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

Abstract

PurposeTo evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation.MethodsThis retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg.ResultsThe mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008).ConclusionsCombined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.

Biometric Predictability in Combined Cataract Surgery and Ahmed Glaucoma Valve Implantation Depending on Tube Position

“…A biometry prediction error within −1D and +0.5D was achieved in 63% patients, slightly higher than the 57% reported by Kwon and Sung with cataract surgery combined with AGV implantation 8 and slightly lower than the 74% reported by Tzu et al with combined cataract and glaucoma surgery. 4 …”

“…14 Within ±0.5D, the biometry prediction error was 53.1% (26/49), higher than the 48.4% reported by Kang et al with cataract surgery with endoscopic cyclophotocoagulation, 15 but lower than the 59.7% reported by Manoharan et al with cataract surgery of glaucoma patients (without glaucoma surgery) 10 and the 72.7% reported by EUREQUO with standard cataract surgery. 14 A biometry prediction error within −1D and +0.5D was achieved in 63% patients, slightly higher than the 57% reported by Kwon and Sung with cataract surgery combined with AGV implantation 8 and slightly lower than the 74% reported by Tzu et al with combined cataract and glaucoma surgery. 4 To our knowledge, this is the first study to document the effects of tube position on the biometric predictability of cataract surgery combined with AGV implantation.…”

“… 4 More recently, Kwon and Sung included refractive outcomes in addition to the IOP control outcomes of phacoemulsification surgery combined with AGV implantation, but all eyes had the tube inserted into the anterior chamber and they only reported the absolute refractive error among the four formulas, so that it was not possible to see whether there is any tendency towards a myopic or hyperopic shift. 8 Currently, there are no published studies in the literature with refractive outcomes discriminating on the basis of tube position. This study aims to evaluate the predictability of biometric results in patients undergoing cataract surgery combined with AGV implantation according to tube position.…”

Surgical outcomes associated with a sutureless drainage valve implantation procedure in patients with refractory glaucoma

“…Although it was not statistically different, baseline IOP and number of medications were slightly lower in patients who underwent AGV + CEIOL surgery, which may account for differences in treatment response in the postoperative subgroup analysis. Retrospective studies have found that AGV + CEIOL surgery reduces IOP and number of medications after surgery 20,21. To our knowledge, there have been no comparative studies between AGV surgery alone vs combined AGV + CEIOL insertion.…”

Risk factors for Baerveldt glaucoma drainage implantation for uveitic glaucoma

“…In this study, the incidence of iris touch was 45.0% (9/20) in the group with no history of phaco, 12.5% (1/8) in the group with phaco, and 17.1% (6/35) in the group with a history of phaco (Table 6 ). The contact between the tube and iris may also cause inflammation, and Kwon et al reported that tube-iris touch is a risk factor with an 8.615 hazard ratio in Ahmed glaucoma valve implantation combined with phaco 21 . The tube should be carefully inserted to avoid touching the iris, and further investigation about the effect of tube-iris touch is needed.…”