The effect of the hypertensive phase on the long-term outcomes of Ahmed glaucoma valve (AGV) implantation.

Abstract

To investigate the long-term effect of hypertensive phase (HP) on the clinical outcomes of Ahmed glaucoma valve (AGV) implantation. The records of patients with different etiologies of glaucoma who underwent AGV implantation with at least 3years of follow-up were retrospectively reviewed. HP was defined as the IOP > 21mm Hg during the first three months after surgery. The main outcome measure was cumulative success defined as 5 < IOP ≤ 21mmHg and 20% reduction from the baseline with or without IOP lowering medications. Results that do not achieve cumulative success or undergo glaucoma reoperation during the follow-up period are considered failures. The secondary outcome measures were intraocular pressure (IOP) and the number of glaucoma medications. A total of 120 patients (28 patients of HP, 92 patients without HP) with an average age (± SD) of 48.9 ± 19.6years and a mean follow-up of 4.5 ± 1.4years were enrolled. The mean duration of survival was 5.3 ± 0.5years in HP which was significantly shorter than 6.4 ± 0.2years in non-HP (log rank = 4.2, P = 0.04). Mean IOP and number of IOP lowering agents were higher in postoperative visits at 1,2, 3, and 4years in HP patients compared with non-HP (all Ps < 0.01). Higher baseline IOP was significantly associated with higher rates of surgical failure. In the long-term follow-up, the duration of survival was significantly longer in the non-HP group. In the non-HP group, the failure rate was significantly lower than the HP group.