Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma

Abstract

To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma. Retrospective comparative cohort study. All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine. Excluding the first postoperative day 1 (POD1), only eyes with IOP 10-15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10-15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months. Proportion achieving overall success; incidence of hypotony and hypertensive phase. Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2±10.1 mmHg) and ST (34.6±12.2 mmHg) groups; P=0.18. Final IOP was lower in the EAS group (12.9±4.6 mmHg) than the ST group (16.4±5.7 mmHg; P=0.02) on 2.6±0.9 medications in the EAS group and 1.8±1.5 in the ST group (P=0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P=0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4%for EAS, 20% for ST; P=0.11), hypotony (7% for EAS, 0% for ST; P=0.50), or hypertensive phase (4%forEAS, 21% for ST; P=0.09). EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.