title: Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma.
abstract: OBJECTIVE
  The aim was to report the outcome of Ahmed glaucoma valve (AGV) (New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation as a surgical intervention following an initial failed combined trabeculotomy + trabeculectomy (trab + trab) in refractory primary congenital glaucoma (RPCG).
  
  
  METHODS
  Retrospective chart review of 11 eyes of 8 patients who underwent implantation of AGV (model FP8) for RPCG between 2009 and 2011. Prior trab + trab had failed in all the eyes. Success was defined as an intraocular pressure (IOP) >5 and ≤ 18 mmHg during examination under anesthesia with or without medications and without serious complications or additional glaucoma surgery.
  
  
  RESULTS
  The mean age at AGV implantation was 15.4 ± 4.9 months. The mean preoperative IOP was 28 ± 5.7 mmHg which reduced to 13.6 ± 3.4 mmHg postoperatively at the last follow-up (P < 0.0001). The number of topical antiglaucoma medications reduced from a mean of 2.6 ± 0.5 to 1.6 ± 0.9 postoperatively (P = 0.009). The definition of qualified success was met in 10 (90%) eyes. One eye developed a shallow anterior chamber with choroidal detachment at 1-week, which resolved spontaneously with medications. None of the eyes developed a hypertensive phase. One eye had a long tube resulting in tube corneal touch that required trimming of the tube. One eye developed tube retraction, which was treated with a tube extender. The mean follow-up was 17.9 ± 9.3 (6.2-35.4) months.
  
  
  CONCLUSIONS
  Managing RPCG remains a challenge. AGV implant was successful in a significant proportion of cases.
authors.affiliation: VST Glaucoma Centre, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh, India ; Department of Glaucoma, Dr. TV Patel Eye Institute, Salatwada, Vadodara, Gujarat, India.
authors.forename: Paaraj
authors.initials: P
authors.lastname: Dave
authors.affiliation: VST Glaucoma Centre, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh, India.
authors.forename: Sirisha
authors.initials: S
authors.lastname: Senthil
authors.affiliation: VST Glaucoma Centre, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Choudhari
authors.affiliation: VST Glaucoma Centre, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh, India.
authors.forename: Garudadri Chandra
authors.initials: GC
authors.lastname: Sekhar
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D020327:Glaucoma Drainage Implants; D006801:Humans; D006871:Hydrophthalmos / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
keywords: Ahmed Valve Implant; Failed Trabeculotomy and Trabeculectomy; Refractory Congenital Glaucoma