Estudio comparativo de la seguridad y eficacia entre el dispositivo valvular de Ahmed modelo M4 (polietileno poroso de alta densidad) y el modelo S2 (polipropileno) en pacientes con diagnóstico de glaucoma neovascular

Abstract

ObjectiveTo prospectively evaluate the safety and efficacy of the Ahmed glaucoma valve model M4 (High density porous polyethylene plate; Medpor) compared with the model S2 (polypropylene plate). MethodMexican patients with neovascular glaucoma were randomly included for each group (M4 and S2). They were operated on using conventional techniques and creating a sub-episcleral tunnel to place the valve tube in the anterior chamber.After one year of follow-up, the results were evaluated with respect to a post-operative reduction in pressure, changes in visual acuity, the need for drugs, and complications, as well as the demographic characteristics of each group.Each operation using the M4 valve was performed by a single surgeon (FGC). Those operated on using the S2 model had their surgery performed by the staff surgeons at the Glaucoma Department of the Mexican Association to Prevent Blindness (APEC). ResultsEach group (M4 and S2) contained 21 eyes of 21 Mexican patients with a diagnosis of neovascular glaucoma, leading to a total of 42 patients undergoing surgery. The mean preoperative intraocular pressure (IOP) was 43.5 (±11.8), and 42.24 (±12.84) mmHg for the M4 and S2 groups, respectively. After one year of follow-up, the IOP reported was 18.9 (±9.7) mmHg for the final 18 patients in the M4 group, and 16.38 (±9.76) mmHg for the 21 patients in the S2 group. DiscussionThe design of a drainage valve device such as that of Ahmed has characteristics such as moderate control of IOP, thanks to the valve component in the immediate post-operative period, which makes them safer than other non-valve devices. This avoids an excess of flat chambers and the presence of low IOPs, which can lead to bleeding in the early post-operative period due to the weak desmosomal junctions of the newly formed vessels, with the advantage of maintaining suitable control of IOP from the first day after surgery. ConclusionFurther studies with longer follow-up with a larger number of patients are needed to evaluate the effectiveness of this porous coating in the control of neovascular glaucoma.