Assessment of conditions affecting surgical success of Ahmed glaucoma valve implants in glaucoma secondary to different uveitis etiologies in adults

Abstract

PurposeThere is little known about the long-term efficacy and safety of Ahmed glaucoma valve (AGV) implant and about the conditions affecting surgical success in uveitic glaucoma (UG).Patients and methodsThe charts of adult patients with UG who underwent AGV implantation from 2006 to 2015 were reviewed retrospectively.ResultsData of 46 eyes of 39 patients were evaluated. Mean follow-up was 51.93±23.08 months. Mean preoperative IOP was 37.05±9.62 mm Hg and mean number of preoperative topical anti-glaucomatous medications was 2.98±0.27. One eye (2%) was defined as failure because of implant extraction surgery. In the rest of the eyes, intraocular pressure (IOP) was under control with or without anti-glaucomatous medications during follow-up. The cumulative probability of complete success (IOP control without medications) was 78% at 6 months, 76% at 1 year, 71% at 2 years, 66% at 3 years, and 63% at 4 years (95% confidence interval, 61.24-87.81). The cumulative probability of eyes without complication was 64% at 6 months, 48% at 12 months, 44% at 24 months, 41% at 36 months, and 38% at 48 months (95% confidence interval, 34.64-62.85). Complete success was lower in eyes with previous ocular surgery than the eyes without (P=0.061) and it was lower in eyes with active inflammation at the time of surgery than the eyes without (P=0.011).ConclusionAGV implantation is an effective and safe alternative method in the management of UG, especially when it is performed as a primary surgical option and when no inflammation is present preoperatively.

The Effect of Perioperative Uveitis Control on the Success of Glaucoma Surgery in Uveitic Glaucoma

“…Sungur et al 29 reported the 4-year outcome of AGV in 46 eyes with UG. Most common diagnoses were idiopathic anterior uveitis (17.4%), ankylosing spondylitis (17.4%) Fuchs heterochromic iridocyclitis (17.4%) pars planitis (15.2%) and viral anterior uveitis (10.9%).…”

“…26 These proinflammatory cytokines are thought to lead to a slow remodeling of extracellular matrix over time leading to a higher risk of surgical failure. 19 In previous studies 9,[27][28][29] which evaluated the success of GDD in UG, different courses of uveitis management were used (Table 4). Factors like preoperative initiation of anti-inflammatory agents, route of medications administered, dosage regimen and duration of perioperative treatment were variable.…”

Bilateral Boston keratoprosthesis type 1 in a case of severe Mooren’s ulcer

“…In our case, we performed CPC because of the uncontrolled inflammatory state, which would have jeopardized the performance of any drainage device. 15 Nonetheless, more clinical studies in severe inflammatory diseases are needed to address this question.…”

Implante de válvula de Ahmed vía pars plana para el manejo del glaucoma uveítico refractario

“…Se ha reportado en la literatura, como complicaciones de este abordaje: oclusión del tubo, descompensación corneal, diplopía, extrusión del tubo, hipotonía severa, maculopatía hipotónica, desprendimiento de retina, desprendimiento coroideo hemorrágico [3,9,11] .…”