Outcomes of Small Size Ahmed Glaucoma Valve Implantation in Asian Chronic Angle-Closure Glaucoma.

Ke-Hao Huang,Da-Wen Lu,Jiann-Torng Chen,Yi-Hao Chen,Ching-Long Chen

doi:10.3390/jcm10040813

Abstract

For chronic angle-closure glaucoma (ACG), Ahmed glaucoma valve (AGV) is a useful drainage device for intraocular pressure (IOP) control but there are few reports discussing the outcomes of small size AGV in adult patients. This retrospective study involved 43 Asian adult patients (43 eyes) with chronic ACG. All patients had undergone small size AGV insertion and were divided into anterior chamber (AC) group and posterior chamber (PC) group. In the AC group, tube was inserted through sclerectomy gap into the anterior chamber. In the PC group, tube was inserted into posterior chamber through a needling tract. Outcome measures were intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, survival curve and incidence of complications. In total, 43 eyes of 43 patients, 24 in the AC group and 19 in the PC group, were reviewed. The mean follow-up period was 28.5 months (95% confidence interval: 25.5–31.4). Mean IOP had significantly decreased following AGV insertion. The Kaplan–Meier survival analysis demonstrated a probability of success at 24 months of 67.4% for qualified success and 39.5% for complete success. There were no significant differences between the AC and PC groups in terms of the mean IOP, cumulative probability of success, visual acuity change or antiglaucoma medication change, except IOP at 1-day and 1-month mean IOP. The most common complications noted was hyphema in the PC group. For adult chronic ACG patients, small size AGV insertion could be effective at lowering IOP. Besides, tube insertion into AC with sclerectomy may prevent the hypertensive phase in the early postoperative period.

Highlights

Angle closure glaucoma (ACG) is caused by impaired outflow facility secondary to appositional or synechial closure of the anterior chamber drainage angle, which leads to elevated intraocular pressure (IOP), optic nerve damage and visual field loss
In the remaining 43 patients, 24 patients were in the anterior chamber (AC) group and the other 19 patients were in the posterior chamber (PC) group, which was based on the presence of anterior synechiae at tube insertion site or not
43 patients with chronic ACG were included in this study: 24 patients in the AC group and 19 in the PC group

Summary

Introduction

Angle closure glaucoma (ACG) is caused by impaired outflow facility secondary to appositional or synechial closure of the anterior chamber drainage angle, which leads to elevated intraocular pressure (IOP), optic nerve damage and visual field loss. In Asian populations, primary ACG is estimated to pose a greater risk of blindness than primary open-angle glaucoma [1]. The gold standard to treat ACG is reducing IOP by medication, peripheral iridotomy and controlling the underlying causes. Some eyes are resistant to these treatments and surgical intervention may be necessary. Several surgical procedures, such as anterior chamber paracentesis, surgical iridectomy, simple lens extraction, trabeculectomy or a combination of lens extraction and trabeculectomy are utilized for treating ACG and different procedures are chosen according to patient’s condition

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Discussion

Conclusion