Figure-of-eight Knot Technique combined with Subtemporal Placement for Prevention of Silicone Oil Blockade in Ahmed Glaucoma Valve：A Novel Surgical Technique for the Treatment of Refractory Glaucoma after silicone oil endotamponade

Figure-of-eight Knot Technique combined with Subtemporal Placement for Prevention of Silicone Oil Blockade in Ahmed Glaucoma Valve：A Novel Surgical Technique for the Treatment of Refractory Glaucoma after silicone oil endotamponade | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Figure-of-eight Knot Technique combined with Subtemporal Placement for Prevention of Silicone Oil Blockade in Ahmed Glaucoma Valve：A Novel Surgical Technique for the Treatment of Refractory Glaucoma after silicone oil endotamponade Lishuai Zhang, Yanzi Chu, Huiyu Xi, Xinxia Chen, Jiajun Wei, Jinqiao Zhao, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5363004/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In recent years, glaucoma valves have played an important role in the management of SOE-related glaucoma. However, the occurrence of tube blockage with SO has emerged as a significant factor contributing to surgical failure in these patients. One reason is that the opening of tube is too close to silicon oil, and the other is the early excessive drainage of aqueous humor. Therefore, we developed this technique to manipulate the positioning of the valve body and restrict early aqueous humor outflow and subsequently assessed its safety and efficacy during an over one-year follow-up. Methods After the glaucoma valve was implanted in the subtemporal region, a figure-of-eight knot was utilized to encircle the tube, forming a knot of continuous double loops. This knot gently compresses the tube, thereby constricting its lumen and restricting drainage of aqueous humor. The IOP, BCVA, and complications in all patients were observed and recorded. Results There are 6 eyes with secondary glaucoma received this surgical treatment. The mean of preoperative IOP was 45.5 ± 6.8mmHg, and decreased to 13.5 ± 3.0mmHg after surgery (P = 0.000). During the follow-up(17.7 ± 4.3months), we observed stable IOP, and none of the patients exhibited tube blockage caused by SO. Conclusions This technique can effectively prevent SO blockage in AGV. glaucoma valve implantation silicone oil blockage figure-of-eight knot refractory glaucoma Figures Figure 1 Figure 2 Figure 3 Background Silicone oil endotamponade (SOE) is commonly utilized for the treatment of complicated retinal detachment, with secondary glaucoma being a frequent complication of silicone oil (SO)-filling surgery. The introduction of Ahmed glaucoma valve (AGV) provides an effective solution to this problem[ 1 ]. The presence of SO, however, increases the risk of AGV failure due to its potential to directly obstruct the drainage pathway or migrate into the subconjunctival space, thereby promoting chronic inflammation and fibrosis[ 2 ]. With the use of antimetabolic agents[ 3 – 6 ], body encapsulation has significantly decreased. The obstruction of the tube by silicone oil can be attributed to two factors. Firstly, the proximity of the tube opening to the silicone oil body is too close. Secondly, it is crucial not to overlook excessive post-surgery drainage. Even though Ahmed glaucoma drainage valves are known to have a flow resistance mechanism that reduces the phenomenon of ultrafiltration due to limited subconjunctival space[ 7 ], it is not uncommon for AVI to cause serious complications such as choroidal detachment, shallow anterior chamber, intraocular hemorrhage, and retinal detachment[ 8 , 9 ]. While the incidence of ciliochoroidal detachment after AVI could be even as high as 57.8%, and eyes with a history of surgery are prone to ciliochoroidal detachment[ 9 ]. In our initial practice, we have attempted to move the valve body downwards and even reduce the length of the tube in the anterior chamber as much as possible. However, in these patients with eyes filled with silicone oil, the phenomenon of tube blockage persists. Therefore, the figure-of-eight knot technique we have developed is designed to effectively manage secondary glaucoma after SOE. In this study, we present our surgical approach for novel AVI and report the results of follow-up in a cohort of patients undergoing this procedure. Methods Study patients In our study, there were 6 patients received this surgical treatment, which were 5 men and 1 woman. The mean age was 47 years, ranging from 30 to 69 years. The lens surgery had been performed on all patients, with five being aphakic and one being pseudophakic; moreover, silicone oil migration was observed in the anterior chamber for all cases. AVG implantation was performed as a last resort after patients had failed to respond to various IOP lowering treatments, including eye drops, oral medications, discontinuation of glucocorticoids, anterior chamber paracentesis, and even partial removal of silicone oil. Moreover, anterior chamber paracentesis under a slit lamp was our routine procedure in the management of patients with elevated intraocular pressure and was typically performed by physicians with over 3 years of clinical training. In four patients, AVG implantation was done approximately 1 month after silicone oil tamponade due to the persistence of excruciating eye pain and lack of response to conventional medical treatment. One patient underwent AVG implantation 8 days after silicone oil tamponade for the same reasons mentioned above. In this case, the primary disease prevented the removal of silicone oil. Another patient opted for AVG implantation 160 days after silicone oil tamponade due to severe diabetic retinopathy resulting in no light perception vision. The decision was made considering long-term maintenance of eyeball shape through silicone oil tamponade despite prolonged ocular hypertension experienced by the patient during those 160 days. To prevent ocular complications associated with prolonged ocular hypertension, surgical control of intraocular pressure was deemed necessary. Fortunately, she subsequently underwent successful removal of silicone oil and maintained normal eyeball shape during the 15-month follow-up. The demographics, primary disease, medication use, and ophthalmological findings of each eye before and after AVI are summarized in Table 1 . The timing of silicone oil tamponade, AVG implantation, and silicone oil removal was meticulously documented. Intraocular pressure (IOP) measurements were taken at four critical time nodes: before Ahmed valve implantation (Before AVI), after Ahmed valve implantation (After AVI), after silicone oil removal (SO-removal) and at the last follow-up (Last follow-up). The glaucoma medication scores (GMS) were defined as 1 point per glaucoma eye drop, 2 points per glaucoma combination eye drop, and 2 points per oral carbonic anhydrase inhibitor. The data were retrospectively collected from case notes and electronic records for patients who underwent this surgical treatment for SOE-related refractory glaucoma in our hospital. The Institutional Review Board/Ethics Committee approved this study [registry number: Xyyll[2023]101]. The data collection process adhered to the tenets of the Declaration of Helsinki. All patients signed the written informed consent for surgery and understood the surgical risk and prognosis. Table 1 Demographics and Clinical Data of patients. Number Sex Age Primary disease Lens status Preoperative Ahmed valve implantation (day)* Silicone oil removal (month)* Last follow-up Follow-up duration (month)# GMS BCVA IOP GMS BCVA IOP 1 Male 55 Trauma Aphakic 2 CF 44 26 4 0 0.02 13 21 2 Male 40 PDR Aphakic 3 CF 45 32 3 0 0.05 16 18 3 Male 34 PDR Aphakic 4 CF 43 18 4 0 0.20 17 23 4 Female 53 PDR Aphakic 4 NLP 42 160 8 0 NLP 15 15 5 Male 69 RRD Pseudophakic 3 HM 40 8 11 0 CF 10 18 6 Male 32 Trauma Aphakic 3 CF 59 19 3 0 0.04 12 11 * Days after vitrectomy # Days after Ahmed valves implantation BCVA, best-corrected visual acuity; GMS, glaucoma medication score; IOP, Intraocular pressure; RRD, rhegmatogenous retinal detachment; PDR, proliferative diabetic retinopathy; NLP, no light perception; LP, light perception; HM, hand move; CF, counting fingers. Surgical technique The surgery was performed by one surgeon (X.C.) using a Zeiss S8 microscope (Carl Zeiss Medical Devices, Jena, Germany). The FP-7 Ahmed glaucoma drainage valve (Newworld Medical Inc, USA) was used for surgery. The sutures used were 6 − 0 suture and 8 − 0 suture (MWI Animal Health, Idaho, United States). The procedure can be seen on the surgical video (video 1) and the details of the procedure are described in Fig. 1 . At the beginning, the silicone oil was restricted from moving forward by injecting a viscoelastic agent into the anterior chamber. A traction suture was used during surgery to expose the inferior temporal sclera area. The bulbar conjunctiva and fascia were opened from 6 mm posterior to the corneoscleral limbus to expose the inferior temporal sclera (Fig. 1 A). 0.04% MMC (two cotton swabs used in these cases) was applied to the infratemporal scleral surface for 5 min (Fig. 1 B). The cotton swab was removed along with the residual MMC with a syringe (Note: do not rinse). In the inferior temporal quadrant, 8.5 mm from the corneoscleral margin, two 6 − 0 sutures were prepositioned between the scleral layers (Fig. 1 C). Before implantation, the valve was primed with a balanced salt solution through a 30-gauge cannula. The AGV implant was inserted under the conjunctiva and Tenon’s capsule and sutured to the sclera with a 6 − 0 suture, at a distance of about 8.5 mm from the limbus (Fig. 1 D). The anterior end of the tubule was cut at 45° with the inclined plane facing upward such that it extended 1.5–2 mm into the anterior chamber. A 23-gauge needle with viscoelastic was used to make a track beginning 2.5 mm posterior to the corneal limbus and enter in the anterior chamber, releasing the viscoelastic while the needle left the eye to lubricate the track. The tube was inserted from the scleral tunnel until the bevel of the tube incision was completely exposed to the anterior chamber, measuring about 1.5–2mm in length. (Fig. 1 E). After completion of valve body placement and insertion of the tube into the anterior chamber, at 6–8mm posterior to the limbus, the tube was lightly ligated with an absorbable 8 − 0 suture(VICRYL® 8 − 0 Polyglactin 910 with 5.5 mm 1/2c spatula, MWI Animal Health, Idaho, United States) using the figure-of-eight knot technique until the tube was deformed into a narrow oval, which is shown clearly in Fig. 2 A and 2 B. The bulbar conjunctival and tenon's layer were sutured intermittently layer-by-layer, to completely cover the drainage valve body and tube. The fascial layer of the eye was intermittently fixed with 8 − 0 sutures, 3 mm posterior to the corneoscleral rim to completely cover the drainage valve body and tubules, and the bulbar conjunctiva was reset and sutured. Finally, the viscoelastic agent in the anterior chamber was rinsed. After surgery, we administered routine postoperative care with antibiotic and anti-inflammatory eye drops. For these patients, close fundus examination and glaucoma postoperative testing were necessary. Statistical analysis Statistical analysis was performed in Microsoft Excel (Microsoft® Excel® 2019MSO). Data are presented as mean, standard deviation, frequency, and range. The paired t-test was utilized to compare means, with statistical significance set at p < 0.05. Results The mean follow-up period after AVI was 17.7 ± 4.3months (range, 11–21 months) (Table-1). Primary diseases included rhegmatogenous retinal detachment, proliferative diabetic retinopathy, and ocular trauma. The visual acuity of one patient in this group remained at no light perception (NLP) throughout the treatment period, which was the underlying cause of her primary disease. The BCVA of the other five patients was improved to varying degrees, thereby preserving some level of vision throughout their lifetime. The mean of preoperative IOP was 45.5 ± 6.8mmHg(range 42–59), decreased to 13.5 ± 3.0mmHg (range 10–17, p = 0.000) after AVI, and the patients were followed up for 17.7 ± 4.3 months (range 11–23) with the IOP stable at 11.3 ± 1.6mmHg (range 10–17, p = 0.000) at the last follow-up. The average time for silicone oil removal was 5.5 months (range 3–11, starting from the time of SOE). The mean IOP after oil removal was 12.2 ± 2.5 mmHg (range 9–15, p = 0.000). The IOP curve is shown in Fig. 3 . The GMS was 3.4 ± 1.2 before AVI. During the follow-up, all patients were weaned from long-term use of anti-glaucoma medications, and the postoperative GMS score was 0 (p = 0.000). The performance of anterior chamber paracentesis was conducted in every 6 patients before AVI, and subsequently discontinued after AVI and follow-up period. The occurrence of postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, and tube/plate migration was not observed in any patient. Discussion In our study, we have described a novel technique for preventing blockage of the AGV tube in patients with secondary glaucoma after SOE. The technique involves subtemporal placement of the valve body, wherein the tube opening is relocated further away from the silicone oil body. Additionally, a figure-of-eight knot technique is utilized to prevent excessive drainage of aqueous humor and minimize forward displacement of silicone oil. Our experience with six eyes demonstrates that this approach effectively reduces IOP and eliminates the need for anti-glaucoma medications, thereby preserving visual function. Importantly, this technique does not cause silicone oil blocking or other complications associated with AVI. Consequently, we conclude that valve body subtemporal placement combined with figure-of-eight ligation of the tube is a safe and effective procedure for AVI in patients with refractory glaucoma secondary to silicone oil tamponade. Since the application of AGV in the treatment of glaucoma, it has become the most commonly used glaucoma drainage device. The AGV has been demonstrated to effectively regulate IOP in the majority of cases involving glaucoma associated with SO[ 10 ]. Although the efficacy of AVI for the treatment of so related refractory glaucoma has been proved, silicone oil blockage is a unique and common complication of this treatment because of the concomitant use of AGV and SO. The tube can facilitate the drainage of small oil droplets or emulsified SO into the subconjunctiva, resulting in subconjunctival inflammation and proliferation, ultimately leading to encapsulation of the valve body. Once inserted into the silicone oil body, the occluded tube can hinder the aqueous humor flow, thereby directly inducing an elevation in IOP. The AGV's superior placement renders it vulnerable to obstruction by SO[ 2 ], necessitating a modification of our conventional process. Some researchers have extended the length of the tube in the anterior chamber, or change the Angle of the tubule, so as to stay away from SO[ 11 , 12 ]. The alteration of the tube extension length, however, presents two significant risks. Firstly, there is a potential for the stump of the tube to cause persistent damage to the corneal endothelium through friction. Secondly, there is a possibility for the stump to become entangled with the iris, resulting in iris obstruction. The alternative method, which is also widely used, involves downward movement of the valve[ 13 ], either nasally or temporally, rendering it highly advantageous. Although the aforementioned methods have demonstrated their effectiveness, practical implementation may still result in SO blockage. Therefore, we have devised a technique involving valve body implantation in the subtemporal region and figure-of-eight knot ligation of the tube. We opted for subtemporal implantation due to its larger space compared to the subnasal region, allowing us to maximize surgical expansion and facilitate long-term maintenance of this space for increased application of MMC (Fig. 1 B). Regarding tube management, our primary approach involves utilizing figure-of-eight knot for ligation, with emphasis placed on achieving optimal knotting strength during the procedure. The figure-of-eight knot technique can narrow the lumen of the tube in the early postoperative period, and play a role in limiting the flow, reducing the incidence of postoperative complications such as shallow anterior chamber, low intraocular pressure, choroidal leakage and detachment. The figure-of-eight knot technique was inspired by previous releasable suture technique, which was used to suture the scleral flap[ 14 , 15 ], and we used the figure-of-eight knot technique to ligate the tube, which adopted the same technical principle. Therefore, in order to better stabilize the postoperative IOP and control the outflow of aqueous humor, we designed a surgical method of ligating the tube. This figure-of-eight knot technique is different from the simple ligation method of one circle because it has two coils, like the 8. In the case of insufficient filtration, the IOP increases, the intraluminal pressure increases, and the two coils can be pressed together to play the role of releasing the tube (Fig. 2 C). If this procedure results in increased IOP due to inadequate drainage, eye massage may be a useful way to avoid this adverse effect. Thus, the effect of this surgical design is to control orderly drainage of the aqueous humor. After 1 month, the suture dissolved and the tube was gradually loosened, releasing the tube to its original diameter. However, it is important to acknowledge certain limitations in our study. Firstly, the sample size of only six patients was relatively small. Secondly, the study focused on a limited number of indicators. Lastly, the follow-up period was relatively short. The objective of this study was to offer an alternative treatment for patients with tube obstruction caused by silicone oil and to preserve their visual potential, particularly those who are at risk of developing glaucoma after SOE. In future research endeavors, we aim to conduct long-term follow-up studies with larger sample sizes in order to provide more robust data regarding the long-term efficacy and safety of this technique. Conclusion The novel surgical technique, which incorporates the figure-of-eight knot technique and subtemporal placement, effectively prevents tube blockage by silicone oil, thereby enhancing the efficacy of AVI in the treatment of SOE-related glaucoma. Abbreviations BCVA Best Corrected Visual Acuity IOP Intraocular pressure SO Silicone oil SOE Silicone oil endotamponade MMC Mitomycin C AGV Ahmed glaucoma valve AVI Ahmed glaucoma valve implantation Declarations Acknowledgements Not applicable. Author contributions LSZ, YZC and HX: idea generation, critical revision of the manuscript, and they are co-first author. XXC, JJW and JQZ: data collection, writing of the manuscript. HYL and XYC: critical revision of the manuscript, supervision, administrative support, and they are co-corresponding author. All the authors were involved in the critical revision of the manuscript, supervision of the manuscript and final approval of the submission. Funding Supported by Xuzhou Medical Key Talent Project (XWRCHT20220048), and Xuzhou Sustainable Development Agenda Innovation Demonstration Zone Construction Project (KC22099). Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information. Data availability The datasets for the analysis of the current study are readily available from the corresponding author on reasonable request. Ethics approval and consent to participate The Institutional Review Board/Ethics Committee approved this study [registry number: Xyyll[2023]101]. Written informed consent was obtained from all patients Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Qian Z, Xu K, Kong X, Xu H: Ahmed Glaucoma Valves versus EX-PRESS Devices in Glaucoma Secondary to Silicone Oil Emulsification . J Ophthalmol 2018, 2018 :8539689. Cornacel C, Dumitrescu OM, Zaharia AC, Pirvulescu RA, Munteanu M, Tataru CP, Istrate S: Surgical Treatment in Silicone Oil-Associated Glaucoma . Diagnostics (Basel) 2022, 12 (4). Dong A, Han L, Shao Z, Fan P, Zhou X, Yuan H: Glaucoma Drainage Device Coated with Mitomycin C Loaded Opal Shale Microparticles to Inhibit Bleb Fibrosis . ACS Appl Mater Interfaces 2019, 11 (10):10244-10253. Promelle V, Lyons CJ: Long-term Results of Ahmed Valve Implantation With Mitomycin-C in Pediatric Glaucoma . J Glaucoma 2021, 30 (7):596-605. Zuo L, Zhang J, Xu X: Combined Application of Bevacizumab and Mitomycin C or Bevacizumab and 5-Fluorouracil in Experimental Glaucoma Filtration Surgery . J Ophthalmol 2018, 2018 :8965709. Perez CI, Verdaguer S, Khaliliyeh D, Maul EA, Ou Y, Han Y: Subconjunctival Injections of Mitomycin C Are Associated with a Lower Incidence of Hypertensive Phase in Eyes with Ahmed Glaucoma Valve . Ophthalmol Glaucoma 2021, 4 (3):322-329. Law SK, Huang JS, Nassiri N, Moghimi S, Nilforushan N, Parham A, Moossai J, Kim M, Caprioli J, Aldave AJ: Technique of combined glaucoma tube shunt and keratoprosthesis implantation . J Glaucoma 2014, 23 (8):501-507. Hong C-H, Arosemena A, Zurakowski D, Ayyala RS: Glaucoma drainage devices: a systematic literature review and current controversies . Survey of Ophthalmology 2005, 50 (1):48-60. Fu L, Chan YK, Nie L, Dai Q, Qian Z, Shih KC, Lai JSM, Huang R, Pan W: Ciliochoroidal detachment after Ahmed glaucoma valve implantation: a retrospective study . BMC Ophthalmology 2019, 19 (1). Albahlal A, Alshamrani A, Khandekar R, Malik R: Outcome of Surgical Management of Glaucoma Following Complex Retinal Detachment Repair With Silicone Oil Tamponade: Drainage Implant Versus Cyclophotocoagulation . J Glaucoma 2020, 29 (3):198-204. Soebijantoro I, Noor NA: Tube Length Adjustment and Tube Trimming Technique in Refractory Glaucoma . Case Rep Ophthalmol Med 2020, 2020 :8889448. Davo-Cabrera JM, Lanzagorta-Aresti A, Alcocer Yuste P: A Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade . J Glaucoma 2017, 26 (10):e232-e235. Al-Jazzaf AM, Netland PA, Charles S: Incidence and management of elevated intraocular pressure after silicone oil injection . J Glaucoma 2005, 14 (1):40-46. Liang YB, Feng MY, Meng HL, Fan SJ, Wang X, Xie LL, Yi P, Tang X, Wang NL, Thomas R: Early Efficacy and Complications of Releasable Sutures for Trabeculectomy in Primary Angle-closure Glaucoma . Journal of Glaucoma 2014, 23 (3):136-141. Xiahou L, Liu C, Zhou W, Yang S: Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma . Pak J Med Sci 2020, 36 (2):234-239. Additional Declarations No competing interests reported. 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Schematic of the figure-of-eight knot technique\u003c/p\u003e\n\u003cp\u003eA The 8-0 suture is wrapped around the tubule and the lumen is a round shape.\u003c/p\u003e\n\u003cp\u003eB The suture is tightened and the lumen becomes an oval shape.\u003c/p\u003e\n\u003cp\u003eC As the IOP increases, the flow increases and the rings gather, releasing the lumen and returning to a round shape.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5363004/v1/06b85d2a2aef2bdfd1d3f07a.png"},{"id":69913598,"identity":"d2678115-3af1-4cd8-8344-ccf53cac44c5","added_by":"auto","created_at":"2024-11-26 14:09:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":114890,"visible":true,"origin":"","legend":"\u003cp\u003eIntraocular pressure (IOP) curve before and after the operation (Mean±SD).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5363004/v1/13775acb9b2a4a0d539fa260.png"},{"id":72364591,"identity":"e1fb84ce-6b69-4b26-b55d-24665aa97586","added_by":"auto","created_at":"2024-12-26 06:31:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1665192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5363004/v1/8d5f9164-53cc-4bd5-aaab-353b9e553700.pdf"},{"id":69913599,"identity":"9745355e-61ea-4d52-9edb-76eddd4a06fa","added_by":"auto","created_at":"2024-11-26 14:09:36","extension":"avi","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":91107680,"visible":true,"origin":"","legend":"","description":"","filename":"100md1.avi","url":"https://assets-eu.researchsquare.com/files/rs-5363004/v1/f939c5281b4f75881b01c978.avi"}],"financialInterests":"No competing interests reported.","formattedTitle":"Figure-of-eight Knot Technique combined with Subtemporal Placement for Prevention of Silicone Oil Blockade in Ahmed Glaucoma Valve：A Novel Surgical Technique for the Treatment of Refractory Glaucoma after silicone oil endotamponade","fulltext":[{"header":"Background","content":"\u003cp\u003eSilicone oil endotamponade (SOE) is commonly utilized for the treatment of complicated retinal detachment, with secondary glaucoma being a frequent complication of silicone oil (SO)-filling surgery. The introduction of Ahmed glaucoma valve (AGV) provides an effective solution to this problem[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The presence of SO, however, increases the risk of AGV failure due to its potential to directly obstruct the drainage pathway or migrate into the subconjunctival space, thereby promoting chronic inflammation and fibrosis[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With the use of antimetabolic agents[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], body encapsulation has significantly decreased. The obstruction of the tube by silicone oil can be attributed to two factors. Firstly, the proximity of the tube opening to the silicone oil body is too close. Secondly, it is crucial not to overlook excessive post-surgery drainage. Even though Ahmed glaucoma drainage valves are known to have a flow resistance mechanism that reduces the phenomenon of ultrafiltration due to limited subconjunctival space[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], it is not uncommon for AVI to cause serious complications such as choroidal detachment, shallow anterior chamber, intraocular hemorrhage, and retinal detachment[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While the incidence of ciliochoroidal detachment after AVI could be even as high as 57.8%, and eyes with a history of surgery are prone to ciliochoroidal detachment[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In our initial practice, we have attempted to move the valve body downwards and even reduce the length of the tube in the anterior chamber as much as possible. However, in these patients with eyes filled with silicone oil, the phenomenon of tube blockage persists. Therefore, the figure-of-eight knot technique we have developed is designed to effectively manage secondary glaucoma after SOE. In this study, we present our surgical approach for novel AVI and report the results of follow-up in a cohort of patients undergoing this procedure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy patients\u003c/h2\u003e \u003cp\u003eIn our study, there were 6 patients received this surgical treatment, which were 5 men and 1 woman. The mean age was 47 years, ranging from 30 to 69 years. The lens surgery had been performed on all patients, with five being aphakic and one being pseudophakic; moreover, silicone oil migration was observed in the anterior chamber for all cases. AVG implantation was performed as a last resort after patients had failed to respond to various IOP lowering treatments, including eye drops, oral medications, discontinuation of glucocorticoids, anterior chamber paracentesis, and even partial removal of silicone oil. Moreover, anterior chamber paracentesis under a slit lamp was our routine procedure in the management of patients with elevated intraocular pressure and was typically performed by physicians with over 3 years of clinical training. In four patients, AVG implantation was done approximately 1 month after silicone oil tamponade due to the persistence of excruciating eye pain and lack of response to conventional medical treatment. One patient underwent AVG implantation 8 days after silicone oil tamponade for the same reasons mentioned above. In this case, the primary disease prevented the removal of silicone oil. Another patient opted for AVG implantation 160 days after silicone oil tamponade due to severe diabetic retinopathy resulting in no light perception vision. The decision was made considering long-term maintenance of eyeball shape through silicone oil tamponade despite prolonged ocular hypertension experienced by the patient during those 160 days. To prevent ocular complications associated with prolonged ocular hypertension, surgical control of intraocular pressure was deemed necessary. Fortunately, she subsequently underwent successful removal of silicone oil and maintained normal eyeball shape during the 15-month follow-up.\u003c/p\u003e \u003cp\u003eThe demographics, primary disease, medication use, and ophthalmological findings of each eye before and after AVI are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The timing of silicone oil tamponade, AVG implantation, and silicone oil removal was meticulously documented. Intraocular pressure (IOP) measurements were taken at four critical time nodes: before Ahmed valve implantation (Before AVI), after Ahmed valve implantation (After AVI), after silicone oil removal (SO-removal) and at the last follow-up (Last follow-up). The glaucoma medication scores (GMS) were defined as 1 point per glaucoma eye drop, 2 points per glaucoma combination eye drop, and 2 points per oral carbonic anhydrase inhibitor. The data were retrospectively collected from case notes and electronic records for patients who underwent this surgical treatment for SOE-related refractory glaucoma in our hospital. The Institutional Review Board/Ethics Committee approved this study [registry number: Xyyll[2023]101]. The data collection process adhered to the tenets of the Declaration of Helsinki. All patients signed the written informed consent for surgery and understood the surgical risk and prognosis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and Clinical Data of patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLens status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAhmed valve implantation\u003c/p\u003e \u003cp\u003e(day)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSilicone oil removal\u003c/p\u003e \u003cp\u003e(month)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eLast follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003cp\u003eduration\u003c/p\u003e \u003cp\u003e(month)#\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIOP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eBCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIOP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNLP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNLP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePseudophakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003e* Days after vitrectomy\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003e# Days after Ahmed valves implantation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eBCVA, best-corrected visual acuity; GMS, glaucoma medication score; IOP, Intraocular pressure; RRD, rhegmatogenous retinal detachment; PDR, proliferative diabetic retinopathy; NLP, no light perception; LP, light perception; HM, hand move; CF, counting fingers.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003eThe surgery was performed by one surgeon (X.C.) using a Zeiss S8 microscope (Carl Zeiss Medical Devices, Jena, Germany). The FP-7 Ahmed glaucoma drainage valve (Newworld Medical Inc, USA) was used for surgery. The sutures used were 6\u0026thinsp;\u0026minus;\u0026thinsp;0 suture and 8\u0026thinsp;\u0026minus;\u0026thinsp;0 suture (MWI Animal Health, Idaho, United States). The procedure can be seen on the surgical video (video 1) and the details of the procedure are described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAt the beginning, the silicone oil was restricted from moving forward by injecting a viscoelastic agent into the anterior chamber. A traction suture was used during surgery to expose the inferior temporal sclera area. The bulbar conjunctiva and fascia were opened from 6 mm posterior to the corneoscleral limbus to expose the inferior temporal sclera (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). 0.04% MMC (two cotton swabs used in these cases) was applied to the infratemporal scleral surface for 5 min (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The cotton swab was removed along with the residual MMC with a syringe (Note: do not rinse). In the inferior temporal quadrant, 8.5 mm from the corneoscleral margin, two 6\u0026thinsp;\u0026minus;\u0026thinsp;0 sutures were prepositioned between the scleral layers (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Before implantation, the valve was primed with a balanced salt solution through a 30-gauge cannula. The AGV implant was inserted under the conjunctiva and Tenon\u0026rsquo;s capsule and sutured to the sclera with a 6\u0026thinsp;\u0026minus;\u0026thinsp;0 suture, at a distance of about 8.5 mm from the limbus (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). The anterior end of the tubule was cut at 45\u0026deg; with the inclined plane facing upward such that it extended 1.5\u0026ndash;2 mm into the anterior chamber. A 23-gauge needle with viscoelastic was used to make a track beginning 2.5 mm posterior to the corneal limbus and enter in the anterior chamber, releasing the viscoelastic while the needle left the eye to lubricate the track. The tube was inserted from the scleral tunnel until the bevel of the tube incision was completely exposed to the anterior chamber, measuring about 1.5\u0026ndash;2mm in length. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE). After completion of valve body placement and insertion of the tube into the anterior chamber, at 6\u0026ndash;8mm posterior to the limbus, the tube was lightly ligated with an absorbable 8\u0026thinsp;\u0026minus;\u0026thinsp;0 suture(VICRYL\u0026reg; 8\u0026thinsp;\u0026minus;\u0026thinsp;0 Polyglactin 910 with 5.5 mm 1/2c spatula, MWI Animal Health, Idaho, United States) using the figure-of-eight knot technique until the tube was deformed into a narrow oval, which is shown clearly in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eA and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eB. The bulbar conjunctival and tenon's layer were sutured intermittently layer-by-layer, to completely cover the drainage valve body and tube. The fascial layer of the eye was intermittently fixed with 8\u0026thinsp;\u0026minus;\u0026thinsp;0 sutures, 3 mm posterior to the corneoscleral rim to completely cover the drainage valve body and tubules, and the bulbar conjunctiva was reset and sutured. Finally, the viscoelastic agent in the anterior chamber was rinsed. After surgery, we administered routine postoperative care with antibiotic and anti-inflammatory eye drops. For these patients, close fundus examination and glaucoma postoperative testing were necessary.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed in Microsoft Excel (Microsoft\u0026reg; Excel\u0026reg; 2019MSO). Data are presented as mean, standard deviation, frequency, and range. The paired t-test was utilized to compare means, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean follow-up period after AVI was 17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3months (range, 11\u0026ndash;21 months) (Table-1). Primary diseases included rhegmatogenous retinal detachment, proliferative diabetic retinopathy, and ocular trauma. The visual acuity of one patient in this group remained at no light perception (NLP) throughout the treatment period, which was the underlying cause of her primary disease. The BCVA of the other five patients was improved to varying degrees, thereby preserving some level of vision throughout their lifetime.\u003c/p\u003e \u003cp\u003eThe mean of preoperative IOP was 45.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8mmHg(range 42\u0026ndash;59), decreased to 13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0mmHg (range 10\u0026ndash;17, p\u0026thinsp;=\u0026thinsp;0.000) after AVI, and the patients were followed up for 17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 months (range 11\u0026ndash;23) with the IOP stable at 11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6mmHg (range 10\u0026ndash;17, p\u0026thinsp;=\u0026thinsp;0.000) at the last follow-up. The average time for silicone oil removal was 5.5 months (range 3\u0026ndash;11, starting from the time of SOE). The mean IOP after oil removal was 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 mmHg (range 9\u0026ndash;15, p\u0026thinsp;=\u0026thinsp;0.000). The IOP curve is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe GMS was 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 before AVI. During the follow-up, all patients were weaned from long-term use of anti-glaucoma medications, and the postoperative GMS score was 0 (p\u0026thinsp;=\u0026thinsp;0.000). The performance of anterior chamber paracentesis was conducted in every 6 patients before AVI, and subsequently discontinued after AVI and follow-up period.\u003c/p\u003e \u003cp\u003eThe occurrence of postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, and tube/plate migration was not observed in any patient.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we have described a novel technique for preventing blockage of the AGV tube in patients with secondary glaucoma after SOE. The technique involves subtemporal placement of the valve body, wherein the tube opening is relocated further away from the silicone oil body. Additionally, a figure-of-eight knot technique is utilized to prevent excessive drainage of aqueous humor and minimize forward displacement of silicone oil. Our experience with six eyes demonstrates that this approach effectively reduces IOP and eliminates the need for anti-glaucoma medications, thereby preserving visual function. Importantly, this technique does not cause silicone oil blocking or other complications associated with AVI. Consequently, we conclude that valve body subtemporal placement combined with figure-of-eight ligation of the tube is a safe and effective procedure for AVI in patients with refractory glaucoma secondary to silicone oil tamponade.\u003c/p\u003e \u003cp\u003eSince the application of AGV in the treatment of glaucoma, it has become the most commonly used glaucoma drainage device. The AGV has been demonstrated to effectively regulate IOP in the majority of cases involving glaucoma associated with SO[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although the efficacy of AVI for the treatment of so related refractory glaucoma has been proved, silicone oil blockage is a unique and common complication of this treatment because of the concomitant use of AGV and SO. The tube can facilitate the drainage of small oil droplets or emulsified SO into the subconjunctiva, resulting in subconjunctival inflammation and proliferation, ultimately leading to encapsulation of the valve body. Once inserted into the silicone oil body, the occluded tube can hinder the aqueous humor flow, thereby directly inducing an elevation in IOP.\u003c/p\u003e \u003cp\u003eThe AGV's superior placement renders it vulnerable to obstruction by SO[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], necessitating a modification of our conventional process. Some researchers have extended the length of the tube in the anterior chamber, or change the Angle of the tubule, so as to stay away from SO[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The alteration of the tube extension length, however, presents two significant risks. Firstly, there is a potential for the stump of the tube to cause persistent damage to the corneal endothelium through friction. Secondly, there is a possibility for the stump to become entangled with the iris, resulting in iris obstruction. The alternative method, which is also widely used, involves downward movement of the valve[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], either nasally or temporally, rendering it highly advantageous.\u003c/p\u003e \u003cp\u003eAlthough the aforementioned methods have demonstrated their effectiveness, practical implementation may still result in SO blockage. Therefore, we have devised a technique involving valve body implantation in the subtemporal region and figure-of-eight knot ligation of the tube. We opted for subtemporal implantation due to its larger space compared to the subnasal region, allowing us to maximize surgical expansion and facilitate long-term maintenance of this space for increased application of MMC (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003eRegarding tube management, our primary approach involves utilizing figure-of-eight knot for ligation, with emphasis placed on achieving optimal knotting strength during the procedure. The figure-of-eight knot technique can narrow the lumen of the tube in the early postoperative period, and play a role in limiting the flow, reducing the incidence of postoperative complications such as shallow anterior chamber, low intraocular pressure, choroidal leakage and detachment.\u003c/p\u003e \u003cp\u003eThe figure-of-eight knot technique was inspired by previous releasable suture technique, which was used to suture the scleral flap[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and we used the figure-of-eight knot technique to ligate the tube, which adopted the same technical principle. Therefore, in order to better stabilize the postoperative IOP and control the outflow of aqueous humor, we designed a surgical method of ligating the tube. This figure-of-eight knot technique is different from the simple ligation method of one circle because it has two coils, like the 8. In the case of insufficient filtration, the IOP increases, the intraluminal pressure increases, and the two coils can be pressed together to play the role of releasing the tube (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). If this procedure results in increased IOP due to inadequate drainage, eye massage may be a useful way to avoid this adverse effect. Thus, the effect of this surgical design is to control orderly drainage of the aqueous humor. After 1 month, the suture dissolved and the tube was gradually loosened, releasing the tube to its original diameter.\u003c/p\u003e \u003cp\u003eHowever, it is important to acknowledge certain limitations in our study. Firstly, the sample size of only six patients was relatively small. Secondly, the study focused on a limited number of indicators. Lastly, the follow-up period was relatively short. The objective of this study was to offer an alternative treatment for patients with tube obstruction caused by silicone oil and to preserve their visual potential, particularly those who are at risk of developing glaucoma after SOE. In future research endeavors, we aim to conduct long-term follow-up studies with larger sample sizes in order to provide more robust data regarding the long-term efficacy and safety of this technique.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe novel surgical technique, which incorporates the figure-of-eight knot technique and subtemporal placement, effectively prevents tube blockage by silicone oil, thereby enhancing the efficacy of AVI in the treatment of SOE-related glaucoma.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eBCVA\u003c/strong\u003e Best Corrected Visual Acuity\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIOP\u003c/strong\u003e Intraocular pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSO\u003c/strong\u003e Silicone oil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSOE\u003c/strong\u003e Silicone oil endotamponade\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMC\u003c/strong\u003e Mitomycin C\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAGV\u003c/strong\u003e Ahmed glaucoma valve\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVI\u003c/strong\u003e Ahmed glaucoma valve implantation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLSZ, YZC and HX: idea generation, critical revision of the manuscript, and they are co-first author. XXC, JJW and JQZ: data collection, writing of the manuscript. HYL and XYC: critical revision of the manuscript, supervision, administrative support, and they are co-corresponding author. All the authors were involved in the critical revision of the manuscript, supervision of the manuscript and final approval of the submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupported by Xuzhou Medical Key Talent Project (XWRCHT20220048), and Xuzhou Sustainable Development Agenda Innovation Demonstration Zone Construction Project (KC22099).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data relevant to the study are included in the article or uploaded as online supplemental information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets for the analysis of the current study are readily available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board/Ethics Committee approved this study [registry number: Xyyll[2023]101]. Written informed consent was obtained from all patients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eQian Z, Xu K, Kong X, Xu H: \u003cstrong\u003eAhmed Glaucoma Valves versus EX-PRESS Devices in Glaucoma Secondary to Silicone Oil Emulsification\u003c/strong\u003e. \u003cem\u003eJ Ophthalmol \u003c/em\u003e2018, \u003cstrong\u003e2018\u003c/strong\u003e:8539689.\u003c/li\u003e\n\u003cli\u003eCornacel C, Dumitrescu OM, Zaharia AC, Pirvulescu RA, Munteanu M, Tataru CP, Istrate S: \u003cstrong\u003eSurgical Treatment in Silicone Oil-Associated Glaucoma\u003c/strong\u003e. \u003cem\u003eDiagnostics (Basel) \u003c/em\u003e2022, \u003cstrong\u003e12\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eDong A, Han L, Shao Z, Fan P, Zhou X, Yuan H: \u003cstrong\u003eGlaucoma Drainage Device Coated with Mitomycin C Loaded Opal Shale Microparticles to Inhibit Bleb Fibrosis\u003c/strong\u003e. \u003cem\u003eACS Appl Mater Interfaces \u003c/em\u003e2019, \u003cstrong\u003e11\u003c/strong\u003e(10):10244-10253.\u003c/li\u003e\n\u003cli\u003ePromelle V, Lyons CJ: \u003cstrong\u003eLong-term Results of Ahmed Valve Implantation With Mitomycin-C in Pediatric Glaucoma\u003c/strong\u003e. \u003cem\u003eJ Glaucoma \u003c/em\u003e2021, \u003cstrong\u003e30\u003c/strong\u003e(7):596-605.\u003c/li\u003e\n\u003cli\u003eZuo L, Zhang J, Xu X: \u003cstrong\u003eCombined Application of Bevacizumab and Mitomycin C or Bevacizumab and 5-Fluorouracil in Experimental Glaucoma Filtration Surgery\u003c/strong\u003e. \u003cem\u003eJ Ophthalmol \u003c/em\u003e2018, \u003cstrong\u003e2018\u003c/strong\u003e:8965709.\u003c/li\u003e\n\u003cli\u003ePerez CI, Verdaguer S, Khaliliyeh D, Maul EA, Ou Y, Han Y: \u003cstrong\u003eSubconjunctival Injections of Mitomycin C Are Associated with a Lower Incidence of Hypertensive Phase in Eyes with Ahmed Glaucoma Valve\u003c/strong\u003e. \u003cem\u003eOphthalmol Glaucoma \u003c/em\u003e2021, \u003cstrong\u003e4\u003c/strong\u003e(3):322-329.\u003c/li\u003e\n\u003cli\u003eLaw SK, Huang JS, Nassiri N, Moghimi S, Nilforushan N, Parham A, Moossai J, Kim M, Caprioli J, Aldave AJ: \u003cstrong\u003eTechnique of combined glaucoma tube shunt and keratoprosthesis implantation\u003c/strong\u003e. \u003cem\u003eJ Glaucoma \u003c/em\u003e2014, \u003cstrong\u003e23\u003c/strong\u003e(8):501-507.\u003c/li\u003e\n\u003cli\u003eHong C-H, Arosemena A, Zurakowski D, Ayyala RS: \u003cstrong\u003eGlaucoma drainage devices: a systematic literature review and current controversies\u003c/strong\u003e. \u003cem\u003eSurvey of Ophthalmology \u003c/em\u003e2005, \u003cstrong\u003e50\u003c/strong\u003e(1):48-60.\u003c/li\u003e\n\u003cli\u003eFu L, Chan YK, Nie L, Dai Q, Qian Z, Shih KC, Lai JSM, Huang R, Pan W: \u003cstrong\u003eCiliochoroidal detachment after Ahmed glaucoma valve implantation: a retrospective study\u003c/strong\u003e. \u003cem\u003eBMC Ophthalmology \u003c/em\u003e2019, \u003cstrong\u003e19\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAlbahlal A, Alshamrani A, Khandekar R, Malik R: \u003cstrong\u003eOutcome of Surgical Management of Glaucoma Following Complex Retinal Detachment Repair With Silicone Oil Tamponade: Drainage Implant Versus Cyclophotocoagulation\u003c/strong\u003e. \u003cem\u003eJ Glaucoma \u003c/em\u003e2020, \u003cstrong\u003e29\u003c/strong\u003e(3):198-204.\u003c/li\u003e\n\u003cli\u003eSoebijantoro I, Noor NA: \u003cstrong\u003eTube Length Adjustment and Tube Trimming Technique in Refractory Glaucoma\u003c/strong\u003e. \u003cem\u003eCase Rep Ophthalmol Med \u003c/em\u003e2020, \u003cstrong\u003e2020\u003c/strong\u003e:8889448.\u003c/li\u003e\n\u003cli\u003eDavo-Cabrera JM, Lanzagorta-Aresti A, Alcocer Yuste P: \u003cstrong\u003eA Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade\u003c/strong\u003e. \u003cem\u003eJ Glaucoma \u003c/em\u003e2017, \u003cstrong\u003e26\u003c/strong\u003e(10):e232-e235.\u003c/li\u003e\n\u003cli\u003eAl-Jazzaf AM, Netland PA, Charles S: \u003cstrong\u003eIncidence and management of elevated intraocular pressure after silicone oil injection\u003c/strong\u003e. \u003cem\u003eJ Glaucoma \u003c/em\u003e2005, \u003cstrong\u003e14\u003c/strong\u003e(1):40-46.\u003c/li\u003e\n\u003cli\u003eLiang YB, Feng MY, Meng HL, Fan SJ, Wang X, Xie LL, Yi P, Tang X, Wang NL, Thomas R: \u003cstrong\u003eEarly Efficacy and Complications of Releasable Sutures for Trabeculectomy in Primary Angle-closure Glaucoma\u003c/strong\u003e. \u003cem\u003eJournal of Glaucoma \u003c/em\u003e2014, \u003cstrong\u003e23\u003c/strong\u003e(3):136-141.\u003c/li\u003e\n\u003cli\u003eXiahou L, Liu C, Zhou W, Yang S: \u003cstrong\u003eMicrosurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma\u003c/strong\u003e. \u003cem\u003ePak J Med Sci \u003c/em\u003e2020, \u003cstrong\u003e36\u003c/strong\u003e(2):234-239.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"glaucoma valve implantation, silicone oil blockage, figure-of-eight knot, refractory glaucoma","lastPublishedDoi":"10.21203/rs.3.rs-5363004/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5363004/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn recent years, glaucoma valves have played an important role in the management of SOE-related glaucoma. However, the occurrence of tube blockage with SO has emerged as a significant factor contributing to surgical failure in these patients. One reason is that the opening of tube is too close to silicon oil, and the other is the early excessive drainage of aqueous humor. Therefore, we developed this technique to manipulate the positioning of the valve body and restrict early aqueous humor outflow and subsequently assessed its safety and efficacy during an over one-year follow-up.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAfter the glaucoma valve was implanted in the subtemporal region, a figure-of-eight knot was utilized to encircle the tube, forming a knot of continuous double loops. This knot gently compresses the tube, thereby constricting its lumen and restricting drainage of aqueous humor. The IOP, BCVA, and complications in all patients were observed and recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere are 6 eyes with secondary glaucoma received this surgical treatment. The mean of preoperative IOP was 45.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8mmHg, and decreased to 13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0mmHg after surgery (P\u0026thinsp;=\u0026thinsp;0.000). During the follow-up(17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3months), we observed stable IOP, and none of the patients exhibited tube blockage caused by SO.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis technique can effectively prevent SO blockage in AGV.\u003c/p\u003e","manuscriptTitle":"Figure-of-eight Knot Technique combined with Subtemporal Placement for Prevention of Silicone Oil Blockade in Ahmed Glaucoma Valve：A Novel Surgical Technique for the Treatment of Refractory Glaucoma after silicone oil endotamponade","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-26 14:09:28","doi":"10.21203/rs.3.rs-5363004/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bad5ebf5-7d0b-4a31-a735-0ed7aeb8a6e2","owner":[],"postedDate":"November 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-26T06:23:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-26 14:09:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5363004","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5363004","identity":"rs-5363004","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}