Ciliochoroidal detachment after Ahmed glaucoma valve implantation: a retrospective study

Lin Fu,Jimmy Shiu Ming Lai,Yau Kei Chan,Li Nie,Qi Dai,Kendrick Co Shih,Weihua Pan,Zhenbin Qian,Rong Huang

doi:10.1186/s12886-019-1060-y

Abstract

BackgroundTo investigate the occurrence of ciliochoroidal detachment (CCD), its risk factors and its impact on the success rate after Ahmed glaucoma valve (AGV) implantation.MethodsThis is a retrospective observational study carried out at Eye Hospital of Wenzhou Medical University, Zhejiang, China. Patients with uncontrolled glaucoma who underwent AGV implantation alone or combined with phacoemulsification (AGV-Phaco) in the hospital from April 1, 2013 to July 31, 2016 were included. The preoperative and postoperative CCD was defined when the detachment between ciliary body and choroid was detected by the ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) respectively. The main outcomes included the incidence of CCD and the success rate at 6 months after surgery.ResultsIn total, 97 male and 56 female patients were included. CCD was observed in 92 (57.8%) eyes. The glaucoma diagnosis in the Non-CCD and CCD group included primary open angle glaucoma (21(31.3%) vs 33(35.9%)), primary angle closure glaucoma (10(14.9%) vs 13(14.1%)), secondary glaucoma (25(37.3%) vs (28(30.4%)) and so on. The preoperative median IOP (interquartile range) were 21.7(16.0,32.0) mmHg and 23.0(16.0,33.0) mmHg in the Non-CCD group and CCD group. Previous surgical history (95% confidence interval (CI), 1.24 to 13.34; odds ratio (OR) 4.06; p = 0.02) and shorter axial length (95% CI, 0.62 to 0.97 OR 0.78; p = 0.02) were the two risk factors of CCD. The success rate between the CCD and Non-CCD group was not significantly different (64.3% vs 62.5%, p = 0.86) at 6 months.ConclusionsThe incidence of CCD is 57.8% after AGV surgery. Eyes with previous surgical procedure was prone to CCD occurrence and longer axial length was protective against CCD. But at 6 months postoperatively, CCD did not reduce the success rate of AGV surgery and may not be a worrisome complication.

Highlights

To investigate the occurrence of ciliochoroidal detachment (CCD), its risk factors and its impact on the success rate after Ahmed glaucoma valve (AGV) implantation
With the more promising success rate of long-term aqueous tube shunt implantation and less additional surgery required than trabeculectomy, the aqueous shunt becomes more preferred in refractory glaucoma over trabeculectomy as the surgical management [10,11,12]
The purpose of this study is to display a detailed description of CCD after AGV surgery, explore the triggers and investigate its effect on the postoperative intraocular pressure (IOP)

Summary

Introduction

To investigate the occurrence of ciliochoroidal detachment (CCD), its risk factors and its impact on the success rate after Ahmed glaucoma valve (AGV) implantation. Ciliochoroidal detachment (CCD) is a common complication after glaucoma filtering surgeries and some retinal procedures [1,2,3,4,5]. The use of aqueous shunt is traditionally considered as the last resort of treatment for refractory glaucoma after failure of medical treatment and trabeculectomy [8, 9]. With the more promising success rate of long-term aqueous tube shunt implantation and less additional surgery required than trabeculectomy, the aqueous shunt becomes more preferred in refractory glaucoma over trabeculectomy as the surgical management [10,11,12].

Objectives

Methods

Results

Conclusion