Clinical Outcomes After Ahmed Glaucoma Valve Implantation for Pediatric Glaucoma After Congenital Cataract Surgery

Geyer, Orna; Segal, Amiel; Melamud, Alina; Wolf, Alvit

doi:10.1097/ijg.0000000000001689

Cited by 12 publications

(32 citation statements)

References 20 publications

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“…38 In a recent study looking at Ahmed valve success rates in 41 pediatric GFCS eyes (27 eyes), the probability of surgical success was 95.1%, 89.8%, 83.1%, 72.6% at 12, 24, 60, and 84 months, respectively, with IOP reduction of 51.4% from baseline (P<0.0001). 42 In this study, most eyes (79%) still required medications for pressure control. The most common complication was early hypotony (19.5%).…”

Section: Gfcsmentioning

confidence: 64%

Surgical Management of Secondary Pediatric Glaucoma

Carrabba¹,

Zhaver²,

Blieden³

2021

International Ophthalmology Clinics

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with acquired conditions. 8,9 Disorders such as Peters anomaly, Axenfeld-Reiger syndrome, and aniridia are associated with secondary pediatric glaucoma due to anterior segment dysgenesis. Other common causes of secondary pediatric glaucoma include trauma, ocular inflammation, and steroid-induced glaucoma (SIG). Clinical ManifestationsIntraocular pressure (IOP) control through various medical and surgical interventions is critical to avoid visual decline. 2 Surgical management is more complex in children with higher rates of failure than adults due to the anatomic differences, aggressive healing response, congenital and development anomalies, difficulty with examination, and a less predictable postoperative course. 10 A variety of surgical options are available for treatment of secondary pediatric glaucoma, and certain subtypes respond better to surgical treatment than others. Surgical options can be categorized based on the following: (1) augmentation of the innate aqueous outflow pathway (angle-based surgery), (2) creation of an external aqueous outflow [filtering surgery such as trabeculectomy and glaucoma drainage devices (GDD)], and (3) decreasing aqueous production (cyclodestructive procedures). 4 Internationally, there is a diverse approach to the management of glaucoma as evidenced by the international childhood glaucoma survey at the World Glaucoma Association consensus meeting on childhood glaucoma. 7 This highlights the rarity of the disease, differences in training, experience, availability of equipment and facilities as well as individual population difficulties such as: affordability, access to care, cultural variation in disease beliefs, and compliance. 7 There is evidence that the first surgical intervention often has the best chance of controlling IOP and preserving vision in childhood glaucoma or, perhaps, failure after the first intervention indicates a more aggressive disease process with guarded prognosis. [11][12][13] Treatment is chosen based on type of glaucoma, age of the patient, surgeon preference, and prognosis of the disease. 10 Angle surgery is often first-line if the angle is visible. 14 Surgical OptionsA variety of surgical options exist for secondary pediatric glaucoma. Goniotomy was first characterized in the 1940-1950s by Otto Barkan and is quick and atraumatic in trained hands. This technique has the advantage of saving the conjunctiva to preserve the option for future filtration surgeries. 10 Visualization of the angle is important in traditional goniotomy, which can preclude its use in patients with opaque corneas. In these cases, the view of the angle structures could potentially be improved with carbonic anhydrase inhibitors, endoscope use, or removal of the corneal 112 ' Carrabba et al

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Section: Gfcsmentioning

confidence: 64%

Surgical Management of Secondary Pediatric Glaucoma

Carrabba¹,

Zhaver²,

Blieden³

2021

International Ophthalmology Clinics

View full text Add to dashboard Cite

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“…Several studies have demonstrated that success rate decreases with time. [93][94][95][97][98][99] Of all the studies reviewed, only 1 study compared the effect of trabeculectomy with mitomycin-C (Trab+MMC) and Ahmed glaucoma valve with MMC (AGI+MMC), 85 which found that the 2 groups had comparable success and complication rates.…”

Section: Gdd Implantationmentioning

confidence: 99%

“…GDD is applied in the anterior chamber as a shunter to draw the aqueous humor through a tube to a subconjunctival end-plate, including valved (Ahmed glaucoma valve) and nonvalved (Molteno and Baerveldt implants) designs. GDD implantation is currently among the most widely used treatments for GFCS 23,81,85,89–100…”

Section: Treatmentmentioning

confidence: 99%

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

Song

Zhou

Bai

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Glaucoma following cataract surgery (GFCS) remains a serious postoperative complication of pediatric cataract surgery. Various risk factors, including age at lensectomy, intraocular lens implantation, posterior capsule status, associated ocular/systemic anomaly, additional intraocular surgery, and a family history of congenital cataract and GFCS, have been reported. However, the optimal surgical approach remains unclear. This review evaluates the diagnostic criteria, classification, risk factors, mechanism, and surgical management, especially the efficacy of minimally invasive glaucoma surgery, in GFCS, and aims to propose an optimal clinical management strategy for GFCS. The results of our review indicate that ab interno trabeculotomy (goniotomy) may be the most appropriate first-line treatment for GFCS.

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“…And the most important way to reduce IOP is surgery, with medications being useful as temporizing measures or adjunctive treatment. Meanwhile, surgical options include angle surgery, filtering surgery, glaucoma drainage devices, and cyclodestructive procedures [12][13][14] . However, due to the strong metabolic and repair ability of children, glaucoma drainage device implantation and traditional filtering surgery may increase the risk of scar formation by organized filtration channels.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

Zhang¹,

Huang²,

Yao³

2022

Int J Ophthalmol

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AIM: To evaluate efficacy of microcatheter-assisted trabeculotomy (MAT) in eyes with secondary glaucoma after congenital cataract surgery and explore its correlation with the different degree of trabeculotomy. METHODS: A retrospective analysis was conducted on patients who underwent the said procedure between September 2019 and September 2020. The patients were classified into two groups according to the degree of trabeculotomy (group 1: ≤240-degree; group 2: 240–360-degree). The intraocular pressure (IOP) and anti-glaucoma drugs before and after operation was collected during the 12-month follow-up. RESULTS: Totally 27 eyes of 25 patients were included: 11 (40.7%) eyes in group 1 and 16 (59.3%) eyes in group 2. The mean IOP of all patients was 34.67±9.18 mm Hg preoperatively and 8.74±4.32, 9.95±5.65, 14.39±5.30, 16.02±4.37, 15.82±3.28, and 16.19±3.56 mm Hg 1d, 1wk, 1, 3, 6, and 12mo after surgery, respectively. In all patients, there were significant differences in IOP at each time point (F=65.614, P<0.01). In each group, IOP after surgery was lower than that before surgery (all P<0.01), but there was no difference in the rate of IOP reduction between the two groups (P=0.246). Furthermore, the amount of anti-glaucoma medications reduced to 0.30±0.67 (0–2) at 12mo from 2.63±0.49 (2–3) preoperatively (P<0.01), and there was no difference between the two groups (P>0.05). At the end of follow-up, the partial success rate was 81.8% in group 1 vs 93.75% in group 2 (P=0.549). Various amount of intraoperative and postoperative hyphema occurred in all eyes, which spontaneously absorbed or cleaned through paracentesis and irrigation. No other serious complications was observed. CONCLUSION: MAT can effectively reduce IOP in patients with secondary glaucoma after congenital cataract surgery with a high success rate and safety. And it can be used as the first choice for the treatment of secondary glaucoma after surgery for congenital cataracts.

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Clinical Outcomes After Ahmed Glaucoma Valve Implantation for Pediatric Glaucoma After Congenital Cataract Surgery

Cited by 12 publications

References 20 publications

Surgical Management of Secondary Pediatric Glaucoma

Surgical Management of Secondary Pediatric Glaucoma

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

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