Document Detail


Histopathologic findings in early encapsulated blebs of young patients treated with the ahmed glaucoma valve.
MedLine Citation:
PMID:  20520569     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE/AIM: Uncontrolled glaucoma presents a challenge for the ophthalmic surgeon especially in children and juvenile patients. For many patients who have undergone failed surgical procedures before, episcleral implants remain the last choice. Encapsulated blebs forming over antiglaucoma devices present a complication leading to malfunctioning or even failure with reincrease in intraocular pressure. We report our histopathologic findings of such blebs developing around the Ahmed glaucoma valve (AGV) after a short time period in young patients.
MATERIALS AND METHODS: Nine young patients (2 to 17 y of age) with otherwise uncontrollable glaucoma were treated with AGV (models FP-7 and FP-8, silicone base plate) by 1 surgeon (H.T.). Four eyes needed surgical revision 2 to 6 months after initial implantation owing to encapsulated bleb development over the valve with total loss of function. The dense capsule around the device was surgically removed and investigated macroscopically, microscopically, and ultrastructurally.
RESULTS: The cystic wall of these encapsulated blebs had an overall thickness of 1.5 to 2 mm. Macroscopically, the tissue was split into 2 layers. Histopathologically, the smooth inner surface (facing the base plate of the AGV) consisted of compressed collagen fibers with signs of elastoid degeneration and with formation of a pseudoendothelium toward the base plate. There was a pronounced transformation of fibroblasts into myofibroblasts in this inner layer. The outer area was highly vascularized. In these vessels electron microscopy revealed thrombosis. Inflammatory responses were nearly absent in all areas of the excised material. Intraocular pressure could be controlled by removal of the encapsulated blebs in all 4 cases.
CONCLUSIONS: Encapsulation of the AGV is an early complication in young patients, leading to inhibition of fluid exchange and failure of the procedure. The valve mechanism is blocked by contracted scar tissue, but the device itself is not affected by the encapsulation. Surgical excision of the capsule immediately leads to an aqueous flow and drop of intraocular pressure.
Authors:
Hagen Thieme; Lars Choritz; Carmen Hofmann-Rummelt; Ursula Schloetzer-Schrehardt; Ulrike B Kottler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of glaucoma     Volume:  20     ISSN:  1536-481X     ISO Abbreviation:  J. Glaucoma     Publication Date:    2011 Apr-May
Date Detail:
Created Date:  2011-04-01     Completed Date:  2011-06-20     Revised Date:  2011-08-25    
Medline Journal Info:
Nlm Unique ID:  9300903     Medline TA:  J Glaucoma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  246-51     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Mainz University Medical Center, Mainz, Germany. thieme@augen.klinik.uni-mainz.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Conjunctival Diseases / etiology,  pathology*,  surgery
Cysts / etiology,  pathology*,  surgery
Glaucoma / surgery*
Glaucoma Drainage Implants*
Humans
Intraocular Pressure
Myofibroblasts / ultrastructure
Postoperative Complications*
Prosthesis Implantation
Tenon Capsule / pathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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