Intraocular pressure control after the implantation of a second Ahmed glaucoma valve.
The objective of this study is to evaluate the efficacy and safety of a second Ahmed glaucoma valve (AGV) in eyes with refractory glaucoma that had undergone prior Ahmed device implantation. This multicenter, retrospective study evaluated 58 eyes (58 patients) that underwent a second AGV (model S2-n = 50, model FP7-n = 8) due to uncontrolled IOP under maximal medical therapy. Outcome measures included IOP, visual acuity, number of glaucoma medications, and postoperative complications. Success was defined as IOP <21 mmHg (criterion 1) or 30 % reduction of IOP (criterion 2) with or without hypotensive medications. Persistent hypotony (IOP <5 mmHg after 3 months of follow-up), loss of light perception, and reintervention for IOP control were defined as failure. Mean preoperative IOP and mean IOPs at 12 and 30 months were 27.55 ± 1.16 mmHg (n = 58), 14.45 ± 0.83 mmHg (n = 42), and 14.81 ± 0.87 mmHg (n = 16), respectively. The mean numbers of glaucoma medications preoperatively at 12 and 30 months were 3.17 ± 0.16 (n = 58), 1.81 ± 0.2 (n = 42), and 1.83 ± 0.35 (n = 18), respectively. The reductions in mean IOP and number of medications were statistically significant at all time intervals (P < 0.001). According to criterion 1, Kaplan-Meier survival curves disclosed success rates of 62.9 % at 12 months and 56.6 % at 30 months. According to criterion 2, Kaplan-Meier survival curves disclosed success rates of 43.9 % at 12 months and 32.9 % at 30 months. The most frequent early complication was hypertensive phase (10.3 %) and the most frequent late complication was corneal edema (17.2 %). Second AGV implantation may effectively reduce IOP in eyes with uncontrolled glaucoma, and is associated with relatively few complications.
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico.
Jesús
J
Jiménez-Román
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico.
Félix
F
Gil-Carrasco
Glaucoma Department, UNICAMP, Sao Paulo, Brazil.
Vital Paulino
VP
Costa
Glaucoma Department, UNICAMP, Sao Paulo, Brazil.
Rui Barroso
RB
Schimiti
Glaucoma Department, Fundación para el estudio del Glaucoma, Buenos Aires, Argentina.
Fabián
F
Lerner
Glaucoma Department, UNICAMP, Sao Paulo, Brazil.
Priscila Rezende
PR
Santana
Glaucoma Department, UNICAMP, Sao Paulo, Brazil.
Jose Paulo Cabral
JP
Vascocellos
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico. a.castillejos@me.com.
Armando
A
Castillejos-Chévez
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico.
Mauricio
M
Turati
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico.
Karina
K
Fabre-Miranda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants / Q000009:adverse effects; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D000959:Antihypertensive Agents
Ahmed drainage device; Glaucoma; Glaucoma drainage device; Surgery