Ahmed glaucoma valve implantation for neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy.
OBJECTIVE
To evaluate the safety and efficacy of Ahmed Glaucoma Valve implantation (AGVI) for the management of neovascular glaucoma (NVG) associated with proliferative diabetic retinopathy (PDR) in the vitrectomized eyes.


METHODS
We reviewed the medical records of patients with NVG associated with PDR who underwent AGVI for intraocular pressure (IOP) control and compared the surgical outcome according to vitrectomy history. The main outcome measures were: postoperative IOP control, visual acuity, and complications. Success was defined as an IOP of ≤21 mm Hg and ≥6 mm Hg, without further glaucoma surgery or loss of light perception and devastating complications.


RESULTS
A total of 73 patients (73 eyes) were included: 42 patients with vitrectomy history before AGVI (vitrectomized group) and 31 patients without vitrectomy history (nonvitrectomized group). The cumulative probabilities of success after AGVI were 89.9% and 83.8% after 1 year, 74.8% and 74.7% after 2 years, and 62.5% and 68.5% after 3 years for the vitrectomized group and the nonvitrectomized group, respectively (P=0.9309). Cox proportional hazards regression showed the intraocular silicone oil tamponade as a risk factor for the surgical failure (odds ratio=4.543, P=0.047). Final visual acuity improved or stabilized in 33 patients (78.6%) in the vitrectomized group and 18 patients (58.1%) in the nonvitrectomized group. Complications were comparable between the groups, but surgical interventions were needed for 5 patients (11.9%) in the vitrectomized group.


CONCLUSIONS
Despite some complications that necessitate surgical intervention, the AGVI is a safe and effective procedure that enables successful IOP control and vision preservation in patients with NVG associated with vitrectomy for the PDR.
Park
Un Chul
UC
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.
Park
Ki Ho
KH
Kim
Dong Myung
DM
Yu
Hyeong Gon
HG
D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000503:physiopathology / Q000601:surgery*; D058450:Endotamponade / Q000009:adverse effects; D005260:Female; D020327:Glaucoma Drainage Implants; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation; D012307:Risk Factors; D012827:Silicone Oils / Q000009:adverse effects; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000009:adverse effects*; D055815:Young Adult
D012827:Silicone Oils