Smile Lenticule Assisted Modified Technique Of Ahmed Glaucoma Valve Implantation.

To describe the application of a modified technique of Ahmed Glaucoma Valve (AGV) implantation surgery, to decrease surgical time, minimize the risk of complications and provide better outcomes.

The Surgery was conducted in a tertiary care superspeciality eye hospital in Surat, India. 

Patient underwent AGV implantation for uncontrolled glaucoma, despite a previous trabeculectomy. Postoperatively, Intraocular pressure (IOP) measurement and ophthalmic examination were done at weekly intervals for a month, to detect complications. The modified surgical technique consisted of using 2 corneal lenticules acquired from one patient who underwent Small incision lenticule extraction (SMILE) for myopia correction. These lenticules were placed over the subconjunctival part of the AGV tube in a manner to provide a triple layered covering over it.

IOP reduced from preoperative value of 38 mm Hg to 12 mm Hg at 1 month follow up. No wound leakage, conjunctival retraction, hypotony or hypotony related posterior segment complications were noted in all the follow-ups. Patient remained comfortable and had no complains of foreign body sensation during this period.

SMILE lenticule can be a better alternative to preserved partial thickness corneal/scleral graft. Ease of manipulation, lack of epithelial/uveal tissue remnants, lower chances of retraction, better patient comfort and cosmesis are some of the various advantages noted of using this technique.