Journal List > J Korean Ophthalmol Soc > v.56(4) > 1010261

Lee, Cho, La, and Choi: Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis

초록

Purpose:

To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs’ heterochromic iridocyclitis.

Case summary:

A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity de-teriorated due to progression of the corneal edema and penetrating keratoplasty was performed.

Conclusions:

Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs’ heterochromic iridocyclitis-induced glaucoma.

References

1. Panek WC, Holland GN, Lee DA, Christensen RE. Glaucoma in patients with uveitis. Br J Ophthalmol. 1990; 74:223–7.
2. Foster CS, Havrlikova K, Baltatzis S, et al. Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis. Acta Ophthalmol Scand. 2000; 78:576–9.
3. Allen RC, Bellows AR, Hutchinson BT, Murphy SD. Filtration surgery in the treatment of neovascular glaucoma. Ophthalmology. 1982; 89:1181–7.
4. Schwartz AL, Anderson DR. Trabecular surgery. Arch Ophthalmol. 1974; 92:134–8.
5. Folberg R, Hargett NA, Weaver JE, McLean IW. Filtering valve implant for neovascular glaucoma in proliferative diabetic retinopathy. Ophthalmology. 1982; 89:286–9.
6. Da Mata A, Burk SE, Netland PA, et al. Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Ophthalmology. 1999; 106:2168–72.
7. Tsai JC, Johnson CC, Dietrich MS. The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma: a single-surgeon comparison of outcome. Ophthalmology. 2003; 110:1814–21.
8. Papadaki TG, Zacharopoulos IP, Pasquale LR, et al. Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol. 2007; 144:62–9.
9. Garudadri CS, Garg P, Senthil S. Changes in corneal endothelial cells after ahmed glaucoma valve implantation: 2-year follow-up. Am J Ophthalmol. 2010; 149:688–9. author reply 689.
10. Britt MT, LaBree LD, Lloyd MA, et al. Randomized clinical trial of the 350-mm2 versus the 500-mm2 Baerveldt implant: longer term results: is bigger better? Ophthalmology. 1999; 106:2312–8.
11. McDermott ML, Swendris RP, Shin DH, et al. Corneal endothelial cell counts after Molteno implantation. Am J Ophthalmol. 1993; 115:93–6.
12. Fiore PM, Richter CU, Arzeno G, et al. The effect of anterior chamber depth on endothelial cell count after filtration surgery. Arch Ophthalmol. 1989; 107:1609–11.
13. Kim JH, Kim CS. The Change in Corneal Endothelial Cells after Ahmed Glaucoma Valve Implantation. J Korean Ophthalmol Soc. 2006; 47:1972–80.
14. Oh WH, Kim TW, Park KH, Kim DM. Location of the Tube Tip in the Anterior Chamber and Change in Corneal Endothelium after Ahmed Valve Implantation. J Korean Ophthalmol Soc. 2013; 54:469–74.
15. Setälä K. Corneal endothelial cell density after an attack of acute glaucoma. Acta Ophthalmol (Copenh). 1979; 57:1004–13.
16. Han GH, Jeon SL. The change of the corneal endothelial cell after acute angle closure glaucoma. J Korean Ophthalmol Soc. 2003; 44:16–21.
17. Gagnon MM, Boisjoly HM, Brunette I, et al. Corneal endothelial cell density in glaucoma. Cornea. 1997; 16:314–8.
18. Bigar F, Witmer R. Corneal endothelial changes in primary acute angle-closure glaucoma. Ophthalmology. 1982; 89:596–9.
19. Yang P, Fang W, Jin H, et al. Clinical features of Chinese patients with Fuchs' syndrome. Ophthalmology. 2006; 113:473–80.
20. Bonfioli AA, Curi AL, Orefice F. Fuchs' heterochromic cyclitis. Semin Ophthalmol. 2005; 20:143–6.
21. Liesegang TJ. Clinical features and prognosis in Fuchs' uveitis syndrome. Arch Ophthalmol. 1982; 100:1622–6.
22. Alanko HI, Vuorre I, Saari KM. Characteristics of corneal endothelial cells in Fuchs' heterochromic cyclitis. Acta Ophthalmol (Copenh). 1986; 64:623–31.
23. Sung VC, Barton K. Management of inflammatory glaucomas. Curr Opin Ophthalmol. 2004; 15:136–40.
24. Wilson MR, Mendis U, Paliwal A, Haynatzka V. Long-term fol-low-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy. Am J Ophthalmol. 2003; 136:464–70.
25. Mehta RR, Mehta CK. Drainage Implant Surgery. Mastering the Tech of Glaucoma Diag & Management. 2006; 292.
26. Murray P. Serum autoantibodies and uveitis. Br J Ophthalmol. 1986; 70:266–8.
27. Kimura SJ, Hogan MJ, Thygeson P. Fuchs' syndrome of heterochromic cyclitis. AMA Arch Ophthalmol. 1955; 54:179–86.
28. Norrsell K, Holmér AK, Jacobson H. Aqueous flare in patients with monocular iris atrophy and uveitis. A laser flare and iris angiography study. Acta Ophthalmol Scand. 1998; 76:405–12.
29. Wang RC, Rao NA. Idiopathic and other anterior uveitis syndromes. Yanoff M, Duker JS, editors. Ophthalmology. 2nd ed.St Louis: Mosby;2004. p. 1209–14.
30. Norrsell K, Sjödell L. Fuchs' heterochromic uveitis: a longitudinal clinical study. Acta Ophthalmol. 2008; 86:58–64.
31. Jones NP. Fuchs' heterochromic uveitis: an update. Surv Ophthalmol. 1993; 37:253–72.
32. Quentin CD, Reiber H. Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor. Am J Ophthalmol. 2004; 138:46–54.
33. Van Gelder RN. Idiopathic no more: clues to the pathogenesis of Fuchs heterochromic iridocyclitis and glaucomatocyclitic crisis. Am J Ophthalmol. 2008; 145:769–71.
34. Chee SP, Jap A. Presumed fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes. Am J Ophthalmol. 2008; 146:883–9.e1.

Figure 1.
Preoperative images: The slit lamp exam shows (A) fine round or stellate keratic precipitates and fine filaments on the endothelium between the keratic precipitates (B) patchy loss of the iris pigment epithelium. (C) The funduscopy shows swol-len optic disc.
jkos-56-643f1.tif
Figure 2.
After the Ahmed valve implantation: (A) the valve tip was well positioned at superotemporal side (POD 1 day) (B) the slit lamp shows depigmented atrophic iris and posterior syn-echiae (POD 8 months) (C) before PPKP: Severely edematous cornea and corneal haziness are shown. POD = Postop date; PPKP = penetrating keratoplasty.
jkos-56-643f2.tif
Figure 3.
Remarkable changes of corneal endothelial cell density: (A) before Ahmed valve implantation (A-1: right eye, A-2: left eye) (B) POD 7 months after Ahmed valve implantation (C) POD 13 months after Ahmed valve implantation (D) before cataract surgery. POD = Postop date.
jkos-56-643f3.tif
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