Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract

Abstract

Combined phacoemulsification and Ahmed glaucoma drainage implant surgery seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP for patients with refractory glaucoma and cataract.

Factors Associated with Outcomes of Combined Phacoemulsification and Ahmed Glaucoma Valve Implantation

“…Postoperative complications occurred in 10 eyes (25%). A hypertensive phase, defined as IOP >21 mmHg in the presence of a functioning bleb and a patent tube and occurring up to 3 months after surgery [ 13 ], was the most common complication (5 eyes, 12.5%). All cases were resolved at postoperative month 6 with antiglaucoma medication.…”

“…Final IOP was defined as that from the most recent examination. Complete success was defined as IOP of 6 to 21 mmHg without medication, qualified success as IOP of 6 to 21 mmHg with medication, and failure as sustained IOP of >21 or <6 mmHg with or without medication on two or more visits [ 3 13 17 18 ]. Treatment was also considered a failure in patients who lost light perception after surgery or underwent further glaucoma surgery [ 17 18 ].…”

“…In some situations, phacotrabeculectomy may be inappropriate. In eyes with a history of failed filtering surgery; refractory glaucoma such as neovascular glaucoma (NVG), uveitic glaucoma, or secondary glaucoma; or previous bleb-related complications, success rates may be low [ 3 13 ]. Common complications after phacotrabeculectomy include hypotony, hyphema, and uveitis, among others [ 14 15 ].…”

“…The outcomes of combined phacoemulsification and glaucoma drainage implant (GDI) surgery were reported in several studies, with a relatively high success rate (range, 87.5% to 100%) [ 3 13 17 18 ]. However, the risk factors for failure of combined phacoemulsification and GDI surgery have not been investigated in depth.…”

Combined Glaucoma and Cataract: An Overview

“…Corneal decompensation after insertion of drainage devices and cataract extraction was likely to be due to pre-existing endothelial loss caused by previously uncontrolled IOP, but it is possible that endothelial injury may also be aggravated during phacoemulsification [39]. The hypertensive phase defined as elevated IOP in the presence of a functioning bleb and a patent tube and occurring up to 9 months after surgery was found to occur in similar rate than in the isolated drainage implant surgery (22-50%) [49][50][51]. Tube erosion and occlusion show no difference between tube implant alone and when it is combined with cataract extraction [49][50][51].…”