title: Adjunctive triamcinolone acetonide for Ahmed glaucoma valve implantation: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effect of intraoperative sub-Tenon injection of triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation.
  
  
  METHODS
  In this triple-blind randomized clinical trial, 104 eyes with refractory glaucoma were randomly assigned to conventional AGV (non-TA group) or AGV with adjunctive triamcinolone (TA group). In the TA group, 10 mg TA was injected in the sub-Tenon space around the AGV plate intraoperatively. Patients were followed for 1 year. The main outcome measure was intraocular pressure (IOP). Other outcome measures included best-corrected visual acuity (BCVA), occurrence of hypertensive phase (HP), peak IOP, number of antiglaucoma medications, and complications.
  
  
  RESULTS
  A total of 90 patients were included in the final analysis. Mean IOP was lower in the TA group at most follow-up visits; however, the difference was statistically significant only at the first month (p = 0.004). Linear mixed model showed that mean IOP was 1.5 mm Hg lower in the TA group throughout the study period (p = 0.006). Peak postoperative IOP was significantly lower in the TA group (19.3 ± 4.8 mm Hg versus 29 ± 9.2 mm Hg, p = 0.032). Rates of success (defined as 6 < IOP <21 mm Hg) were similar in both groups at 12 months. There was no difference in the occurrence of the HP between the 2 groups (p = 0.123). Loss of BCVA >2 lines was more common in the non-TA group (p = 0.032).
  
  
  CONCLUSIONS
  Adjunctive intraoperative TA injection during AGV implantation can blunt peak IOP levels and reduce mean IOP up to 1 year. Visual outcomes also seem to be superior to standard surgery.
authors:  Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.| Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors: Shahin
authors: S
authors: Yazdani
authors:  Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors: Azadeh
authors: A
authors: Doozandeh
authors:  Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors: Mohammad
authors: M
authors: Pakravan
authors:  Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors: Vahid
authors: V
authors: Ownagh
authors:  Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran - Iran.
authors: Mehdi
authors: M
authors: Yaseri
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D019919:Prosthesis Implantation / Q000379:methods*; D014065:Tonometry, Ocular; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D014222:Triamcinolone Acetonide