FINAL PROGRAM - Imo

Video Program
Video #31
Reimplantation of Ahmed Glaucoma Valve in a Case of
Ahmed Glaucoma Valve Extrusion
Sr. Producer: Avik Kumar Roy MBBS**
Co-Producer(s): Senthil Sirisha, Paaraj Rajendra Dave, Chandra Shekhar Garudadri
MD*
Glaucoma drainage devices (GDDs) are very good alternatives in managing
refractory glaucomas. Adequate conjunctival closure is a must to
ensure that the implant is not exposed or extruded. In the presence of
extreme conjunctival scarring following multiple intraocular procedures,
placement of GDD can be a big challenge. However, proper preoperative
planning and meticulous surgical technique using a free conjunctival autograft
along with GDD can be a solution to this relative contraindication.
We present to you a procedure of inferior Ahmed glaucoma valve (AGV)
implantation with primary scleral and conjunctival autograft in the presence
of severely scarred conjunctiva in a 45-year-old, one-eyed, aphakic,
highly myopic woman, status post vitreoretinal surgery for retinal detachment
with previous extruded AGV and uncontrolled IOP.
Video #32
Amniotic Membrane and Tenon Advancement for Repeated
Shunt Tube Exposure
Sr. Producer: Hosam Ibrahim El Sheha MD*
Co-Producer(s): Scheffer C G Tseng MD PhD*
Purpose: To describe the use of amniotic membrane graft (AM) with Tenon
advancement for repair of repeated shunt tube exposure. Methods: A
75-year-old female with a history of dry eye, multiple corneal transplants,
and repeated tube exposure in the right eye. Tube exposure occurred 12
months after Ahmed valve implantation with scleral graft, and 6 months
after revision with pericardium. A thick AM was secured over the tube
using 8/0 vicryl suture, and the Tenon capsule was dissected to cover the
graft and then covered with the conjunctiva. Results: There was no epithelial
breakdown over the AM-Tenon baitlayer, with no re-exposure, no
graft thinning, and no ocular infection during 12 months follow-up. Conclusion:
AM with Tenon advancement is an effective alternative method
for repair of tube exposure.
Video #33
A Better Way to Detect an Afferent Pupillary Defect
Sr. Producer: Mohsin Ali BS
Co-Producer(s): M Reza Razeghinejad MD, Lan Lu MD, George L Spaeth MD FACS*
Testing for a relative afferent pupillary defect (APD) is a way of comparing
the health of the right and left optic nerves. The swinging flashlight method
is the conventional method of detecting an APD. In this video, a new,
more sensitive method for detecting subtle APDs is described in detail:
the magnifier-assisted swinging flashlight method (MA-SFM) using a +20
D lens. After a general discussion of the APD and the light reflex pathway,
cases of positive APDs are illustrated: an APD that is easily detectable
by the conventional swinging flashlight method and cases of subtle APDs
more easily detectable by the MA-SFM. Viewers will appreciate the clinical
usefulness of the MA-SFM and learn how to better detect APDs using
this method.
Video #34
The Role of Releasable Sutures With Trabeculectomy
Sr. Producer: George L Spaeth MD FACS*
Co-Producer(s): L Jay Katz MD*, Marlene R Moster MD*, Valerie Trubnik MD, Nont
Rutnin MD
The goal of trabeculectomy (or guarded filtration procedure) is to lower
IOP as safely as possible to a predetermined level. However, excessive
filtration and its consequences still occur, as commonly reported. Using
releasable sutures can minimize excessive filtration and allow titration
of IOP. We describe the theory and practice of releasable sutures: their
advantages and disadvantages, especially in comparison to laser suture
lysis; how to place them; how to evaluate the amount of filtration at surgery;
and when and how to remove the sutures. Three different, proven
techniques of releasable suture placement are demonstrated, each having
is own advantages and disadvantages.
Video #35
Boston Type 1 Keratoprosthesis With Glaucoma Drainage
Device
Sr. Producer: Samar K Basak MD DNB MBBS*
The Boston type 1 keratoprosthesis (KPro) is the most commonly implanted
keratoprosthesis worldwide. One of the main challenges with the
Boston KPro is treating concurrent glaucoma. Also, in many cases secondary
glaucoma is a major complication that is very difficult to control. Ultimately,
there is permanent visual loss due to glaucomatous optic atrophy
in spite of a very well retained and successful Boston KPro. Thus in many
cases, it is advisable to combine the procedure with a glaucoma drainage
device to prevent this long-term complication. This video demonstrates a
step-by-step approach to this combined procedure by a corneal surgeon.
It starts with conjunctival dissection, valve priming and fixation, then
Boston KPro assembly and suturing, placement of the tube, and ultimately
conjunctival closure.
Video #36
Tube Extender for Retracted Tube in a Child With Aniridia
Sr. Producer: Paaraj Rajendra Dave
Co-Producer(s): Senthil Sirisha, Chandra Shekhar Garudadri MD*
Glaucoma associated with aniridia is refractory to conventional surgical
treatment, and better results are obtained with glaucoma drainage devices.
In children, ocular growth causing tube retraction is one of the causes
of failure of the procedure. Tube extenders may be used successfully in
these cases to salvage the retracted drainage implant. A 1-year-old aniridic
child, post-keratoplasty and lens aspiration with posterior chamber
IOL, presented with secondary glaucoma and 2 failed filtering procedures.
Ahmed valve implantation resulted in well controlled IOP until the tube retracted
6 months later. A tube extender was used successfully to salvage
the implant and stabilize IOP. The video shows a tube extender implantation
technique in simple steps that can be quickly and easily learned.
Video Program
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date.
No asterisk indicates that the presenter has no financial interest.
Up-to-date information is available in the Program Search on the Academy’s website: www.aao.org/2012.
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