Insertion of Ahmed Implant With Partial Buckle Resection: A Case Report

This report describes a case of poor intraocular pressure control after the encircling procedure for traumatic retinal detachment. We inserted an Ahmed Glaucoma Valve Implant® (AGVI) with partial sponge resection and obtained good results. The results are reported here. An 11-year-old boy had a traumatic globe rupture in the right eye (OD). Corneo-scleral repair and lens extraction were performed on the injured eye. About one month after the injury, the intraocular pressure (IOP) of OD had increased to 25 mmHg. Glaucoma eye drops were started, and the IOP was subsequently controlled at 11-19 mmHg. Five months after the injury, the total retinal detachment was observed, and the encircling procedure with a silicone sponge was performed. Soon, right IOP control deteriorated, increasing to over 30 mmHg despite the maximum eye drops dosage. Given the poor condition of the cornea and iris after the trauma and the limited surgical space after the encircling procedure, we chose to partially cut the sponge and insert the AGVI. Intraoperatively, the adhesions between the conjunctiva and the Tenon's capsule were dissected. The sponge was partially cut at the 10 o'clock position, and both ends were sutured to the sclera. The AGVI was subsequently inserted into the space obtained. The plate was placed posterior to the sponge, and the tube was placed between the cut sponges and inserted into the anterior chamber. The right IOP was 8 mmHg on the day after the surgery and remained at 15-20 mmHg until nine months after surgery postoperatively under two medications. No recurrence of retinal detachment was further observed. In our case of post-traumatic glaucoma, the partial removal of the sponge along with the insertion of an AGVI has shown beneficial results in terms of IOP control.