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Successful Management of Bilateral Uncontrolled Advanced Primary Open Angle Glaucoma in a Pregnant Woman during the
Asem A Alqudah1, Abdelwahab Aleshawi1
1Division of Ophthalmology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
A pregnant woman with advanced primary open-angle glaucoma received Ahmed glaucoma valves (AGV) during a COVID-19 lockdown. The surgery successfully lowered her intraocular pressure (IOP) long-term.
Area of Science:
- Ophthalmology
- Public Health
Background:
- COVID-19 pandemic led to national lockdowns, impacting healthcare services.
- Hospitals prioritized emergency and inpatient care, canceling elective procedures.
- Access to specialized eye care, particularly for advanced glaucoma, became challenging.
Purpose of the Study:
- To report a case of advanced primary open-angle glaucoma in a pregnant patient during a COVID-19 lockdown.
- To describe the surgical management and long-term outcomes of Ahmed glaucoma valve implantation in this unique scenario.
Main Methods:
- A 38-year-old pregnant female with uncontrolled primary open-angle glaucoma presented with high intraocular pressure (IOP).
- Despite maximal medical therapy, IOP remained elevated (53 mmHg OD, 40 mmHg OS).
- Bilateral Ahmed glaucoma valve (AGV) implantation was performed under general anesthesia.
Main Results:
- The AGV implantation surgery was successful in both eyes.
- At a 4-year follow-up, the patient's IOP was maintained at 15 mmHg.
- The intervention effectively controlled intraocular pressure in a challenging clinical situation.
Conclusions:
- Ahmed glaucoma valve implantation is a viable surgical option for advanced primary open-angle glaucoma in pregnant patients.
- Effective glaucoma management can be achieved even during public health crises like the COVID-19 pandemic.
- This case highlights the importance of adapting tertiary care services to ensure continuity of care for complex conditions.
Abstract:
COVID-19 is a viral illness that can cause severe respiratory symptoms. COVID-19 has caused a worldwide pandemic that necessitated many countries to perform a national lockdown. In Jordan, a lockdown was imposed by the government. During the lockdown, the hospitals were only dealing with outpatient emergency cases, urgent referrals from primary or secondary health institutions, and inpatients whose medical conditions required keeping them admitted. Elective clinics and surgeries were canceled. At the King Abdullah University Hospital (KAUH), which is the only tertiary center in northern Jordan, we dealt with an unusual case of uncontrolled and advanced primary open angle glaucoma in a 38-year-old pregnant female patient. The patient was presented with an intraocular pressure (IOP) of 53 mmHg in the right eye and 40 mmHg in the left eye despite using dorzolamide and timolol eye drops twice daily. The angle was opened in gonioscopy. The decision was made to implant Ahmed glaucoma valves (AGV) in each eye in one session under general anesthesia which was performed successfully. At the last follow-up visit 4 years later, the IOP was maintained at 15 mmHg.
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