Intraluminal stenting versus external ligation of Ahmed glaucoma valve in prevention of postoperative hypotony.

Abstract

To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP≤21 mm Hg without medications indicated complete success while IOP≤21 mm Hg with medications indicated qualified success; and IOP<6 mm Hg was defined as hypotony. After a year of follow-up, IOP was significantly reduced in the intraluminal stenting group than in the external ligation group (11.67±0.89 vs 14.2±4.0 mm Hg, respectively, P=0.024). Postoperative hypotony was more common in the external ligation group (2 cases, 13.33%) than in the intraluminal stenting group (1 case, 6.67%). Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony (transient and persistent) that occurs in conventional AGV surgery.