Abstract
BackgroundMany studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively. The aim of this study was to compare the 1-year outcomes of AGV implantation with and without Ologen adjuvant for the treatment of refractory glaucoma.MethodsThis retrospective study included a total of 20 eyes of 20 glaucoma patients, who were followed for at least 1-year after undergoing AGV implantation. In 12 eyes of 12 patients, conventional AGV (CAGV) surgery was performed, while in 8 eyes of 8 patients, Ologen-augmented AGV (OAGV) implantation was performed. The outcomes were evaluated according to intraocular pressure (IOP) and the number of IOP-lowering medications. Complete success was defined as IOP ≤ 21 mmHg without medications throughout the 1-year follow-up period, and qualified success was defined as IOP ≤ 21 mmHg with or without medications throughout the 1-year follow-up period.ResultsThe rate of complete success was significantly higher in the OAGV group (50.0%) than in the CAGV group (8.3%) (p = 0.035). There were no significant differences between the two groups in terms of qualified success or incidence of the early hypertensive phase. The IOP changes were similar between the groups within 1-year postoperatively, though the number of IOP-lowering medications was significantly lower in the OAGV group during the early hypertensive phase (p = 0.031, 0.031, and 0.025 at postoperative months 1, 2, and 3, respectively). When subjects were divided into groups according to the occurrence of the early hypertensive phase, the group with early hypertensive phase was more likely to use IOP-lowering medications at postoperative 6 months and 1 year (p = 0.002 and 0.005, respectively).ConclusionsOAGV surgery shows encouraging results for patients with refractory glaucoma, specifically with respect to the achievement of complete success and the reduction of the number of IOP-lowering medications during the early hypertensive phase. Furthermore, our results suggest that occurrence of the early hypertensive phase is predictive of which patients will require IOP-lowering medications at postoperative 6 months and 1 year.
Highlights
IntroductionIts benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively
Many studies have investigated the clinical benefits of Ologen for trabeculectomy
Since the publication of the “Tube Versus Trabeculectomy” paper, which reported a landmark study showing a higher long-term success rate and a lower complication rate for glaucoma drainage devices (GDD) compared with trabeculectomy with Mitomycin C (MMC), the role of GDD has been expanding to a wider range of patients [3,4,5]
Summary
Its benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively. Among GDD, the Ahmed glaucoma valve (AGV) is widely used due to its effectiveness in reducing the occurrence of postoperative hypotony and the related complications [14,15,16,17]. Song et al [21] investigated clinical and biological aspects of Ologen on AGV surgeries with at least 6 month follow-up period, group setting (cylindrical Ologen group vs rectangular Ologen group vs control group) and the number or shape of Ologen (two cylindrical Ologens vs one rectangular Ologen) that had been used were different. Song et al [21] investigated clinical and biological aspects of Ologen on AGV surgeries with at least 6 month follow-up period, group setting (cylindrical Ologen group vs rectangular Ologen group vs control group) and the number or shape of Ologen (two cylindrical Ologens vs one rectangular Ologen) that had been used were different. (In contrast, we used only one cylindrical Ologen that more closely fits the subconjunctival space and does not require suturing to the AGV to maximize the plasticity of the collagen matrix.)
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