Outcomes of a Second Ahmed Glaucoma Implant with Mitomycin-C in Pediatric Glaucoma After Initial Valve Failure.

Abstract

After failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium- and long-term survival. The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma. To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children. Retrospective chart review of patients with a history of at least one GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5 to 21mmHg without glaucoma medication and qualified success as a final IOP of 5 to 21mmHg with one or more glaucoma medication, without loss of vision. Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95%CI: 29% - 75%] at 2 years and 34% [95%CI: 18% - 65%] at 4 years. The probability of qualified success was 74% [95%CI: 56% - 97%] at 2 years, and 54% [95%CI: 34% - 84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 [6mo - 15y], 5 of which (23%) for severe complication or loss of vision. This study of implantation of a second valve with MMC reports a significant decrease of IOP and medications with medium- and long-term success rates close to those reported for a first valve implantation, although with a high risk of complications.