Glaucoma Shunt after Keratoprosthesis: Tips to Handle the Challenges

This video presents the case of an 8-year-old boy who lost vision after a helium-cylinder blast injury. He underwent multiple surgeries over 4 years, including amniotic membrane transplant, limbal stem-cell transplant twice, keratoplasty twice, and finally keratoprosthesis to salvage the eye. Thereafter, it was determined that he had glaucoma, which was then managed by performing Ahmed glaucoma valve placement through a pars plana approach. This video explains in detail the problems that can be encountered in such cases due to poor ocular surface, thinning of ocular coats, scarring, etc. It demonstrates the surgical technique in a stepwise manner, precautions at each step, and modifications required for this procedure in eyes after chemical injuries. A systematic approach helped manage a complex situation, with the child achieving 20/60 vision and stable visual field. In a nutshell, pars plana glaucoma shunt for a refractory glaucoma could help restore ambulatory vision in a child with blast injury.