The Ahmed Versus Baerveldt Study

Christakis, Panos G.; Kalenak, Jeffrey W.; Zurakowski, David; Tsai, James C.; Kammer, Jeffrey A.; Harasymowycz, Paul; Ahmed, Iqbal Ike K.

doi:10.1016/j.ophtha.2011.05.004

Cited by 359 publications

(76 citation statements)

References 40 publications

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“…The 6-month IOP outcomes and success rates we report for both groups are comparable with previously published results on the AGV 2–4. Compared with cohorts in prospective studies comparing AGV with BGI, our cohort had slightly lower mean IOP (14.2 mmHg in the non-TA group and 14.7 mmHg in the TA group compared with 15.7 mmHg and 16.7 mmHg in the Ahmed Baerveldt Comparison Study3 and Ahmed Versus Baerveldt Study4 trials, respectively) on a similar average number of medications at 6 months. Prior studies using antimetabolites and antivascular endothelial growth factor agents as adjuncts to Ahmed valve implantation similarly found no difference in final outcomes with adjunctive treatment 19–22…”

Section: Discussionsupporting

confidence: 91%

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Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

Turalba

Pasquale²

2014

OPTH

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ObjectiveTo evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation.DesignRetrospective comparative case series.ParticipantsForty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA.MethodsA retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery.Main outcome measuresPrimary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures.ResultsFive out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.2±4.6 in TA cases versus [vs] 14.7±5.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.8±1.3 in TA cases vs 1.6±1.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group.ConclusionsSubtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery.

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Section: Discussionsupporting

confidence: 91%

“…The AGV has been shown to have comparable intermediate-term efficacy with its nonvalved counterpart, the Baerveldt glaucoma implant (BGI), in two prospective randomized clinical trials 3,4. However, the AGV resulted in slightly less IOP lowering compared with the BGI.…”

Section: Introductionmentioning

confidence: 99%

Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

Turalba

Pasquale²

2014

OPTH

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“…The AGV was developed in 1993 and has become the most commonly used glaucoma drainage device with high success rates of 60–90% in 1 year and 40–50% in up to 4 years [1, 10–14]. It has been particularly used for the management of glaucoma refractory to standard filtering surgery.…”

Section: Discussionmentioning

confidence: 99%

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

et al. 2018

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BackgroundTo describe a new technique and present its long-term outcome for prevention of Ahmed glaucoma valve (AGV) tube exposure in patients with refractory glaucoma.MethodsTwenty-seven eyes of 24 patients (mean age, 50 years; age range, 16–78 years; 8 females, 16 males) with refractory glaucoma who had the AGV implant were retrospectively reviewed. For AGV implantation, a long scleral flap combined with Tenon advancement and duplication was used. In this technique, a long scleral flap is created to completely cover the extraocular part of valve’s tube, and the flap surface is covered with duplicated Tenon’s tissue. The average follow-up after AGV implantation was 21.7 months (range, 12–36 months).ResultsThe mean intraocular pressure before the operation, which was 44.1 mmHg (range, 26–62 mmHg), decreased to 14.2 mmHg (range, 8–20 mmHg) at the last follow-up visit, showing 67% reduction with AGV implantation. The mean number of antiglaucomatous medications was 4.1 before the AGV implantation and decreased to 0.9 after the operation, showing 88% reduction. In 14 eyes (51.9%), there was no change in the best corrected visual acuity (BCVA), and in 11 eyes (40.7%), the BCVA increased by 2 lines on the Snellen chart postoperatively. No patient developed postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, or tube/plate migration.ConclusionsThe long scleral flap augmented with Tenon advancement and duplication is an effective and safe surgical technique for the implantation of AGV and preventing tube exposure in cases of refractory glaucoma.

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“…14;16 The AVB Study randomized 238 patients (124 to the AGV and 114 to the BGI) with similar but slightly broader patient eligibility to the ABC Study. There were minor demographic differences with a slight female preponderance in the BGI group and more white patients in the AVB Study, with slightly more POAG (50% versus 40%) and less NVG (21% versus 29%) compared with ABC.…”

Section: Discussionmentioning

confidence: 99%

“…The ABC Study has previously reported a comparison of these two implants with one year postoperative follow up. 16 In this manuscript we report the treatment outcomes of the ABC Study after three years of follow-up.…”

mentioning

confidence: 99%

Three-year Treatment Outcomes in the Ahmed Baerveldt Comparison Study

et al. 2014

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Purpose To compare three year outcomes and complications of the Ahmed FP7 Glaucoma Valve (AGV) and Baerveldt 101–350 Glaucoma Implant (BGI) for the treatment of refractory glaucoma. Design Multicenter randomized controlled clinical trial. Participants 276 patients; 143 in the AGV group and 133 in the BGI group. Methods Patients aged 18–85 years with refractory glaucoma and intraocular pressures (IOPs) ≥18 mmHg in whom an aqueous shunt was planned were randomized to either an AGV or a BGI. Main Outcome Measures IOP, visual acuity, supplemental medical therapy, complications, and failure (IOP > 21 mmHg or not reduced by 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or removal of implant, or loss of light perception vision). Results At 3 years, IOP (mean ± standard deviation) (SD) was 14.3 ± 4.7 mmHg (AGV group) and 13.1 ± 4.5 mmHg (BGI group) (p = 0.086) on 2.0 ± 1.4 and 1.5 ± 1.4 glaucoma medications respectively (p = 0.020). The cumulative probabilities of failure were 31.3% (standard error = 4.0%) (SE) (AGV) and 32.3% (4.2%) (BGI) (p = 0.99). Postoperative complications associated with reoperation or vision loss of ≥ 2 Snellen lines occurred in 24 patients (22%) (AGV) and 38 patients (36%) (BGI) (p = 0.035). The mean change in the Logarithm of the Minimum Angle of Resolution visual acuity (logMAR VA) at 3 years was similar (AGV: 0.21 ± 0.88, BGI: 0.26 ± 0.74) in the two treatment groups at 3 years (p=0.66). The cumulative proportion of patients (SE) undergoing reoperation for glaucoma prior to the three year postoperative time point was 14.5% (3.0%) in the AGV group compared to 7.6% (2.4%) in the BGI group (p=0.053, log-rank). The relative risk of reoperation for glaucoma in the AGV group was 2.1 times that of the BGI group (95% Confidence Interval:1.0–4.8, p=0.045; Cox proportional hazards regression). Conclusions AGV implantation was associated with the need for significantly greater adjunctive medication to achieve equal success relative to BGI implantation and resulted in a greater relative risk of reoperation for glaucoma. More subjects experienced serious postoperative complications in the BGI group than in the AGV group.

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The Ahmed Versus Baerveldt Study

Cited by 359 publications

References 40 publications

Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

Three-year Treatment Outcomes in the Ahmed Baerveldt Comparison Study

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