Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

Figure 3

(a) Patient with a CRVO develops recalcitrant macular edema associated with the use of travoprost. Also she is struggling to achieve her target IOP despite maximal medical management and elects to proceed with Ahmed Valve surgery. Pre-op VA is 20/60. (b) POD 1, IOP reduced to 0 mmHg off all antiglaucoma medications but placed on topical steroid difluprednate (Durezol, Alcon) at QID for the postoperative edema. POD 1 VA is 20/200. (c) POD 15 VA is 20/200 and, given the residual edema, intravitreal bevacizumab injection is given. (d) POD 36 VA improves to 20/60; IOP stabilizes at 14 mmHg while off all antiglaucoma medications and edema starts to resolve.

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