title: Ahmed valve, suture-less implantation: A new approach to an easier technique.
abstract: OBJECTIVE
  Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma.
  
  
  METHODS
  Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥ 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo).
  
  
  RESULTS
  IOP control, defined as IOP ≤ 21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76 ± 2.60 and 6 ± 0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed.
  
  
  CONCLUSIONS
  These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation.
authors.affiliation: *Ophthalmology Department, La Fe University Hospital †Ophthalmology Department, Medicine Faculty, Catholic University of Valencia §Ophthalmology Department, Medicine Faculty, University of Valencia ‡Research Center for Rare Diseases (CIBERER), Valencia, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: García-Delpech
authors.forename: Empar
authors.initials: E
authors.lastname: Sanz-Marco
authors.forename: Sebastian
authors.initials: S
authors.lastname: Martinez-Castillo
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: López-Prats
authors.forename: Patricia
authors.initials: P
authors.lastname: Udaondo
authors.forename: David
authors.initials: D
authors.lastname: Salom
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz-Llopis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000601:surgery; D003487:Cyanoacrylates; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors; D014065:Tonometry, Ocular; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates