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      Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma

      research-article
      Author(s): 1 , 2 , 2 , 1 , 2 ,
      Publication date (Electronic):
      Journal: Journal of Ophthalmology
      Publisher: Hindawi

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          Abstract

          Results

          The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6 mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline ( P < 0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%).

          Conclusion

          An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.

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          Most cited references37

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          A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma.

          R Monshizadeh, R Ayyala, William Layden … (1998)
          To assess clinical outcomes and establish the incidence and management of a hypertensive phase (HP) (defined as intraocular pressure [IOP] > 21 mmHg in the first 6 postoperative months) in patients with Ahmed glaucoma valve implant. Retrospective noncomparative case series. A total of 85 patients were included in the current study, including consecutive patients who had intractable glaucoma and underwent Ahmed valve implant insertion at the University Glaucoma Center, Tampa, Florida (DWR and WEL) and the Massachusetts Eye and Ear Infirmary (PAN) between January 1993 and June 1997. Only patients with a minimum of 6 months' follow-up were included. Ahmed glaucoma valve implant insertion to control intractable glaucoma was performed. Success was defined as IOP less than 22 mmHg and greater than 4 mmHg on the last two visits, a decrease of no more than two lines in the visual acuity and no additional surgical interventions to control IOP. The cumulative probability of success at 12 months was 77%. A total of 26 patients (30.6%) failed during the study period, and 70 patients (82%) exhibited HP. Hypertensive phase peaked at 1 month after the operation and stabilized at 6 months. There were 34 patients (48%) with HP who were controlled with additional medications: 14 (20%) with needling and 5-fluorouracil injections and 20 (28%) who needed secondary surgical intervention. There were 8 patients (9.4%) who exhibited hypotony (< 5 mmHg) on postoperative day 1 and 3 (3.5%) at 3 months. Visual acuity returned to baseline between 3 and 6 months after the operation. The major complications associated with the valve were hyphema in 14 cases (16.5%), suprachoroidal hemorrhage in 4 cases (4.7%), end-plate exposure in 10 cases (11.7%), tube exposure in 6 cases (7%), tube block in 4 cases (4.7%), loss of vision in 5 cases (5.8%), and corneal graft failure in 4 (30%) of 13 cases with clear grafts. The overall success rate is comparable to that of prior studies using different implants. The majority of the patients exhibit an HP that peaks at 1 month, with gradual stabilization over 6 months. One third of the patients needed secondary surgical intervention to control the HP. The incidence of postoperative hypotony and flat or shallow anterior chambers is very low after Ahmed glaucoma valve insertion.
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            Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve.

            Joseph Caprioli, Kouros Nouri-Mahdavi (2003)
            To investigate the postoperative hypertensive phase (HP) in patients undergoing glaucoma drainage implant surgery. Interventional case series. A retrospective chart review of 156 consecutive eyes (139 patients) who underwent placement of an Ahmed Glaucoma Valve (AGV) with a follow-up of >or=3 months was performed. Main outcome measures were occurrence and resolution of the HP and intraocular pressure (IOP) control. The HP was defined as IOP > 21 mm Hg during the first 3 months after surgery. Resolution of the HP was defined as an IOP < 22 mm Hg and an IOP reduction of 3 mm Hg with the same or fewer number of glaucoma medications. An HP was observed in 88 eyes (56%). It occurred after a mean of 5.0 weeks (median, 4 weeks; range, 1-13 weeks) with an average (+/- standard deviation) peak IOP of 30.1 (+/- 7.5) mm Hg. Resolution of the HP occurred in 19 of 68 eyes (28%) with available data. Eyes with an HP had a higher mean IOP and needed more medications 6 to 12 months after surgery than eyes without an HP (17.2 +/- 5.6 vs 14.3 +/- 5.8 mm Hg; P =.012 and 1.7 +/- 1.2 vs 0.3 +/- 0.6 medications; P <.001, respectively). A hypertensive phase occurs frequently after implantation of the AGV. However, it resolves in only a minority of eyes. The majority of eyes with an HP have no significant improvement of IOP control and continue to require the same number of glaucoma medications as they did during the HP.
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              Practice Preferences for Glaucoma Surgery

              Kateki Vinod, Steven Gedde, William Feuer … (2017)
              The purpose of this study is to assess surgical practice patterns among the American Glaucoma Society (AGS) membership.
              Article 0 comments Cited 66 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Victor Koh:
                ORCID: https://orcid.org/0000-0003-4134-7142
                Journal
                Journal ID (nlm-ta): J Ophthalmol
                Journal ID (iso-abbrev): J Ophthalmol
                Journal ID (publisher-id): JOPH
                Title: Journal of Ophthalmology
                Publisher: Hindawi
                ISSN (Print): 2090-004X
                ISSN (Electronic): 2090-0058
                Publication date Collection: 2020
                Publication date (Electronic): 23 March 2020
                Volume: 2020
                Electronic Location Identifier: 8741301
                Affiliations
                1Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
                2Department of Ophthalmology, National University Hospital, 119228, Singapore
                Author notes

                Academic Editor: Dirk Sandner

                Author information
                https://orcid.org/0000-0003-4134-7142
                Article
                DOI: 10.1155/2020/8741301
                PMC ID: 7125488
                SO-VID: bc110c16-82df-41ce-b02e-d8cc0dcb7dfb
                Copyright © Copyright © 2020 Sze Chuan Ong et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 8 September 2019
                Date accepted : 2 March 2020
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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