AHMED VALVE IMPLANTATION IN PATIENT WITH PREVIOUS ENDOKPRO AFTER SEVERE CAUSTICATION

To present a clinical case of glaucoma and Ahmed Valve implantation in a patient with previous deep anterior lamellar keratoplasty and EndoKpro and no alternatives to other glaucoma surgeries. 

A 55-year-old male with bilateral severe ocular caustication with secondary total limbar insufficiency. In the right eye, after several interventions and due to the poor prognosis of a penetrating transplant, an EndoKpro was implanted. The device was placed between the recipient cornea and the donor keratoplasty to avoid contact and rejection of the donor. The pseudocamera was stable and the prosthesis was tolerated, but she suffered postoperative acute glaucoma due to secondary angular closure. Peripheral iridotomies did not decrease intraocular pressure (IOP).

Due to the absence of viable conjunctiva and limbus for a filtering surgical technique, Ahmed valve was implanted with the retroiridian tube and posterior to one of the branches of the EndoKpro. Gonioscopy was performed with a 360º synechiated angle to the corneal graft flange which required 360º synechiolysis with a 27G cannula. Subsequently, the valve plate was sutured to the sclera in the superior temporal quadrant. The placement of the retroiridian valve tube posterior to one of the EndoKpro stems and with the bevel oriented backwards would avoid the feared suction of the recipient corneal graft.

Currently, the plate is covered and the tube is not in contact with the graft. The EndoKpro is well implanted with double chamber and depth. The patient has stable and low IOP (10-12 mmHg).

The advantages of the EndoKpro are its implantation in patients with or without previous transplantation and being a non-perforating lamellar technique with closed chamber. It generates less inflammatory reaction, risk of rejection and endophthalmitis. Ahmed Valve implantation in patients with EndoKpro can be an effective and safe procedure in patients with glaucoma refractory to a first line of treatment and not candidates to other filtering surgeries or drainage devices, either due to alterations in the functionality of the anterior pole or in its anatomical structures.