Abstract
Results The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6 mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline (P < 0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%). Conclusion An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.
Highlights
When the initial glaucoma tube shunt fails in eyes with refractory glaucoma, one option is implantation of an additional Ahmed glaucoma valve (AGV) to control intraocular pressure (IOP)
One of the most common implant is Ahmed glaucoma valve (AGV; New World Medical, Inc., CA), a glaucoma drainage device (GDD) that drains aqueous humour into a 184 mm2 plate close to the equator of the eye. e tube versus trabeculectomy (TVT) study showed that the glaucoma tube shunt group experienced fewer early postoperative complications, were less likely to undergo additional glaucoma surgery, and had higher success rates when compared to using trabeculectomy with MMC [5, 6]. is has encouraged the utility of GDD for both primary and secondary glaucoma [7, 8]
Several studies have reported the surgical outcomes of a second AGV, with varying success, but there is a lack of studies in an Asian glaucoma population. e purpose of this study is to evaluate the short- and longterm outcomes of a second AGV implant and to define risk factors for failure of the second AGV implant in an Asian population
Summary
When the initial glaucoma tube shunt fails in eyes with refractory glaucoma, one option is implantation of an additional Ahmed glaucoma valve (AGV) to control intraocular pressure (IOP). Data collected included demographic characteristics, best corrected visual acuity, IOP, and number of medications Both intraoperative and postoperative complications or interventions were recorded. An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed. If the first glaucoma tube shunt implant fails to control IOP adequately, there are limited surgical options for subsequent IOP control which includes revision of the primary tube shunt, implantation of a second GDD, and cyclodestructive laser procedures. Levinson et al demonstrated that while both second GDDs and cyclodestructive procedures effectively reduce IOP after a failed primary GDD, a second GDD had better long-term success rates [10, 11]. e growing use of GDDs and Journal of Ophthalmology increased lifespan of our glaucoma patients has contributed to the use of sequential GDD to lower IOP and reduce glaucomatous optic neuropathy [12, 13].
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