Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

Abstract

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods : In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis

“…A total of 3795 eyes were included in this study, which included 670 eyes in the Ahmed group, 561 eyes in the Baerveldt group, 473 eyes in the Ex-PRESS group, 199 eyes in the XEN group and 1892 eyes in the trabeculectomy group. Sixteen of the 49 studies had an RCT design,25–27 37 39 48 49 51–53 55 56 59 62 64 66 and the others had a retrospective or prospective comparative design 19–24 28–36 38 40–47 50 54 57 58 60 61 63 65 67. Overall, the included RCTs demonstrated a low risk of bias for the majority of domains evaluated (online supplemental figure S1).…”

“…In all, 3552 articles were initially identified. After applying the exclusion criteria, 49 articles were included in this meta-analysis, as shown in figure 1 19–67. A total of 3795 eyes were included in this study, which included 670 eyes in the Ahmed group, 561 eyes in the Baerveldt group, 473 eyes in the Ex-PRESS group, 199 eyes in the XEN group and 1892 eyes in the trabeculectomy group.…”

Peripapillary and Macular Choroidal Vascularity Index in Eyes with Fuchs’ Uveitis

“…Glaucoma and ocular hypertension have been reported as common complications of FU in several reports (38,39) . It is known that FU has an increased risk of glaucoma for reasons abnormal angle vessels, obstruction of trabecular meshwork by in ammatory cells, disruption of uveal and juxtacanalicular structures, trabecular meshwork brosis and steroid-induced ocular hypertension (22,40) . Therefore vascular support of peripapillary area should be well evaluated in these eyes.…”

Glaucoma drainage devices implantation in uveitic glaucoma: a systematic review

“…Uveitic eyes are prone to developing hypotony in the early postoperative period secondary to ciliary body shutdown. [16][17][18][19] This study has several limitations. We do not categorize patients by age, so it is included all uveitic glaucoma patients, pediatric and adults.…”