Clinicopathological findings 11 months after implantation of a functioning aqueous-drainage silicone implant

  • Wolfgang Philipp
  • Günther Klima
  • Klaus Miller
Clinical Investigations

Abstract

An aqueous-drainage silicone device was implanted in a 57-year-old diabetic patient with neovascular glaucoma after failure of conventional therapy. Postoperative intraocular pressure (IOP) was well controlled, ranging between 10 and 20 mm Hg without the use of supplemental agents. Despite the normal IOP, the eye became painful and amaurotic 11 months after implantation due to progression of the retinopathy accompanied by the development of severe tractional retinal detachment. Enucleation was performed and the eye underwent histopathological examination. The filtering bleb around the silicone plate of the implant on the equatorial sclera was lined with a thick layer of collagenous connective tissue. Numerous microcystic spaces could be seen in the bleb wall by light microscopy. Electron microscopy confirmed this finding; in addition, only a meshwork of collagen fibre-like bundles was visible at some areas of the innermost bleb wall. Control of IOP in spite of bleb fibrosis in this particular case may have been due to a loss of matrix components and to the formation of microcystic spaces in the bleb wall, which seem likely to be channels for the passage of aqueous humor.

Keywords

Glaucoma Histopathological Examination Intraocular Pressure Thick Layer Retinal Detachment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Addicks EM, Quigley HA, Green WR, Robin AL (1983) Histologic characteristics of filtering blebs in glaucomatous eyes. Arch Ophthalmol 101:795–798PubMedGoogle Scholar
  2. 2.
    Allen RC, Bellows AR, Hutchinson BT, Murphy SD (1982) Filtration surgery in the treatment of neovascular glaucoma. Ophthalmology 89:1181–1187PubMedGoogle Scholar
  3. 3.
    Bellows AR, Grant WM (1973) Cyclocryotherapy in advanced inadequately controlled glaucoma. Am J Ophthalmol 75:679–684PubMedGoogle Scholar
  4. 4.
    Boniuk M (1974) Cryotherapy in neovascular glaucoma. Trans Am Acad Ophthalmol Otolaryngol 78:337–343Google Scholar
  5. 5.
    Cameron JD, White TC (1988) Clinico-histopathologic correlation of a successful glaucoma pump-shunt implant. Ophthalmology 95:1189–1194PubMedGoogle Scholar
  6. 6.
    Epstein E (1959) Fibrosing response to aqueous: its relation to glaucoma. Br J Ophthalmol 43:641–647PubMedGoogle Scholar
  7. 7.
    Feibel RM, Bigger JF (1972) Rubeosis iridis and neovascular glaucoma. Evaluation of cyclocryotherapy. Am J Ophthahnol 74:862–867Google Scholar
  8. 8.
    Folberg R, Hargett NA, Weaver JE, McLean IW (1982) Filtering valve implant for neovascular glaucoma in proliferative diabetic retinopathy. Ophthalmology 89:286–289PubMedGoogle Scholar
  9. 9.
    Grant WM (1974) Management of neovascular glaucoma. In: Leopold IH (ed) Symposium on ocular therapy, vol 7. Mosby, St. Louis, pp 36–61Google Scholar
  10. 10.
    Herschler J, Claflin AJ, Fiorentino G (1980) The effect of aqueous humor on the growth of subconjunctival fibroblasts in tissue culture and its implications for glaucoma surgery. Am J Ophthalmol 89:245–249PubMedGoogle Scholar
  11. 11.
    Hoskins HD (1974) Neovascular glaucoma: current concepts. Trans Am Acad Ophthalmol Otolaryngol 78:330–333Google Scholar
  12. 12.
    Joseph JP, Grierson I, Hitchings RA (1989) Chemotactic activity of aqueous humor. A cause of failure of trabeculectomies? Arch Ophthalmol 107:67–74Google Scholar
  13. 13.
    Kornblueth W, Tenenbaum E (1956) The inhibitory effect of aqueous humor on the growth of cells in tissue culture. Am J Ophthalmol 42:70–74PubMedGoogle Scholar
  14. 14.
    Krupin T, Podos SM (1976) Valve implants in filtering surgery. Am J Ophthalmol 81:232–235PubMedGoogle Scholar
  15. 15.
    Krupin T, Mitchell KB, Becker B (1978) Cyclocryotherapy in neovascular glaucoma. Am J Ophthalmol 86:24–26PubMedGoogle Scholar
  16. 16.
    Krupin T, Kaufmann P, Mandell AI (1983) Long-term results of valve implants in filtering surgery for eyes with neovascular glaucoma. Am J Ophthalmol 95:775–782PubMedGoogle Scholar
  17. 17.
    Krupin T, Ritch R, Camras CB, Brucker AJ, Muldoon TO, Serle J, Podos SM, Sinclair SH (1988) A long Krupin-Denver valve implant attached to a 180° scleral explant for glaucoma surgery. Ophthalmology 95:1174–1180PubMedGoogle Scholar
  18. 18.
    Loeffler KU, Jay JL (1988) Tissue response to aqueous drainage in a functioning Molteno implant. Br J Ophthalmol 72:29–35PubMedGoogle Scholar
  19. 19.
    Minckler DS, Shammas A, Wilcox M, Ogden TE (1987) Experimental studies of aqueous filtration using the Molteno implant. Trans Am Ophthalmol Soc 85:368–392PubMedGoogle Scholar
  20. 20.
    Minckler DS, Heuer DK, Hasty B, Baerveldt G, Cutting RC, Barlow WE (1988) Clinical experience with the single-plate Molteno implant in complicated glaucomas. Ophthalmology 95:1181–1188PubMedGoogle Scholar
  21. 21.
    Molteno ACB (1969) New implant for drainage in glaucoma. Clinical trial. Br J Ophthalmol 53:606–615PubMedGoogle Scholar
  22. 22.
    Molteno ACB (1981) The optimal design of drainage implants for glaucoma. Trans Ophthalmol Soc NZ 33:39–42Google Scholar
  23. 23.
    Molteno ACB (1986) Use of Molteno implants to treat secondary glaucoma. In: Cairns JE (ed) Glaucoma, vol 1. Grime =& Stratton, London, pp 211–238Google Scholar
  24. 24.
    Molteno ACB, Van Rooyen MMB, Bartholomew RS (1977) Implants for draining neovascular glaucoma. Br J Ophthalmol 61:120–125PubMedGoogle Scholar
  25. 25.
    Molteno ACB, Van Biljon G, Ancker E (1979) Two-stage insertion of glaucoma drainage implants. Trans Ophthalmol Soc NZ 31:17–26Google Scholar
  26. 26.
    Radius RL, Herschler J, Claflin A, Fiorentino G (1980) Aqueous humor changes after experimental filtering surgery. Am J Ophthalmol 89:250–254PubMedGoogle Scholar
  27. 27.
    Schocket SS, Lakhanpal V (1982) Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma. Ophthalmology 89:1188–1194PubMedGoogle Scholar
  28. 28.
    Schocket SS, Nirankari VS, Lakhanpal V (1985) Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma and other refractory glaucomas. Ophthalmology 92:533–562PubMedGoogle Scholar
  29. 29.
    Teng CC, Chi HH, Katzin HM (1960) Aqueous degenerative effect and the protective role of endothelium in eye pathology. Am J Ophthalmol 50:365–379PubMedGoogle Scholar
  30. 30.
    Von Denffer H, Wertheimer R (1986) Silikonimplantat für die Operation therapierefraktärer Glaukome. Klin Monatsbl Augenheilkd 189:176–177PubMedGoogle Scholar
  31. 31.
    Von Denffer H, Wertheimer R, Fabian E (1986) Klinische Erfahrungen mit einem Silikon-Implantat bei Glaukom mit schwer verändertem Kammerwinkel. Fortschr Ophthalmol 83:664–666PubMedGoogle Scholar
  32. 32.
    Wertheimer R, Von Denffer H, Fabian E (1986) Tierexperimentelle Untersuchungen über ein Implantat für die Glaukomchirurgie. Fortschr Ophthalmol 83:667–672PubMedGoogle Scholar
  33. 33.
    White TC (1986) Implantable glaucoma pumpshunt. Proceedings, XXV International Congress of Ophthalmology, Rome, May 5–10,1986Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Wolfgang Philipp
    • 1
  • Günther Klima
    • 2
  • Klaus Miller
    • 1
  1. 1.Universitäts-Klinik für Augenheilkunde InnsbruckInnsbruckAustria
  2. 2.Institut für Histologic und Embryologic der Universität InnsbruckInnsbruckAustria

Personalised recommendations