Short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve.

Abstract

To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy (ERC) after Ahmed glaucoma valve (AGV) failure. Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval. The number of anti-glaucoma medications (AGMs), intraocular pressure (IOP) and best corrected visual acuity (BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d. Intra- and postoperative complications were also recorded. Positive outcome was defined as IOP≤21 mm Hg with or without AGMs. Fourteen eyes [14 patients, median age 69.5y, interquartile range (IQR) 61.3-80] were included. Pseudoexfoliative glaucoma (n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo (IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0 (IQR 3.0-4.0) to 2.0 (IQR 1.5-3), the median IOP decreased from 26 mm Hg (IQR 22-29) to 16.5 mm Hg (IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1, 3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes (36%), which were resolved spontaneously during the first week following ERC. ERC has a high success rate for short-term management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.