEI) from January 1991 through December 1997 and at the Dean A. McGee Eye Institute (DMEI) from January 1994 through July 2001. A total of 306 patients qualified for the study group. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) was used as a control. Demographic and clinical data were extracted to determine characteristics of patients with diabetic ophthalmoplegia. The subsets of data regarding type of DM and level of diabetic retinopathy in the study population were compared with the WESDR control data for statistical analysis. The prevalence of diabetic retinopathy in patients with diabetic ophthalmoplegia. Of 2229 patients at both institutions with ocular motor CN palsy, 306 (13.7%) were associated with DM. The frequency of CN involvement was 6 (50.0%), 3 (43.3%), and 4 (6.7%). There was a total of 12 patients (3.9%) with consecutive palsies and 8 patients (2.6%) with simultaneous palsies (5 unilateral and 3 bilateral). At both institutions, the prevalence of retinopathy controlling for duration of DM was lower in both insulin-dependent DM (IDDM) and non-IDDM (NIDDM) type II diabetics as compared with controls (BPEI, P = 0.009 and P = 0.005; DMEI, P = 0.004 and P = 0.29). When data from both locations were combined, the difference was even more significant (IDDM, P = 0.001 and NIDDM, P = 0.006). There were no significant differences between the two institutions in gender, type or duration of DM, age at presentation, or frequency of CN involvement. Diabetic ophthalmoplegia most commonly involves CN 3 and 6, with relative sparing of CN 4. Multiple cranial nerves are affected simultaneously in 2.6% of cases, and consecutive palsies occurred in 3.9% of cases. Type II diabetics with ocular motor CN palsy have significantly less diabetic retinopathy than do controls. This may imply a different pathophysiologic mechanism for these two microvascular complications of DM

Aniridic glaucoma: diagnosis and treatment

Aniridia is a bilateral iris aplasia/hypoplasia, associated with other ocular anomalies arising during the childhood: nystagmus, photophobia, amblyopia, keratopathies, cataract and lens luxation, glaucoma, fovea and optic nerve hypoplasia. In 6-75 % of cases aniridia is accompanied by a dysgenetic secondary glaucoma caused by an iridogoniodysgenesis for abnormal migration of neural crest neuroectodermal cells, and a higher vulnerability of the optic nerve head for possible microstructural alterations in lamina cribrosa. Congenital glaucoma associated with aniridia is uncommon. The poor young patient collaboration for several clinical and instrumental analyses entails in many cases the need of examinations under general anesthesia. Medical therapy represents the first step, whereas low-responsive patients may undergo laser treatments (transscleral diode laser cyclophotocoagulation or cyclocryotherapy) and/or surgery (trabeculectomy with or without antimetabolites). Refractory cases, frequently with an early onset, require glaucoma drainage devices (Molteno implant, Ahmed valve, or Baerveldt tube shunt). A prophylactic goniotomy can be performed with a long-term effectiveness in reducing risks of aniridic glaucoma onset or progression. \ua9 Springer International Publishing Switzerland 2015. All rights are reserved