Abstract
We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy (n =16) or Ahmed valve implantation (n = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, p = 0.987). The mean IOPs were similar as well (p = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; p = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group (p = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.
Highlights
Uveitic glaucoma is a disease caused by elevated intraocular pressure (IOP) due to increased resistance to aqueous outflow associated with the etiology of uveitis and inflammation [1,2]
We retrospectively reviewed the medical records of patients who had undergone trabeculectomy with MMC or Ahmed valve implantation with MMC for medically uncontrolled uveitic glaucoma between June 2009 and April 2020 at Ajou University Hospital
Uveitic glaucoma is defined as the type of glaucoma that manifests as glaucomatous optic nerve head damage and/or visual field defect due to elevated IOP associated with increased resistance to aqueous outflow following inflammation [22]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Uveitic glaucoma is a disease caused by elevated intraocular pressure (IOP) due to increased resistance to aqueous outflow associated with the etiology of uveitis and inflammation [1,2]. The incidence of glaucoma in uveitic patients has been reported to be between 9.6% and 18.3% and as high as 46% in severe chronic uveitis [3], according to disease etiology. Medical therapy including an IOP-lowering agent is considered to be the first choice for IOP control in uveitic glaucoma. Surgical intervention often is required, due to the detrimental effect of acute or chronic inflammation on the aqueous outflow, manifesting as aggravated outflow resistance and uncontrolled IOP elevation [2,4,5]
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