Abstract
To evaluate the clinical outcomes of pseudophakic/aphakic eyes with uncontrolled glaucoma that underwent Ahmed glaucoma valve implantation with the tube placement in the ciliary sulcus. Medical records of the patients who underwent Ahmed glaucoma valve implantation through the ciliary sulcus, between December 2017 and June 2019, were reviewed retrospectively. Patients' age, gender, glaucoma diagnosis, visual acuity, intraocular pressure levels, and complications were recorded. Forty-seven eyes of 43 patients with glaucoma were enrolled. The mean age was 54.5 ± 19.9years (range, 7-88years) at the time of surgery, and the mean postoperative follow-up period was 7.9 ± 3.4months (range, 3-16months). The mean preoperative intraocular pressure level was 35.2 ± 6.8mmHg (range, 25-55mmHg), and it was found as 15.6 ± 5.4mmHg (range, 9-33mmHg) at the last follow-up visit. Decrease in intraocular pressure level was statistically significant (P < 0.001). At the last follow-up visit, success (postoperative IOP ≥ 6mmHg and ≤ 21mmHg with or without antiglaucomatous medications, without further surgery for IOP control, without loss of light perception and without removal of the implant) was achieved in 41 eyes (87.2%). Hyphema was the most common postoperative complication and developed in 11 eyes (23.4%) and resolved spontaneously in all of them within one month. In pseudophakic or aphakic eyes with uncontrolled glaucoma, placement of Ahmed glaucoma valve tube in the ciliary sulcus is a safe and effective procedure. Ciliary sulcus can be considered as a potential space during tube shunt surgery in eyes with high risk of tube-corneal touch or corneal decompensation.
Highlights
Glaucoma drainage devices have been used widely for many years in the management of refractory or complicated glaucoma cases and usually preferred when trabeculectomy has failed or is unlikely to succeed
Ciliary sulcus can be considered as a potential space during tube shunt surgery in eyes with high risk of tube-corneal touch or corneal decompensation
Since our hospital is a tertiary referral center in the region, we often encounter refractory or complicated glaucoma cases such as primary or secondary angle closure glaucoma, glaucoma associated with vitreoretinal surgery, aphakic glaucoma, traumatic, uveitic or postkeratoplasty glaucoma
Summary
Glaucoma drainage devices have been used widely for many years in the management of refractory or complicated glaucoma cases and usually preferred when trabeculectomy has failed or is unlikely to succeed. Ahmed glaucoma valve (AGV; New World Medical Inc., Rancho Cucamonga, CA, USA) is mostly used and readily available GDD in our country and recently, we have begun to insert the AGV tube into the ciliary sulcus in certain glaucoma cases. We prefer this surgical technique in aphakic/ pseudophakic eyes in which there is high risk of corneal decompensation after AC tube shunt placement such as the presence of shallow AC depth, compromised corneal endothelium or corneal transplant. The current study presents the results of 47 eyes of 43 patients from a single center
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