Abstract
Objective To evaluate and compare the clinical effects of Ahmed glaucoma valves (AGVs) and EX-PRESS implants on glaucoma secondary to silicone oil (SO) emulsification. Methods A retrospective case-series study was designed. A total of 23 eyes with late intraocular pressure (IOP) elevation secondary to SO emulsification were included in the study. Antiglaucoma surgery with implantation of AGVs or EX-PRESS devices was performed. Pre- and postoperative ocular parameters were recorded at each visit during a 1-year follow-up period. The rates of complete success (IOP < 21 mmHg without medication) and qualified success (IOP < 21 mmHg with ≤3 glaucoma medications) were analyzed. Results A total of 14 eyes underwent AGV implantation, and 9 underwent EX-PRESS implantation. The mean IOP and number of medications used at the last follow-up decreased significantly compared with that before surgery (P < 0.001). The total success rate for all eyes including complete success (7/23) and qualified success (7/23) was 60.9% (14/23) at 1 year. The total success rate in the AGV group was 78.6% (11/14), whereas it was 33.3% (3/9) in the EX-PRESS group; the difference between the 2 groups was significant (P < 0.05). Conclusion For glaucoma secondary to SO emulsification, glaucoma implants could be effective at lowering IOP, and AGVs might produce better outcomes than EX-PRESS devices.
Highlights
Silicone oil (SO) is widely used in the management of complicated retinal detachment
A major reason for the occurrence of glaucoma secondary to SO tamponade is SO emulsification. e incidence of open-angle glaucoma (OAG) after SO emulsification varies from 11% to 56% [4, 5]. e underlying mechanism might be the migration of SO droplets into the anterior chamber, which could directly obstruct the trabecular meshwork or cause inflammation in it [6]
We retrospectively reviewed a series of patients who were diagnosed with glaucoma secondary to SO emulsification and received EX-PRESS or Ahmed glaucoma valves (AGVs) implants
Summary
Silicone oil (SO) is widely used in the management of complicated retinal detachment. A series of complications can be caused by intraocular SO tamponade, including transient or permanent intraocular pressure (IOP) elevation [1,2,3]. A major reason for the occurrence of glaucoma secondary to SO tamponade is SO emulsification. E underlying mechanism might be the migration of SO droplets into the anterior chamber, which could directly obstruct the trabecular meshwork or cause inflammation in it [6]. Medical control of IOP is the first choice treatment. Budenz et al [8] reported a success rate of 69% for medical IOP control at 6 months, which dropped to 48% at 24 months. If IOP cannot be satisfactorily controlled, silicone removal is recommended. Additional invasive procedures include trabeculectomy, cycloablation, and implantation of glaucoma drainage devices
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