title: Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy.
abstract: OBJECTIVE
  To compare outcomes of resident-performed Ahmed valve surgery vs trabeculectomy in a Veteran Affairs medical facility.
  
  
  METHODS
  A retrospective cohort of 103 eyes in 91 patients receiving Ahmed valve (valve) or trabeculectomy (trab) performed at a Veterans Administration Medical Center by residents in their third year of training. The primary outcomes included intraocular pressure (IOP), treatment failure, and complications over 1 year.
  
  
  RESULTS
  Of 103 eyes, 44 received valve and 59 received trab. Primary open-angle glaucoma was primary diagnosis more often in trab, while neovascular glaucoma predominated in the valve group (p < 0.001). Preoperative mean IOP was 35.1 ± 11.8 and 24.5 ± 7.1 mm Hg for valve and trabeculectomy respectively (p < 0.001), but at 1 year the IOP difference between groups was not statistically significant (p = 0.064). Overall, 11 (25.0%) and 11 (18.6%) eyes met any criteria for failure for valve and trab respectively. At 1 year, 22.5% of valves had IOP > 21 mm Hg vs only 4.3% of trab (p = 0.02). Complications were infrequent. There were no intraoperative complications for valve, whereas five for trab. Most common immediate complication for valve was hyphema. Both groups had low rates of choroidal effusions and reoperation.
  
  
  CONCLUSIONS
  Ahmed valve implantation and trabeculectomy produce significant reductions in IOP when performed by residents-in-training. Valves tend to be used more frequently in patients with secondary glaucoma. Although complication profiles differ between procedures, both are safe and well tolerated when performed by resident physicians.
  
  
  CONCLUSIONS
  This study provides support for evidence-based patient counseling that supervised, resident-performed Ahmed valve implantation and trabeculectomy are indeed safe and effective. How to cite this article: Sharpe RA, Kammerdiener LL, Wannamaker KW, Fan J, Sharpe ED. Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy. J Curr Glaucoma Pract 2016;10(2):60-67.
authors.affiliation: Resident, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sharpe
authors.affiliation: Fellow, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Kammerdiener
authors.affiliation: Resident, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Kendall W
authors.initials: KW
authors.lastname: Wannamaker
authors.affiliation: Research Instructor, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Fan
authors.affiliation: Professor, Department of Ophthalmology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Sharpe
keywords: Glaucoma; Resident; Trabeculectomy; Training; Valve.