Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant (original) (raw)
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Delayed-Onset Streptococcus Pyogenes Endophthalmitis Following Ahmed Glaucoma Valve Implantation
Japanese Journal of Ophthalmology, 2005
Background To report a case of delayed-onset Streptococcus pyogenes endophthalmitis following implantation of an Ahmed glaucoma valve. Case A 10-year-old patient presented with acute endophthalmitis 1 year after Ahmed glaucoma valve implantation. Observations The conjunctiva and Tenon’s capsule over the valve plate had been penetrated by one of the polypropylene fixation sutures. The valve was removed, and pars plana vitrectomy was performed. Vitreous specimens and removal of the discharge over the plate revealed Streptococcus pyogenes. Conclusions This is the first documented case of Streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation. We think the conjunctival buttonhole caused by the polypropylene suture provided an entry site for the infection. Jpn J Ophthalmol 2005;49:315–317 © Japanese Ophthalmological Society 2005
Pyogenic granuloma after a non-sutured transconjunctival blepharoplasty in the lower eyelid
European Journal of Plastic Surgery, 2019
Pyogenic granuloma (PG) is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. Pyogenic granuloma was found involving the skin or mucosal surfaces, and it is associated with tissue irritation or inflammation. Pyogenic granuloma as a complication after blepharoplasty is uncommon. The treatment is simple and saves the patients from the discomfort caused by the lesion. Surgical excision is effective in patients who do not improve with a local application of steroids. We describe two cases of uncommon pyogenic granuloma occurring after lower transconjunctival blepharoplasty, with no suture and alert ophthalmologists and oculoplastic surgeons to the possibility of encountering and treating these lesions. Level of Evidence: Level V, therapeutic/diagnostic study.
Saudi Journal of Ophthalmology, 2019
A 70-year-old glaucoma patient who underwent Ahmed Glaucoma Valve (AGV) implantation developed orbital cellulitis (OC) 5 days postoperatively. On presentation, the valve was not exposed and no intraocular involvement was noted. After successful treatment of OC with intravenous and oral antibiotics, the patient presented to the clinic with the AGV completely extruded from the eye. There are only 10 previous cases of OC reported in the literature following glaucoma drainage device (GDD) implantation and no previous reports of spontaneous AVG extrusion. Close observation and thorough evaluation of the tube and plate positions are warranted to achieve better outcomes.
Case Report: Corneal Pyogenic Granuloma: Rare Complication of Infectious Keratitis
Ethiopian Journal of Health Sciences, 2014
BACKGROUND: Pyogenic granuloma is an excessive proliferation of granulation tissue that usually develops after minor trauma or surgery. Ocular involvement usually happens on the external surface and cornea is rarely involved. The objective of our report is to describe the clinicopathological feature of this rare disease and give insight on clinical features that help in the diagnosis. CASE REPORT: This report presents a case of a four year old child who had fleshy growth of one week duration on the right eye after seven weeks of pain and redness. Slit lamp examination showed vascularized central corneal mass with surrounding stromal infiltrates. The mass was excised, and histopathological examination confirmed pyogenic granuloma of the cornea. CONCLUSION: Corneal pyogenic granuloma could be a rare complication of infectious keratitis. Therefore, it should be considered as a differential diagnosis in corneal mass especially after an infection or trauma.
Endophthalmitis associated with the Ahmed glaucoma valve implant
British Journal of Ophthalmology, 2005
To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. Methods: A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. Results: 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Conclusion: Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended.
Cureus
Ocular pyogenic granuloma is a benign vascular tumor that occurs primarily in children. Treatment options for pyogenic conjunctival granulomas include topical steroids, topical timolol, surgery, cryotherapy, and electrocautery. Patients with giant pyogenic granulomas are usually treated with surgical intervention. In this case, a 13-year-old Egyptian girl developed a giant pyogenic granuloma after strabismus surgery. Topical steroids showed a poor response and failed to demonstrate any improvement. While on timolol, the granuloma completely regressed, with no signs of recurrence. Despite the usual surgical approach to the treatment of purulent giant granulomas, we believe that topical timolol can be the preferred option as a noninvasive alternative therapy since it is considered safe when compared to the potential risks of topical steroid therapy or surgical exposure.
Ophthalmic Plastic and Reconstructive Surgery, 2007
Radioactive iodine (RAI) treatment is associated with several ophthalmic complications, including dry eyes and chronic or recurrent conjunctivitis. However, a relationship between excess tearing due to nasolacrimal system obstruction (NLSO) and RAI treatment is potentially underestimated. This relationship was first postulated by Kloos et al. 1 in 2002. Their initial suspicion of a link between NLSO and RAI was based on a patient who developed symptomatic epiphora that developed 4 months after 450 mCi RAI therapy. They initially reported a retrospective series in which 10 cases from 390 RAI-treated patients, with the lowest cumulative dose of 150 mCi, developed NLSO. 1 An extended series from the same institution added 6 more cases out of a new 109 patients, and reported a 3.4% incidence of NLSO after RAI treatment. 2 The association was dose-dependent. Morgenstern et al. 3 subsequently described a mechanism to explain the relation between RAI and NLSO due to the expression of a sodium iodine symporter system in the lacrimal sac and the nasolacrimal duct, which correlated to the anatomic obstruction areas. The authors speculated that sodium iodine symporter may be the vector of radiation-induced damage in patients treated with at least 150 mCi RAI. There have been 2 other case reports in the literature describing NLSO after RAI. 4,5 However, most of these patients were middle-aged or older and predominantly females. Thus, it may be hard to distinguish RAI-related NLSO from the common idiopathic NLSO occurring in the same demographic population. Although we have seen several older female patients who seemed to develop NLSO after RAI, we have been reluctant to attribute this to the RAI, considering the age and gender of the patients. However, we recently saw a 16-year-old girl who developed NLSO 2 months after receiving a second dose of RAI (total of 392 mCi) for treatment of metastatic papillary thyroid carcinoma (cell type-I). Her tearing symptoms, worse in the left eye, started 4 weeks to 6 weeks after the second dose and 1 year after the first dose. She denied any history of allergies, nasal/sinus problems, or midfacial trauma. Examination revealed an increased tear lake OS and an abnormal dye disappearance delay on the left, and irrigation showed total reflux OS and partial reflex OD without evidence of canalicular stenosis. No mass lesions or mucosal abnormalities were found on nasal endoscopy. The patient had a successful dacryocystorhinostomy (DCR) with stents. One week after surgery, the left eye was tear free, and the patient complained of tearing OD. Irrigation this time showed total reflux OD, which is scheduled for DCR with stent insertion. We are now ready to embrace the relationship between RAI and subsequent NLSO that has been nicely documented by Kloos et al. 1 and confirmed by Burns et al. 2 and Morgenstern et al. 3 Our current practice involves informing and educating the patients and the physicians who may be involved in these patients' care.
Epithelial Ingrowth and Glaucoma Drainage Implants
Ophthalmology, 1994
Background: The authors report four cases of conjunctival epithelial invasion into the fibrous capsule surrounding a Baerveldt glaucoma implant. All cases were associated with concurrent or recent prior scleral buckling surgery. Methods: Three patients had postoperative conjunctival wound leaks, one in the immediate postoperative period and the other two at 9 and 17 days postoperatively after release of the tube ligature. In the fourth patient, a fistulous tract developed over the implant after a first-stage insertion. Histopathologic confirmation of subconjunctival epithelialization was obtained in two of these patients. Results: Surgical revision was performed in all patients. Excision and debridement of all epithelium-lined subconjunctival tissues and extensive bipolar cautery were used in the three patients with wound leaks. Implant removal also was performed in one of these. Fistulectomy and bipolar cautery were used in the fourth patient. No recurrent wound leaks or other adverse sequelae were noted. Conclusions: Epithelial invasion of the subconjunctival space and inner bleb wall after implantation of glaucoma drainage devices can lead to breakdown of the conjunctival wound and persistent aqueous leak. Prior or concurrent scleral buckling surgery may predispose to this occurrence. Surgical revision involving epithelial debridement, cautery, and meticulous wound closure, with or without implant removal, has been used successfully in the management of this complication.