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Ahmad Glaucoma Valve

A 75 year old lady came with complaint of decrease in vision in the right eye since the last three months, more so since the last 2 weeks. Since the last 2 days, she could only make out light. She did not have any vision in the left eye, being lost to glaucoma.

On enquiring further, she revealed that she had a corneal transplantation done a year ago in the right eye. Her vision was very good initially but slowly deteriorated. When we examined her, she could only percieve light from the right eye. The pressure of the eye which should be 8-20 was 66. There was redness all around the eye. The corneal graft was totally clear and all 16 sutures were perfectly placed. But on further examination, her nerve was totally damaged due to the effect of high pressures in the eye for prolonged periods- a condition known as glaucoma.

We knew that damage due to glaucoma is permanent, but there is a small component of visual loss which we can recover. Immediately we gave her injections, tablets and eye drops to control the eye pressure. It came down to 30 and she could see fingers close to her face. We decided that a surgery has to be done at the earliest. Normal glaucoma surgery is highly prone to failure in eyes which have had a  corneal transplant, so we decided to go for an Ahmed Glaucoma valve implantation.

The next day, we took her up for surgery. We told her that we did not know if there will be any improvement in vision at all. Even if there is an improvement, it would not be too much. But there was no other alternative. The surgery went very smoothly. A tube was inserted in her eye which takes the eye fluid out to a valve implanted behind her eye. This releases the pressure if it rises above 8.

The next day, she could see our faces from close for the first time. She could see objects 1 meter away- a big relief from the prospect of total blindness which was almost certain. Over the next few weeks, the vision improved to 2 meters and has been stable since. Her pressures after 2 years still remain at 8. Her corneal graft still remains perfectly clear, all the sutures have been removed and she can still see at least partially – her near and dear ones