Abstract
Purpose. To compare the changes in corneal endothelial cells after pars plana Ahmed glaucoma valve (AGV) implantation with those after the anterior chamber AGV implantation for refractory glaucoma. Methods. The medical records of 18 eyes with pars plana implantation of AGV (ppAGV) were reviewed retrospectively and were compared with 18 eyes with the anterior chamber AGV (acAGV) implant. The preoperative and postoperative endothelial cells, intraocular pressure (IOP), and postoperative complications during the follow-up in both groups were compared. Results. The average follow-up was 18 months. The postoperative endothelial cells in the ppAGV and acAGV groups were 2044 ± 303 and 1904 ± 324, respectively (P = 0.25). The average percentage decrease in the endothelial cells in the ppAGV and acAGV groups at 18 months was 12.5% and 18.4%, respectively, and showed significant difference between the 2 groups (P = 0.01). No difference in IOP control and the number of postoperative glaucoma medications was observed between the 2 groups. Conclusions. Endothelial cell damage in the ppAGV group for refractory glaucoma appeared to be lower than that in the acAGV group. Therefore, pars plana implantation of AGV may be preferred as it may have lower level of endothelial cell damage while maintaining similar level of IOP control.
Highlights
Glaucoma drainage device (GDD) is used in the management of refractory glaucoma
The mean preoperative corneal endothelial cell count, best corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were similar in the 2 groups (P > 0.05)
At the postoperative 18 months of follow-up, the mean endothelial cell count in the plana implantation of AGV (ppAGV) and anterior chamber AGV (acAGV) groups was 2044 ± 303 cells/mm2 and 1904 ± 324 cells/mm2, respectively, and was not significant between the 2 groups (P = 0.25)
Summary
Glaucoma drainage device (GDD) is used in the management of refractory glaucoma. In a multicenter randomized clinical trial, tube shunt surgery had a higher success rate compared to trabeculectomy, with similar reductions in intraocular pressure and the need for supplemental glaucoma medications [1]. The implant can be placed through pars plana in eyes with advanced glaucoma having secondary angle closure or angle neovascularization, corneal diseases, and other anterior chamber abnormalities [4,5,6]. Several studies have shown that pars plana vitrectomy with implantation of a drainage tube achieved a success rate comparable to that of an anterior chamber implant in refractory glaucoma [7,8,9]
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