Exchange of Ahmed glaucoma valve for a Paul glaucoma implant and management of postoperative hypotony: a case report
Nawaf Alkuhaimi, Anas Alqurashi, Dania BameflehIntroduction:
Glaucoma can manifest in several forms, and some, such as uveitic glaucoma, are refractory to standard treatment. Glaucoma drainage devices (GDDs) play a crucial role in managing these diseases. The Paul glaucoma implant (PGI) is a relatively new addition to the array of available GDDs.
Case presentation:
We present the case of a 20-year-old woman with a history of juvenile idiopathic arthritis and uveitic glaucoma. The glaucoma was previously managed with an Ahmed Glaucoma Valve (AGV) in the left eye. Despite initial control of the intraocular pressure (IOP), it increased to 36 mmHg two years after AGV implantation, necessitating AGV removal and same-quadrant replacement with a PGI. At 2.5 months postoperatively, the patient experienced persistent IOP elevation despite maximum topical and systemic treatment for glaucoma. Ripcord removal was performed to prevent glaucomatous progression. One day later, the patient developed severe hypotony with 360° choroidal detachment within a week. The hypotony was managed with external tube ligation, resulting in resolution of choroidal detachment and improvement in visual acuity.
Discussion:
PGI was selected because of its small design, which may reduce the risk of hypotony. Ripcord removal should be avoided in uveitic glaucoma, as previous studies have suggested a higher incidence of hypotony. Tube ligation could be utilized for managing severe hypotony and its associated complications.
Conclusion:
Same-quadrant exchange with PGI may be viable after failed GDD surgery. Eyes with uveitis may have a higher risk of hypotony, especially after ripcord removal. Tube ligation effectively manages severe hypotony and maintains IOP and visual acuity.