Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

Hamed Esfandiari,Chao Wang,Shahin Yazdani,Nils A Loewen,Kiana Hassanpour,Mohammad Pakravan,Ali Fatourechi,Mehdi Yaseri

doi:10.12688/f1000research.15244.1

Abstract

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

Highlights

Fuchs heterochromic iridocyclitis (FHIC) is a rare form of uveitis
Since there is an average 3.7-year delay in diagnosing FHIC, it should be considered as a differential diagnosis for any young patient with unilateral low-grade uveitis and good visual acuity[5]
The chart review occured at the Labbafinejad Medical Center, Tehran, Iran, and included charts from May 2001 to September 2017, yielding 26 patients with FHIC-associated glaucoma that either had mitomycin C (MMC)-augmented trabeculectomy or a primary Ahmed glaucoma valve (AGV) implantation

Summary

Introduction

While the incidence of all forms of uveitis is approximately 0.035% of the population[1], the incidence of FHIC is only about 0.00105% (3% of all uveitis cases)[2,3] and occurs in both eyes in 10% of patients[4]. It is characterized by low-grade intraocular inflammation, small stellate keratic precipitates, and iris stromal atrophy[5]. The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP

Objectives

Methods

Results

Conclusion