Abstract
PurposeTo evaluate the long-term efficacy of intraocular pressure (IOP) reduction and complications of Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma.DesignRetrospective study.SubjectsThe study involved 302 refractory glaucoma patients who underwent AGV implantation and had a minimum follow-up of 6 months between March 1995 and December 2013.MethodsAn operation was defined as successful when (1) the postoperative IOP remained between 5 and 21 mmHg and was reduced 30% compared to the baseline IOP with or without medication, (2) there was no loss of light perception or vision-threatening severe complications, and (3) no additional filtering or aqueous drainage surgery was required. Clinical records were reviewed.Main outcome measuresIOP, anti-glaucoma medications, and complicationsResultsThe mean follow-up period was 62.25 months (range, 6 to 190 months). The cumulative probability of success was 89% at 6 months, 81% at 1 year, 66% at 3 years, 44% at 10 years, and 26% at 15 years. IOP was reduced from a mean of 32.2 ± 10.5 mmHg to 18.6 ± 9.1 mmHg at 1 month, 15.2 ± 7.0 mmHg at 6 months, and 14.2 ± 3.5 mmHg at 15 years. Surgical failures were significantly increased when preoperative IOP was high, and when severe complications occurred after AGV implantation (P < 0.05).ConclusionAGV implantation was successful for IOP control in patients with refractive glaucoma in the long term. However, the success rate of surgery decreased over time. Preoperative high IOP and severe complications related to the operation were significant risk factors for failure.
Highlights
Refractory glaucoma such as neovascular, uveitic, and angle recession glaucoma, cases of previously failed glaucoma surgery, and other secondary glaucomas are usually known as poorly responsive to traditional glaucoma medical and surgical procedures [1,2,3]
An operation was defined as successful when (1) the postoperative intraocular pressure (IOP) remained between 5 and 21 mmHg and was reduced 30% compared to the baseline IOP with or without medication, (2) there was no loss of light perception or vision-threatening severe complications, and (3) no additional filtering or aqueous drainage surgery was required
Surgical failures were significantly increased when preoperative IOP was high, and when severe complications occurred after Ahmed Glaucoma Valve (AGV) implantation (P < 0.05)
Summary
Refractory glaucoma such as neovascular, uveitic, and angle recession glaucoma, cases of previously failed glaucoma surgery, and other secondary glaucomas are usually known as poorly responsive to traditional glaucoma medical and surgical procedures [1,2,3]. If medical and surgical therapy were not effective, diverse surgical approaches have been proposed for the treatment of refractory glaucomas. These include trabeculectomy with mitomycin and cyclophotocoagulation procedures. The Tube Versus Trabeculectomy study demonstrated that in patients who had undergone previous intraocular surgery, glaucoma drainage devices had a higher success rate with fewer complications when compared to trabeculectomy with mitomycin C after 3 years of follow- up [9]. Very long-term follow-up data are scarce and studies on severe complications, especially those affecting clinical outcomes, have rarely been presented far. We set out to evaluate the very long-term clinical outcomes of Ahmed valve implantation in refractory glaucoma, including its severe complications and success rate
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