AimTo evaluate the results of Ahmed glaucoma valve (AGV) in eyes with a failed trabeculectomy.Materials and methodsThis retrospective study evaluated 61 eyes with a failed trabeculectomy that underwent implantation of an AGV due to uncontrolled intraocular pressure (IOP) on maximal medical therapy. Success was defined as IOP ≤ 21 mm Hg (criterion 1) or 20% reduction in IOP (criterion 2) with or without antiglaucoma medications. Persistent hypotony, loss of light perception, and reoperation for IOP control were defined as failure.ResultsMean preoperative IOP and mean lOPs at 6, 12, and 24 months were 21.93 ± 6.32 mm Hg (n = 61), 14.15 ± 4.33 mm Hg (n = 59), 13.21 ± 4.44 mm Hg (n = 56), and 13.60 ± 3.27 mm Hg (n = 25) respectively. Mean number of antiglaucoma medications preoperatively and at 6, 12, and 24 months was 3.95 ± 0.85, 2.19 ± 1.38, 2.48 ± 1.44, and 2.40 ± 1.32 respectively. The reductions in the number of medications and IOP measurements were statistically significant at all time intervals (p < 0.001, Wilcoxon signed rank test). According to criterion 1, the Kaplan-Meier survival curve disclosed success rates of 75% at 12 and 24 months. According to criterion 2, the success rates were 57% at 12 months and 55% at 24 months. The most frequent complications were hypertensive phase (18%) and shallow anterior chamber (16.4%).ConclusionThe AGV may effectively reduce IOP in eyes that had a failed trabeculectomy.Clinical significanceThe AGV is an alternative in eyes with a failed trabeculectomy.How to cite this articleSchimiti RB, Abe RY, Tavares CM, Vasconcellos JPC, Costa VP. Intraocular Pressure Control after Implantation of an Ahmed Glaucoma Valve in Eyes with a Failed Trabeculectomy. J Curr Glaucoma Pract 2016;10(3):97-103.

Purpose. To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma in a tertiary hospital in Brazil. Methods. Retrospective case series of patients who underwent AGV implantation. Primary outcome was to assess the rate of failure, which was defined as intraocular pressure (IOP) in two consecutive visits greater than 18 or lower than 5 mmHg (criterion 1) or IOP greater than 15 or lower than 5 mmHg (criterion 2). The secondary outcome was to investigate risk factors for failure. Results. 112 eyes from 108 patients underwent AGV implantation between 2000 and 2012. Mean follow-up time was 2.54 (±1.52) years. Kaplan-Meier survival analysis showed cumulative probabilities of success of 80.3%, 68.2%, and 47.3% at 1, 3, and 5 years using 18 mmHg as endpoint. When adopting 15 mmHg as endpoint, cumulative success rates were 80.3%, 60.7%, and 27.3% at 1, 3, and 5 years, respectively. Multivariate analysis with generalized estimating equations revealed that African American ancestry and early hypertensive phase were risk factors for failure (P = 0.001 and P = 0.002, resp.). Conclusion. A success rate of approximately 50% was obtained 5 years after the implantation of an AGV. African American ancestry and early hypertensive phase were associated with increased risk of failure.

To compare ocular surface parameters in rosacea patients with those of controls. Methods: Ninety-three participants took part in this cross-sectional, observational, non-interventional study. These consisted of a rosacea group (n=40) and a control group (n=53). We compared objective parameters of the ocular surface, including conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, and ocular surface staining, between the two groups. Results: In the rosacea group, 69.23% were female. The mean age was 47.34 ± 12.62 years old. No statistically significant differences between groups were found in visual acuity (p=0.987), tear film parameters (tear meniscus height (p=0.338), noninvasive tear film rupture time (p=0.228), invasive rupture time (p=0.471), Schirmer's test scores (p=0.244), conjunctival hyperemia (p=0.106), and fluorescein staining (p=0.489). Significant differences were found in meibography evaluations (p=0.026), mucous layer integrity (p=0.015), and ocular surface symptoms (p<0.0001). Rosacea patients also showed important eyelid differences in glandular expressibility (p<0.001), glandular secretion pattern (p<0.001), and telangiectasia (p<0.001) compared to controls. Conclusion: Meibomian gland dysfunction is frequently associated with dermatological conditions. It can be observed in morphological findings from meibography as well as lipid secretion impairment, leading to evaporative dry eye, ocular surface dysfunction, and inflammation.

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Background: Rosacea frequently evolve the eyes with impact on life and vision quality. There are gaps in the understanding of ocular involvement, specially related to eyelid glands, which share common features to sebaceous glands.Purpose: Describe ocular surface disease related to Rosacea and its associations.Methods: Ninety-three individuals were selected to this cross-sectional, observational, non-interventionist study, divided into groups: rosacea (n=40) and controls (n=53). We investigated objective parameters of the ocular surface (conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, ocular surface staining) comparing healthy individuals with rosacea patients.Results: 69.23% of rosacea group were women, mean age of 47.34 ± 12.62 years old. Compared to matched controls there was no statistically significant differences regarding to visual acuity (p=0.987) and tear film parameters (tear meniscus height (p=0.338), non-invasive tear film rupture time (NIBUT) (p= 0.228), invasive rupture time (TBUT) (p=0.471) and Schirmer's test (p=0.244)) as well as conjunctival hyperemia (p = 0.106), and fluorescein staining (p = 0.489). Significant association was found in meibography evaluation (p = 0.026), mucous layer integrity (p = 0.015) and ocular surface symptoms (p <0.0001). Rosacea patients also showed important eyelid changes: glandular expressibility (p <0.001), glandular secretion pattern (p <0.001) and telangiectasia (p <0.001) compared to controls.Conclusion: Meibomian gland dysfunction is frequently associated to dermatologic conditions and is characterized by morphological findings in the meibography as well as lipid secretion impairment that lead to evaporative dry eye and ocular surface dysfunction and inflammation.