Risk factors for hypertensive phase after Ahmed glaucoma valve implantation

Özalp, Onur; İlgüy, Serdar; Atalay, Eray; Şimşek, Tülay; Yıldırım, Nilgün

doi:10.1007/s10792-021-02009-3

Cited by 12 publications

(11 citation statements)

References 36 publications

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“…Previous studies describe high myopia, high preoperative IOP, and young age as risk factors for HP after AGI surgery 9,10. Our bivariate analysis found no statistically significant association between preoperative IOP, preoperative mean, number of glaucoma medications, age, sex, or race/ethnicity, and HP (Table 4).…”

Section: Discussioncontrasting

confidence: 45%

“…Previous studies describe high myopia, high preoperative IOP, and young age as risk factors for HP after AGI surgery. 9,10 Our bivariate analysis found no statistically significant association between preoperative IOP, preoperative mean, number of glaucoma medications, age, sex, or race/ethnicity, and HP (Table 4). Studies of demographically diverse patient populations should be conducted in the future to better characterize the risk factors for HP and guide the clinical management of postoperative IOP.…”

Section: Discussionmentioning

confidence: 77%

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Anterior Chamber Washout During Ahmed Valve Glaucoma Surgery Reduces the Incidence of Hypertensive Phase

Chang

Yang

Ly³

et al. 2023

Journal of Glaucoma

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Intraoperative anterior chamber (AC) washout reduces the odds of hypertensive phase (HP) by 95% compared with those not receiving washout during Ahmed glaucoma implant (AGI), suggesting AC washout is an effective prophylaxis for postoperative HP.Purpose: To characterize the incidence of postoperative HP in patients receiving AC washout at the time of AGI.Patients and Methods: A total of 24 patients with medically refractory glaucoma who underwent AGI surgery at a tertiary academic medical center in Southern California from December 2018 through March 2021 were included in this retrospective comparative case series. Patients who received a pediatric implant and underwent concurrent intraocular surgery or did not complete a minimum of 6 months of follow-up were excluded. Nine patient's eyes received AC washout and 15 controls that were analyzed through 6 months postprocedure. HP was defined as intraocular pressure (IOP) above 21 mm Hg within 6 months postprocedure with maximum tolerated medical therapy. AC washout was performed by irrigating the AC with a 5 mL balanced salt solution before placing the tube of the AGI into the AC. The rate of postoperative HP, defined as peak IOP > 21 mm Hg, at 6 months follow-up, was observed as the primary outcome measure.Results: Patients included in the study had a high mean preoperative IOP (X̅ = 44.11, SD = 13.85). There were no baseline differences between the washout and control groups. The odds of HP were significantly reduced (odds ratio: 0.050; 95% CI: 0.004, 0.706; P = 0.027) for patients who underwent intraoperative AC washout compared with those who did not. Bivariate analysis of subject baseline characteristics revealed that only washout status was significantly different in subjects with HP compared with subjects without HP (P = 0.015). A multivariate logistic regression model using washout status and autoimmune conditions as covariates was significant in predicting HP (X 2 (2) = 12.337, P = 0.002), with washout as a significant predictor when controlling for autoimmune comorbidities (P = 0.027).Conclusions: AC washout significantly decreases the odds of HP after AGI surgery. AC washout with balanced salt solution adds minimal time and risks to surgery and therefore may be an effective adjunct during AGI placement.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 77%

Anterior Chamber Washout During Ahmed Valve Glaucoma Surgery Reduces the Incidence of Hypertensive Phase

Chang

Yang

Ly³

et al. 2023

Journal of Glaucoma

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“…However, the number of needling procedures required did not differ significantly between the groups. In a recent report investigating the risk factors for HP, a higher preoperative IOP, and a younger age were found to be risk factors (20) . In the same report, HP, defined as an IOP rise within the postoperative three months, was mostly encountered in traumatic glaucoma cases.…”

Section: Discussionmentioning

confidence: 94%

Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control

Un,

Imamoglu

2024

ABO

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As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. Methods: This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant-Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. Results: Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). Conclusion: The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.

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“…A higher preoperative IOP and younger age are risk factors for the hypertensive phase [ 185 , 186 ]. Pharmacological agents aimed to decrease the occurrence of the hypertensive phase include prostaglandin analogs and aqueous suppressant treatment [ 187 ]. However, recent findings suggest that the use of aqueous suppressants and prostaglandin analogs may affect wound healing.…”

Section: Strategies To Prevent Ocular Fibrosis Following Glaucoma Fil...mentioning

confidence: 99%

“…However, recent findings suggest that the use of aqueous suppressants and prostaglandin analogs may affect wound healing. Aqueous suppressants have been shown to decrease the expression of α-SMA, reduce the transformation of fibroblasts to myofibroblasts, attenuate growth factors, and reduce mechanical stress from aqueous pressure on the bleb [ 187 ]. Prostaglandin analogs have been shown to induce collagen contraction, upregulate IL-2, and upregulate MMP-9.…”

Section: Strategies To Prevent Ocular Fibrosis Following Glaucoma Fil...mentioning

confidence: 99%

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

et al. 2023

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Conjunctival fibrosis remains the major impediment to the success of glaucoma filtration surgery. Anti-metabolites remain the gold standard for mitigating post-surgical fibrosis, but they are associated with high complication rates and surgical failure rates. Establishing a more targeted approach to attenuate conjunctival fibrosis may revolutionize the surgical approach to glaucoma. A new strategy is needed to prevent progressive tissue remodeling and formation of a fibrotic scar, subsequently increasing surgical success and reducing the prevalence of glaucoma-related vision loss. Advancements in our understanding of molecular signaling and biomechanical cues in the conjunctival tissue architecture are broadening the horizon for new therapies and biomaterials for the mitigation of fibrosis. This review aims to highlight the strategies and current state of promising future approaches for targeting fibrosis in glaucoma filtration surgery.

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Risk factors for hypertensive phase after Ahmed glaucoma valve implantation

Cited by 12 publications

References 36 publications

Anterior Chamber Washout During Ahmed Valve Glaucoma Surgery Reduces the Incidence of Hypertensive Phase

Anterior Chamber Washout During Ahmed Valve Glaucoma Surgery Reduces the Incidence of Hypertensive Phase

Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

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