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Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report
RATIONALE: The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2–3 μg/min each), representing approximately 1% of the content of the...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270613/ https://www.ncbi.nlm.nih.gov/pubmed/34232212 http://dx.doi.org/10.1097/MD.0000000000026603 |
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author | Tanabe, Hirotaka Nakakura, Shunsuke Tabuchi, Hitoshi |
author_facet | Tanabe, Hirotaka Nakakura, Shunsuke Tabuchi, Hitoshi |
author_sort | Tanabe, Hirotaka |
collection | PubMed |
description | RATIONALE: The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2–3 μg/min each), representing approximately 1% of the content of the anterior chamber; therefore, it is challenging to visualize its flow. PATIENT CONCERNS: A 69-year-old man who had high intraocular pressure (IOP) (>20 mm Hg) with the maximum glaucoma eyedrop dose and presented with severe visual field loss (Humphrey Field Analyzer 30–2: –26.32 dB) had been implanted with a 350-mm(2) Baerveldt tube of the aqueous chamber type for refractory open-angle glaucoma. The IOP ultimately decreased (<15 mm Hg) with no need for glaucoma eyedrops. DIAGNOSES: After the procedures, a fibrin membrane repeatedly formed on the anterior surface of the intraocular lens. INTERVENTIONS: This issue was resolved by two rounds of neodymium-doped yttrium aluminum granet (Nd:YAG) laser surgery and prescription steroidal eyedrops. OUTCOMES: During the laser surgery, an unusual and unintended fibrin flap appeared at the opening of the Baerveldt tube; this flap moved synchronously with the heartbeat, as verified by checking the pulse at the radial artery of the wrist. The fibrin flap mimicked the behavior of a cardiac valve, and the aqueous humor and stray fibrin particles mimicked the blood in the chambers of the heart. Although the Baerveldt tube itself is an artificial instrument that is not present in normal human eyes, we hypothesize that our observation shows the fundamental mechanism of aqueous humor drainage. LESSONS: This novel, vividly descriptive observation highlights the important role of the heartbeat as a drainage pump in aqueous humor flow dynamics and IOP homeostasis, which are treatment targets for glaucoma, the leading cause of blindness. |
format | Online Article Text |
id | pubmed-8270613 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-82706132021-07-12 Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report Tanabe, Hirotaka Nakakura, Shunsuke Tabuchi, Hitoshi Medicine (Baltimore) 5800 RATIONALE: The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2–3 μg/min each), representing approximately 1% of the content of the anterior chamber; therefore, it is challenging to visualize its flow. PATIENT CONCERNS: A 69-year-old man who had high intraocular pressure (IOP) (>20 mm Hg) with the maximum glaucoma eyedrop dose and presented with severe visual field loss (Humphrey Field Analyzer 30–2: –26.32 dB) had been implanted with a 350-mm(2) Baerveldt tube of the aqueous chamber type for refractory open-angle glaucoma. The IOP ultimately decreased (<15 mm Hg) with no need for glaucoma eyedrops. DIAGNOSES: After the procedures, a fibrin membrane repeatedly formed on the anterior surface of the intraocular lens. INTERVENTIONS: This issue was resolved by two rounds of neodymium-doped yttrium aluminum granet (Nd:YAG) laser surgery and prescription steroidal eyedrops. OUTCOMES: During the laser surgery, an unusual and unintended fibrin flap appeared at the opening of the Baerveldt tube; this flap moved synchronously with the heartbeat, as verified by checking the pulse at the radial artery of the wrist. The fibrin flap mimicked the behavior of a cardiac valve, and the aqueous humor and stray fibrin particles mimicked the blood in the chambers of the heart. Although the Baerveldt tube itself is an artificial instrument that is not present in normal human eyes, we hypothesize that our observation shows the fundamental mechanism of aqueous humor drainage. LESSONS: This novel, vividly descriptive observation highlights the important role of the heartbeat as a drainage pump in aqueous humor flow dynamics and IOP homeostasis, which are treatment targets for glaucoma, the leading cause of blindness. Lippincott Williams & Wilkins 2021-07-09 /pmc/articles/PMC8270613/ /pubmed/34232212 http://dx.doi.org/10.1097/MD.0000000000026603 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | 5800 Tanabe, Hirotaka Nakakura, Shunsuke Tabuchi, Hitoshi Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title | Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title_full | Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title_fullStr | Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title_full_unstemmed | Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title_short | Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report |
title_sort | heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: the heartbeat acts as a drainage pump for the aqueous humor: a case report |
topic | 5800 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270613/ https://www.ncbi.nlm.nih.gov/pubmed/34232212 http://dx.doi.org/10.1097/MD.0000000000026603 |
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