Combined Bleb Revision with Ahmed Valve Placement

In this surgical video, Dr. David Smits, Dr. Lucy Shen and colleagues combine a bleb revision with Ahmed valve placement. The patient had a remote history of trabeculectomy for severe primary open-angle glaucoma in both eyes. Bleb-related endophthalmitis developed in his left eye following a bleb leak, leaving him functionally monocular. He presented with a bleb leak at the limbus in his right eye and an IOP of 3 mm Hg. He was intolerant to multiple glaucoma medications and conservative treatment failed to stop the leak.

Drs. Smits, Shen and colleagues use tutoplast sclera, pericardium and fibrin glue to repair the trabeculectomy and simultaneously insert an Ahmed valve. They chose this surgical approach over more conventional bleb repair techniques due to difficulties with fully closing a bleb leak at the limbus, the patient's history of infection in the fellow eye, the severity of his glaucoma and his intolerance to glaucoma medications. The goal was to shut down the leaky trabeculectomy and restore aqueous outflow with a tube shunt. Following the surgery, the leak was successfully repaired and IOP was controlled with the valve.

Relevant Financial Disclosures: None