Glaucoma Valve Research Articles

Combined Ahmed glaucoma valve implantation and 23-gauge vitrectomy for neovascular glaucoma with vitreous hemorrhage

Objective To evaluate the clinical efficacy of Ahmed glaucoma valve (AGV) implantation combined with transconjunctival sutureless 23-gauge vitrectomy(23G-TSV) for treatment of neovascular glaucoma (NVG) with vitreous hemorrhage.Methods 25 eyes of 25 patients with neovascular glaucoma and vitreous hemorrhage were treated with combined AGV implantation and 23G-TSV.The intraocular pressure(IOP),best corrected visual acuity,success rate and postoperative complications were followed up for 6-12 months.The avevage follow up time was (9.96 ± 1.93) months.Results The IOP was(15.94±6.05),(14.76±2.39),(17.12±6.06),(17.44±2.75) and (18.96 ± 3.56) mmHg (1 mm Hg =0.133 kPa) at 1 day,1 week,1 month,3 months and the last follow-up postoperatively.Compared with pre-operative IOP of (48.12 ± 7.29) mmHg,the IOP was significantly(t =16.733,P ＜ 0.05 ; t =21.961,P＜0.05;t =16.917,P＜0.05 ;t =17.609,P＜0.05 ;t =18.091,P＜0.05)decreased after surgery; The total success rate was 84.0％ at final follow-up; The visual acuity was improved in all patients.Conclusion AGV implantation combined with 23G-TSV is effective for treating NVG with vitreous hemorrhage. Key words: Implants, drainage, glaucoma, Ahmed; Vitrectomy, 23G; Hemorrhage, Vitreous; Glaucoma, neovascular

Transscleral Diode Laser Cyclophotocoagulation After Baerveldt Glaucoma Implant Surgery

To evaluate the safety and efficacy of transscleral cyclophotocoagulation (TSCPC) in patients requiring intraocular pressure (IOP) reduction despite prior Baerveldt glaucoma implant (BGI) surgery. Twenty eyes of 20 patients who had previously undergone BGI placement and subsequently underwent TSCPC with the red (810 nm) diode laser between April 2005 and January 2010 were retrospectively reviewed. All patients underwent BGI placement an average of 34.7±24.2 months before TSCPC. The mean follow-up period after TSCPC was 25.6±17.4 months (range, 2.3 to 56.5 mo). IOPs were reduced from a mean of 21.8±4.6 to 10.8±3.2 mm Hg at the most recent follow-up, which represents a 50.2% reduction in mean IOP. Successful postoperative IOP control was achieved in 16 (80%) of 20 patients. The number of glaucoma medications decreased from 4.2±0.6 to 2.2±1.2. The life-table success rate was 78.6% at 12, 24, and 36 months. Postoperative complications included persistent corneal edema in 1 patient and both persistent corneal edema and cystoid macular edema in another patient. Both patients sustained a >2 line reduction in Snellen visual acuity. TSCPC is safe and effective in the management of patients requiring IOP reduction after BGI surgery. Although our sample size was limited, the safety profile of TSCPC after BGI seems promising.

Clinical evaluation of FP-7/FP-8 Ahmed glaucoma valve implantation for childhood refractory glaucoma

Background Clinical study showed that FP-7/FP-8 Ahmed glaucoma valve implantation is effective and safe for the adult refractory glaucoma.However,it is welt-known that childhood glaucomatous eyes have different pathogenesis and protean clinical manifestations.So the efficacy of FP-7/FP-8 Ahmed glaucoma valve implantation in child deserves some attention.Objective This study was to retrospectively evaluate the efficacy and safety of FP-7/FP-8 Ahmed glaucoma valve implantation for refractory glaucoma in children.Methods The clinical data of 30 eyes of 26 children with refractory glaucoma who undergone FP-7/FP-8 Ahmed glaucoma valve implantation in the Center Hospital of Cangzhou from October 2008 to April 2011 were retrospectively analyzed.The age of patients was 4 months to 16.5 years.The patients included ocular hypertension after trabculectomy/goniotomy for cogenital glaucoma,later stage of cogenital glaucoma,aphakic or pseudophakic glaucoma,traumatic glaucoma and Sturge-Weber syndrome.The follow-up ranged from 1 week to 24 months to obverse the changes of intraocular pressure (IOP),postoperative complications and cumulative success rate.Results The mean IOP was significantly different among various time points (F=58.929,P＜0.05).The IOP was (36.93± 10.56) mmHg in preoperation and (13.13± 3.34),(14.13±3.15),(15.93±4.76),(17.96±5.37),(19.74±5.43) mmHg 1 week,1 month,6 months,12 months,24 months following surgery,showing significant reduce after operation.Compared with preoperative IOP,the IOP of 1 week,1 month,6,12,24 months after AGI was significant decreased,with significant differences between them (t =11.641,11.458,10.688,7.988,8.018,all at P ＜ 0.05).The total cumulative success rate after Ahmed glaucoma valve implant was 100％,96.67％,93.21％,85.76％ and 71.46％ 1 week,1 month,6 months,12 months,24 months after surgery.The postoperative complications occurred in 8 eyes,including shallow anterior chamber,drainage tube obstruction,hyphema of anterior chamber and valve exposure,and these were cured by medicine and surgery.No serious complication appeared in all patients after operation.Conclusions FP-7/FP-8 Ahmed glaucoma valve implantation is an effective and safe method for the treatment of refractory glaucoma,and it can be considered as one of the first choices for management of refractory glaucoma in childhood. Key words: Glaucoma drainage implant; Glaucoma/surgery; Child; Intraocular pressure; Postoperative complication

Three-year Treatment Outcomes in the Ahmed Baerveldt Comparison Study

To compare 3-year outcomes and complications of the Ahmed FP7 Glaucoma Valve (AGV) (New World Medical, Cucamonga, CA) and the Baerveldt Glaucoma Implant (BGI) 101-350 (Abbott Medical Optics, Abbott Park, IL) for the treatment of refractory glaucoma. Multicenter, randomized, controlled clinical trial. A total of 276 patients: 143 in the AGV group and 133 in the BGI group. Patients aged 18 to 85 years with refractory glaucoma and intraocular pressures (IOPs) ≥ 18 mmHg in whom an aqueous shunt was planned were randomized to an AGV or a BGI. The IOP, visual acuity (VA), supplemental medical therapy, complications, and failure (IOP >21 mmHg or not reduced by 20% from baseline, IOP <5 mmHg, reoperation for glaucoma or removal of implant, or loss of light perception vision). At 3 years, IOP (mean ± standard deviation) was 14.3 ± ± 4.7 mmHg (AGV group) and 13.1 ± 4.5 mmHg (BGI group) (P = 0.086) on 2.0 ± 1.4 and 1.5 ± 1.4 glaucoma medications, respectively (P = 0.020). The cumulative probabilities of failure were 31.3% (standard error [SE], 4.0%) (AGV) and 32.3% (4.2%) (BGI) (P = 0.99). Postoperative complications associated with reoperation or vision loss of >2 Snellen lines occurred in 24 patients (22%) (AGV) and 38 patients (36%) (BGI) (P = 0.035). The mean change in the logarithm of the minimum angle of resolution VA at 3 years was similar (AGV: 0.21 ± 0.88, BGI: 0.26 ± 0.74) in the 2 treatment groups at 3 years (P = 0.66). The cumulative proportion of patients (SE) undergoing reoperation for glaucoma before the 3-year postoperative time point was 14.5% (3.0%) in the AGV group compared with 7.6% (2.4%) in the BGI group (P = 0.053, log rank). The relative risk of reoperation for glaucoma in the AGV group was 2.1 times that of the BGI group (95% confidence interval, 1.0-4.8; P = 0.045, Cox proportional hazards regression). Implantation of the AGV was associated with the need for significantly greater adjunctive medication to achieve equal success relative to implantation of the BGI and resulted in a greater relative risk of reoperation for glaucoma. More subjects experienced serious postoperative complications in the BGI group than in the AGV group.

Ahmed glaucoma valve implantation in diabetic patients with neovascular glaucoma personalized treatment and care

Objective To observe and care Ahmed glaucoma valve implantation early postoperative complications for diabetic patients with neovascular glaucoma , hoping to reduce complications and all its implications hazard .Methods The clinical data of 38 patients （ 38 eyes ） with diabetic neovascular glaucoma who underwent Ahmed glaucoma valve implantation were observed and targeted treatments .Results Among 38 patients （38 eyes） with diabetic neovascular glaucoma , there were 7 cases （7 eyes） with ocular hypotension and shallow anterior chamber , 4 cases （ 4 eyes ） with transient ocular hypertension , 12 cases （ 12 eyes ） with hyphema, 2 cases （2 eyes） with valve tube blockage in the early postoperative .Compared postoperative intraocular pressure with that of preoperative , intraocular pressure was decreased with the average decline （34.17 ±14.99）mmHg.There were 11 cases （11 eyes） with improved vision, one case （one eye） with decreased vision, and 26 cases （26 eyes） with stable vision.Conclusions Blood sugar of stability control in perioperative , patient psychological counseling , individualized treatment of intraoperative and timely detection of postoperative complications to give the right treatment and care with the doctors , can get a more satisfactory clinical efficacy . Key words: Diabetes; Glaucoma,neovascular; Ahmed glaucoma valve; Personalized care

Panretinal photocoagulation combined with Ahmed glaucoma valve implantation for neovascular glaucoma

Objective To evaluate the clinical effect of panretinal photocoagulation combined with Ahmed glaucoma valve implantation for neovascular glaucoma (NVG).Methods This study was based on 30 eyes of 28 patients with NVG who underwent panretinal photocoagulation combined with Ahmed glaucoma valve implantation.The best corrected visual acuity,the new vessels of iris,intraocular pressure (IOP) and complication were observed preoperatively and postoperatively.Results The best corrected visual acuities were improved in 13 eyes,decline in 5 eyes and no change in 12 eyes.The average IOP was (43.2 ±5.4)mm Hg preoperatively,(12.9 ± 4.9) mm Hg at 1 week,(14.8 ± 4.5) mm Hg at 1 month,(16.3 ± 3.9)mm Hg at 3 months postoperatively (t =16.584,t =17.576,t =14.328,P ＜ 0.05).These differences were statistically significant (P ＜ 0.05).The new vessels of iris in 30 eyes had disappeared completely or partly.The predominant complications were hyphema (4 eyes),shallow anterior chamber (7 eyes),drainage tube blocking (2 eyes),choroidal detachment (2 eyes).Conclusion The panretinal photocoagulation combined with Ahmed glaucoma valve implantation is an ideal operation for NVG,because it can lower IOP,decrease complication and preserve visual function. Key words: Glaucoma, neovascular; Photocoagulation, panretinal; Valve, glaucoma, Ahmed

Confirming and Establishing Patency of Glaucoma Drainage Devices Using Trypan Blue

The use of trypan blue is increasing in complicated cataract, retina, and glaucoma surgeries. We report on the use of trypan blue to help visualize the capsule over a glaucoma drainage implant and to assess adequate flow in different situations involving both valved and nonvalved implants. These cases demonstrate 3 key points. One, when completing the second stage of a tube, it is essential to prime the tube to ensure adequate flow. Two, when extensive conjunctival scarring is present, trypan blue can be used to stain the capsule around the plate and confirm adequate flow. Three, if one is concerned of the functionality of a valved glaucoma implant, trypan blue can be used to both confirm and reestablish functionality of the valve mechanism.

Surgical Outcomes of the Baerveldt Glaucoma Implant

During the last decades, the Baerveldt Glaucoma Implant (BGI) has proven effective in the surgical treatment of glaucoma. Various surgical procedures have been used for its implantation and these may yield different clinical outcomes and different intraoperative and postoperative complications. We evaluated the success rate of BGI and compared complications between 2 different surgical implantation techniques. Retrospective analyses of medical records of consecutive adult patients who underwent a BGI implantation at the Rotterdam Eye Hospital between September 2007 and August 2008. Patients were divided by the surgical implantation technique. Success was defined as an intraocular pressure ≥6 mm Hg and ≤21 mm Hg as well as a reduction of ≥20% from preoperative values. Other outcome measures were intraoperative and postoperative complications and surgical revisions of the BGI. A total of 173 BGI procedures were performed during the study period. Only first-ever BGI implantations in adult patients were analyzed, yielding 141 implants for the analyses. The length of follow-up averaged 11.5 months (range, 0.3 to 24.7 mo) and the mean (SD) preoperative intraocular pressure was 25.6 (8.6). Overall success rates were 75% and 83%, respectively, for the 2 different groups (P=0.40 for differences between groups). Nine patients (6%) needed a reoperation, whereas complications were documented in another 9 patients without significant differences between groups. Overall complication rates of the BGI were low and they combined with high success rates. Outcomes did not differ between the various surgical techniques. The choice of a certain technique might therefore be based on differences in costs and length of surgery between these techniques.

Combined Baerveldt Glaucoma Implant and Scleral Buckling Surgery for Patients With Retinal Detachment and Coexisting Glaucoma

To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral buckling surgery for patients with glaucoma requiring a scleral buckle for retinal detachment repair. Retrospective, consecutive, noncomparative, and interventional case series of 30 eyes (30 patients) that underwent simultaneous scleral buckle and BGI surgery, using a staged (group 1, n=21 patients) or nonstaged (group 2, n=9 patients) approach to BGI implantation. Successful intraocular pressure (IOP) control was defined as 6 mm Hg≤IOP≤18 mm Hg. Although not statistically significant, mean best corrected visual acuity (LogMAR) improved from 2.0 before surgery to 1.7 after surgery (P=0.13) with a mean follow-up of 27.7 months. Of the 21 patients in group 1, only 13 (62%) required second-stage tube insertion at a mean of 7.0±8.0 months (range, 1 to 24 mo) postoperatively. For these eyes combined with group 2 eyes, mean IOP was reduced from 31.1±10.8 to 12.7±6.0 mm Hg (P<0.0001), and the mean number of glaucoma medications was reduced from 2.9±1.4 to 1.2±1.3 (P<0.001). Life table rates of successful IOP control were 90% and 80% at 12 and 24 months, respectively. Combined scleral buckle and BGI is an effective technique for managing coexisting glaucoma and retinal detachment and provides the clinician with a useful surgical option while minimizing surgical risk.

Glaucoma drainage implant surgery - An evidence-based update with relevance to Sub-Saharan Africa

Glaucoma represents a leading cause of preventable vision loss in Sub-Saharan Africa. Recent studies evaluating outcomes of glaucoma drainage implant (GDI) surgery suggest an important role for this approach in the African patient population. The Tube Versus Trabeculectomy study demonstrated a higher success rate with non-valved GDI surgery compared to trabeculectomy with mitomycin C after five years. The Ahmed Baerveldt Comparison study showed no difference in surgical failure rates between the Ahmed Glaucoma Valve and the Baerveldt Glaucoma Implant (BGI) but better intraocular pressure outcomes with the BGI at one year. The Ahmed Versus Baerveldt study demonstrated a lower failure rate for the BGI, but also a requirement for more post-operative interventions. Further study of GDI surgery in the Sub-Saharan Africa is necessary to determine its optimal place in the treatment paradigm for glaucoma patients in the region.

Leutectomy and vitrectomy combined with Ahmed glaucoma valve for secondary glaucoma with lens displacenment

Objective To evaluate the clinical effect of lentectomy and vitrectomy combined with Ahmed glaucoma valve for secondary glaucoma with lens displacement.Methods The data in 32 cases(32eyes)of secondary glaucoma with traumatic lens displacement were analysed retrospectively.The routine operation of lentectomy and vitrectomy were done,combined with Ahmed glaucoma valve implanting in the superior temporal Tenon' s Capsule.Visual acuity,intraocular pressure and complication were observed preoperatively and postoperatively.Results The corrected visual acuity of 28 eyes were improved,the visual acuity of 4 eyes were constant postoperatively after 6 months.The average intraocular pressure was(39.58 +15.84)mmHg preoperatively,(9.66 ± 2.84)mmHg 3 days after surgery,(11.50 ± 3.41)mmHg in 1week,(13.36 ± 2.42)mmHg in 1 month,(15.80 ± 3.80)mmHg in 6 months,the average intraocular pressure was descended noticeably.The predominant complications were hyphema,shallow anterior chamber,drainage tube blocking,filtered bleb scarring.Conclusion Lentectomy and vitrectomy combined with Ahmed glaucoma valve is a kind of operation ideally for complex traumatic glaucoma caused by lens displacement,with lower postoperative intraocular pressure and preserving visual function. Key words: Lentectomy; Vitrectomy; Lens displacement; Glaucoma,secondary; Ahmed glaucoma valve

Long term comparison between single stage Baerveldt and Ahmed glaucoma implants in pediatric glaucoma

PurposeTo compare the long term intraocular pressure control in pediatric glaucoma patients who underwent single stage Baerveldt glaucoma valve and Ahmed glaucoma valve S2 implantation. Study designA retrospective study was conducted to analyze the data of patients with single stage Baerveldt glaucoma valve and Ahmed valve implantation at Children Hospital Los Angeles. MethodsMedical records of patients were reviewed retrospectively and divided into two groups. All cases received single stage valve implantation in which the tube was inserted primarily into the anterior chamber. In cases with Baerveldt implants, the silicone tube was ligated near its plate location with a single absorbable suture. Group 1 included patients with Baerveldt glaucoma implant model BG 101–350, while group 2 included patients with Ahmed valve implant model S-2. Patients’ data collected ranged over the period from 2001 to 2008. The minimum follow up period was 6month; maximum follow up period was 8years. All patients were below 18years of age. Success was considered if last postoperative IOP was between 8 and 24mm Hg (with or without medications), no additional glaucoma surgery after valve implantation, and absence of visually significant complications. ResultsGroup 1 included 20 cases and group 2 included 11 cases. Long term success rate based on criterion defined was 80% for group 1 (Baerveldt) with average IOP postoperatively on last follow-up of 19.6mm Hg. In group 2 (Ahmed), average postoperative pressure was 24mm Hg with 6 out of 11 considered successful based on criterion giving 54.5% success rate. ConclusionIn the long term, single stage Baerveldt implantation appears to control pressure well in pediatric glaucoma.

The efficacy of Ahmed glaucoma valve implantation in the management of early stage of glaucoma secondary to blunt ocular trauma

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in the early stage of glaucoma secondary to contusion injuries. A retrospective case series study. The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 months after the trauma. The duration from injury to IOP elevation was 1 to 30 (6.10 ± 1.13) days. The time from injury to AGV implantation was 16 to 60 (40.03 ± 2.97) days. The patients were followed-up for a period of 6 to 42 (20.75 ± 1.66) months. The main outcome measures included intraocular pressure (IOP), visual acuity (VA), number of glaucomatous medications, intra- and postoperative complications. IOPs were analyzed by repeated measures analysis of variance, numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test, and VA comparison was performed using paired Student t-test. The absolute success rate was 86.21% and the conditional success rate was 13.79% after AGV implantation. Compared with pre-operation, the IOP was significantly(F = 124.09, P < 0.05) lowered at the last following-up of post-operation(42.59 ± 1.82)vs (15.12 ± 0.56) mm Hg(1 mm Hg = 0.133 kPa), the numbers of glaucomatous medications were significantly (H = 131.73, P < 0.05) reduced post-operatively (3.93 ± 0.15) vs (0.21 ± 0.12) species, and the VA was significantly (t = -3.466, P < 0.05) improved post-operatively (logMAR 0.40 vs logMAR 0.70). Two cases with shallow anterior chamber and three cases with hyphema were observed in the early stage after the surgery. No persistent hypotony, tube exposure or other serious complications were noted. AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

Outcomes of Ahmed glaucoma valve implantation versus trabeculectomy in the treatment of refractory glaucoma after scleral buckling

Objective To evaluate the efficacy and safety of Ahmed glaucoma valve implantation versus trabeculectomy in the treatment of refractory glaucoma after scleral buckling.Methods A total of 41 eyes of 41 patients with glaucoma after scleral buckling who accepted Ahmed glaucoma valve implantation or trabeculectomy were enrolled,including 19 patients in the valve group and 22 patients in the trabeculectomy group.The successful rate,intraocular pressure (IOP) reduction,visual acuity,complications and medical therapy were observed for one year.Results The successful rate was 63.16％ in the valve group 12 months after surgery,and 31.82％ in the trabeculectomy group.The success rate in the valve group was significantly higher than that in the trabeculectomy group at 12 months follow-up (x2 =4.027,P =0.0427).IOP decreased from (24.7±2.8) mmHg at baseline to (16.5 ±4.9) mmHg in the valve group 12 months after surgery,and it decreased from (25.5 ± 3.6) mmHg to (19.8 ± 4.3) mmHg in the trabeculectomy group.The IOP in the valve group was significantly lower than that in the trabeculectomy group at 12 months followup (t =2.1102,P =0.0427).There was no significant difference in visual acuity,complications or medical therapy between those two groups.Conclusion Compared with trabeculectomy,Ahmed glaucoma valve implantation is an option with more persistence and same security in the treatment of glaucoma after scleral buckling. Key words: Ahmed glaucoma valve ; Trabeculectomy ; Scleral buckling; Glaucoma

AGV pars planna implantation combined with MMC in treating traumatic glaucoma underwent pars plana vitrectomy

Objective To evaluate the effect of Ahmed glaucoma valve pars plana implantation combined with MMC in treating ocular traumatic glaucoma patients who underwent pars plana vitrectomy. Methods 17 cases of traumatic glaucoma who underwent pars plana vitrectomy were treated by Ahmed glau- coma valve pars planna implantation combined with MMC from January 2007 to January 2010. Results Fol- low-up durations were 10 ~ 32 months and the average follow-up time was（ 14.5 ＋ 2.3 ）months. the success rate of the procedure was 82.4%, in which 76.5% was completely successful. Post-operatvie visual acuity was stable or improved in 88.2% of the patients. Surgical complications were mild vitreous hemorrhage （2 cases） and early-stage low tension（3 cases）. Conclusion Ahmed glaucoma valve pars planna implantation combined with MMC was effective in treating ocular traumatic glaucoma patients who underwent pars plana vitrectomy. Key words: Ahmed glaucoma valve; MMC; Glaucoma; Ocular trauma, pars plana vitrectomy

Clinical results of preventing postoperative shallow anterior chamber at early stage by implanting Ahmed glaucoma valve with adjustable suture

Objective To evaluate the effect of preventing the postoperative shallow anterior chamber at early stage by implanting Ahmed glaucoma valve with adjustable suture. Methods Thirty neovascular glaucoma cases (31 eyes) , who received the implantation of Ahmed glaucoma valve with adjustable suture (removable suture + ligating drainage tube with absorbable 6-0 Vcry1 suture) were retrospectively reviewed in the study. The postoperative early shallow anterior chamber, IOP and success rate of surgery was discussed. Results The incidence of postoperative early shallow anterior chamber was 6. 45% , postoperative early high IOP was 12.90% , the mean IOP in the last follow -up visit was (23.5 ±4.0)mmHg , The complete success rate was 54.84% , the relative success rate was 19.35% , the average success rate was 74.19%. Conclusion Applying the adjustable suture in the implantation of Ahmed glaucoma valve for neovascular glaucoma patients , which is a simple techinique, can effectively decreases the incidence of shallow anterior chamber postoperative. Key words: adjustable suture; glaucoma, neovascular; Ahmed glaucoma valve; anterior chamber, shallow

Long-term effects of biological amnion combined with glaucoma valve implantation for neovascular glaucoma

Background Neovascular glaucoma is a type of refractory glaucoma.Biological amnion combined with glaucoma valve implantation is a primary therapy and its long-term effectiveness is noticeable. Objective The goal of this Survey was to evaluate the effectiveness of biological amnion combined with glaucoma valve implantation for neovascular glaucoma and compare the clinical outcome with simple glaucoma valve implantation. Methods This was a retrospective observational case series.The clinical data of 44 eyes of 44 patients received biological amnion combined with glaucoma valve implantation for neovascular glaucoma and 43 eyes of 43 patients received simple glaucoma valve implantation for neovascular glaucoma were retrospectively analyzed and compared.The age,sex and disease-cause were matched between these two groups.Patients were followed-up for 24 months after operation.Surgery success was identified as the intraocular pressure(IOP) 0.05). Conclusion The biological amnion combined with glaucoma valve implantation surgery may be more effective and safe for the treatment of neovascular glaucoma than with glaucoma va]ve only. Key words: Biological amnion; Glaucoma valve; Glaueoma/neovascular

Treatment Outcomes in the Ahmed Baerveldt Comparison Study after 1 Year of Follow-up

To determine the relative efficacy and complications of the Ahmed glaucoma valve (AGV) model FP7 (New World Medical, Ranchos Cucamonga, CA) and the Baerveldt glaucoma implant (BGI) model 101-350 (Abbott Medical Optics, Abbott Park, IL) in refractory glaucoma. Multicenter, randomized, controlled clinical trial. Two hundred seventy-six patients, including 143 in the AGV group and 133 in the BGI group. Patients 18 to 85 years of age with refractory glaucoma having intraocular pressure (IOP) of 18 mmHg or more in whom an aqueous shunt was planned were randomized to undergo implantation of either an AGV or a BGI. The primary outcome was failure, defined as IOP >21 mmHg or not reduced by 20% from baseline, IOP ≤5 mmHg, reoperation for glaucoma or removal of implant, or loss of light perception vision. Secondary outcomes included mean IOP, visual acuity, use of supplemental medical therapy, and complications. Preoperative IOP (mean±standard deviation [SD]) was 31.2±11.2 mmHg in the AGV group and 31.8±12.5 mmHg in the BGI group (P = 0.71). At 1 year, mean±SD IOP was 15.4±5.5 mmHg in the AGV group and 13.2±6.8 mmHg in the BGI group (P = 0.007). The mean±SD number of glaucoma medications was 1.8±1.3 in the AGV group and 1.5±1.4 in the BGI group (P = 0.071). The cumulative probability of failure was 16.4% (standard error [SE], 3.1%) in the AGV group and 14.0% (SE, 3.1%) in the BGI group at 1 year (P = 0.52). More patients experienced early postoperative complications in the BGI group (n = 77; 58%) compared with the AGV group (n = 61; 43%; P = 0.016). Serious postoperative complications associated with reoperation, vision loss of ≥2 Snellen lines, or both occurred in 29 patients (20%) in the AGV group and in 45 patients (34%) in the BGI group (P = 0.014). Although the average IOP after 1 year was slightly higher in patients who received an AGV, there were fewer early and serious postoperative complications associated with the use of the AGV than the BGI.

Nursing in patients with refractory glaucoma undergone ahmed valve insertion with donor human sclera patch

Objective To summarize the nursing points of the patients with refractory glaucoma un-dergone ahmed valve insertion with donor human sclera patch.Methods The nursing points of 102 con-secutive refractory glaucoma cases who underwent ahmed glaucoma valve implant insertion with donor hu-man sclera patch placed over the tube were studied retrospectively.Results 100 (98.04%) glaucoma-tous valves kept on being unobstructed postoperatively.Complications occurred in some patients including hyphema(5 cases), tube exposure (1 cases), shallow anterior chamber(16 cases), hypertension accom-panied with eye pain, headache, and corneal edema early after surgery (14 cases received paracentisis within 3 days), tubes obstructed by the vitrous needed vitrectomy (3 cases), obstructed by silicon oi1(2 cases).Conclusions Paying attention to psychological nursing and health instruction preoperatively, close observation after surgery, and correct instructions for the out- patients, are the key points in the reha-bilitation process after ahmed valve insertion with donor human sclera patch. Key words: Glaucoma; Ahmed valve insertion; Nursing

Baerveldt glaucoma implants in the management of refractory glaucoma after vitreous surgery

To examine the effectiveness and safety of Baerveldt glaucoma implants in eyes with refractory glaucoma following vitrectomy. We performed a retrospective study of a non-comparative case series of 30 eyes of 30 patients who had undergone the implantation of a Baerveldt glaucoma device. All eyes (30/30) had a minimum follow-up of 6 months, and 16/30 (53%) had a follow-up of 24 months. Surgical success was defined as intraocular pressure (IOP) < 22 mmHg on the last two follow-up visits with or without glaucoma medication and a decrease in IOP of at least 20% compared to preoperative values with or without glaucoma medication. The mean IOP before implantation of a Baerveldt glaucoma device was 30 mmHg [+/- 11.4 mmHg standard deviation (SD)] with maximally tolerated medical therapy. Six months after implantation of the Baerveldt glaucoma device, the mean IOP was 17.3 mmHg (+/- 6.7 mmHg SD) and the mean number of glaucoma medications had gone down from 3.0 (+/- 0.4 SD) to 0.3 (+/- 0.3 SD). Successful outcomes were found in 24 eyes (80%). Small complications occurred in six eyes (20%): transient postoperative hypotony (17%) and tube retraction (3%). Larger complications occurred in another six eyes (20%): corneal decompensation requiring keratoplasty (7%), suprachoroidal haemorrhage (3%) and persistently high IOP (10%). Baerveldt glaucoma devices are a valid treatment option in eyes with refractory glaucoma after vitreous surgery, although failure occurred in 20% of our patients. Transient complications occurred in 20% and severe complications in another 20%.