Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman

A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma

Purpose

Methods

Results

Conclusion

How to cite this article

Neovascular Glaucoma Progress and Impact of Therapeutic Intervention in Saudi Arabia

Purpose: This study aimed to present the outcomes of the therapeutic interventions for neovascular glaucoma (NVG) between 2002 and 2012 at a tertiary eye hospital in Saudi Arabia.

Methods: A retrospective chart review of the patients with NVG treated in the last 10 years at King Khaled Eye Specialist Hospital was carried out. The demographics, visual acuity, and intraocular pressure (IOP) at the baseline were compared to that, at last, follow-up. The clinical course of treated eyes and causes for poor vision were reviewed.

Results: Among 597 eyes with NVG, the mean IOP at presentation was 32 mmHg. A total of 335 eyes (56.1%) were treated with pan-retinal photocoagulation (PRP). In 459 (77%) eyes, IOP was controlled with medications or different surgeries. The vision on the last follow-up was 20/20 to 20/40 in 19 (3%) eyes, 20/50 to 20/200 in 67 (11%) eyes, <20/200 to 20/400 in 267 (45%) eyes, and <20/400 in 225 (38%) eyes. Nineteen eyes were soft/enucleated. In 45 (8%, 95% CI 6-10) eyes vision improved. The IOP was reduced to <22 mmHg in 369 (62%, 95% CI 58.2-65.9) eyes, 23-30 mmHg in 69 (12%) eyes and was > 31 mmHg in 102 (17%) eyes. In 26 (3.7%) eyes, ocular hypotony was noted. The causes of poor vision included retinal ischemia (n=75, 13%), optic nerve head cupping (n=104, 17%), retinal detachment (n= 42, 7%) and other (n=17, 3%).

Conclusion: The NVG is a serious ocular ischemic complication. Prompt therapy maintained or improved the vision and controlled IOP in 50% and more cases.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM

To evaluate the long-term results and complications of Ahmed glaucoma valve (AGV) implantation in a cohort of Egyptian patients.

METHODS

A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure (IOP) measurement before surgery and at 1d, weekly for the 1^st month, 3, 6mo, and 1y after surgery and yearly afterward for 5y. IOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as IOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery.

RESULTS

Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery. IOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes (41.1%), complicated cataract in 9 eyes (7.25%), recessed tube in 8 eyes (6.45%), tube exposure in 6 eyes (4.8%) and corneal touch in 6 eyes (4.8%). Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes (1.6%).

CONCLUSION

Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful IOP control after AGV implantation. However, effective complications management can improve the rate of success.

[Ahmed valve in glaucoma surgery]

This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

Ahmed glaucoma valve in various etiologies of refractory glaucoma: Surgical outcomes and success factors

PURPOSE

To study the epidemiology and mid-term results of the Ahmed glaucoma valve (AGV) in various etiologies of refractory glaucoma in a Lebanese center, and to assess complications and factors that influence the surgical success rate.

METHODS

In this retrospective epidemiological study, we reviewed 108 eyes with refractory glaucoma that underwent an AGV implantation in a tertiary care center in Lebanon between January 2002 and August 2014. Findings including best-corrected visual acuity (BCVA), intra-ocular pressure (IOP), number of antiglaucoma medications, factors influencing the surgical outcome, success rate and complications were also reviewed.

RESULTS

The mean duration of follow-up was 29.85±21.45 months [range, 3-60 months]. As in other Arab countries and compared to the rest of the world, the rate of neovascular glaucoma (NVG) was particularly high, occurring in 63 eyes (58.3%), and represented the primary cause of refractory glaucoma. Mean IOP was significantly reduced to 17.97±7.35mmHg at the last follow-up visit (P<0.05). Similarly, a significant decrease was noted in the number of antiglaucoma medications (P<0.05). The surgical success rate, defined as a postoperative IOP<21, was significantly higher (62.0%), in older patients, those with baseline BCVA≤2 LogMAR and those with a history of hypertension (P<0.01). Hyphema was the most noted complication.

CONCLUSION

The AGV is a safe and effective procedure for lowering IOP in refractory glaucoma patients, with hyphema being the most frequent complication. Both the presence of hyperstension and initial BCVA≤2 LogMAR seem to increase the success rate of the procedure. NVG remains the most common etiology for implantation, probably due to uncontrolled diabetes in the Middle East and North Africa.

The efficacy of Alahmady ring implantation in the management of neovascular glaucoma

Purpose

To evaluate the efficacy and safety of Alahmady ring implantation in the management of neovascular glaucoma.

Methods

A total of 15 eyes of 15 patients with intractable neovascular glaucoma with intraocular pressure (IOP) ≥28 mmHg not responding to medical treatment were retrospectively analyzed. All patients had poor visual acuity and underwent Alahmady ring implantation. The ring was designed from fenestrated silicon tube used in lacrimal surgeries and was implanted subsclerally after passing it through the anterior chamber. Patients were followed up for at least 24 months. Success in this study was defined based on IOP ≥8 mmHg and <21 mmHg, with not more than 1 glaucoma drug, and improvement of patient symptoms and signs with maximum use of beta blocker as antiglaucoma drug.

Results

A total of 15 eyes of 15 patients (9 males [60%] and 6 females [40%]) were analyzed in this study. The mean IOP before surgery was 38.6 mmHg (standard deviation [SD]: 6.98) and it was 14.05 mmHg (SD =7.57) after surgery. The follow-up range was 24–36 months. Success of silicon drainage device was defined as an IOP <21 mmHg on the last follow-up visit. Medications included only beta-blockers and topical steroids for those who were without severe complications or for those who were not in a condition to undergo a further glaucoma surgery.

Conclusion

Alahmady ring implantation proves to be a good surgical option for neovascular glaucoma; however, a longer follow-up period is recommended.

The Ahmed Glaucoma Valve in Refractory Glaucoma: Experiences in Southwest Ethiopia

Background

The management of refractory glaucoma is a challenging task for any glaucoma surgeon. This study is aimed to evaluate the efficacy of Ahmed Glaucoma Valve implantation in refractory glaucomas in South-West Ethiopia.

Methods

A retrospective review was conducted on the charts of consecutive patients treated with Ahmed glaucoma valve implantation at Jimma University Specialized Hospital between August 2012 and August 2014. Success was defined as Intraocular Pressure (IOP) less than 22 mm Hg and greater than 5mm Hg at 6 months, with at least 30% reduction from baseline, without medical therapy (complete success) or either with or without medication (qualified successes).

Results

A total of 12 eyes of 11 patients were included. The mean age of patients was 40.7 (SD= 19.0) years; 63.6% of them were males. The main types of glaucoma were pseudoexfoliative (3 eyes), uveitic (2 eyes), chronic angle closure (2 eyes) and Juvenile Open Angle (JOAG) (2 eyes). The mean IOP was reduced from preoperative level (32.75±7.14 mmHg) to (15.75 ±4.35 mmHg) at six postoperative months, (P<0.001); 66.7% eyes had complete successes while 83.3% had qualified success. Intra-operative complications were encountered in 2(16.7%) eyes, while 5/12 (41.7%) eyes had post-operative complications-hypotony (one with choroidal effusion) and progression of cataract in 2 eyes each. Hypertensive phase was diagnosed in 2(16.7%) eyes.

Conclusion

The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas with success rate comparable with those reported from other studies. KEYWORDS: Ahmed glaucoma valve, refractory glaucoma, complications, Ethiopia

Intraocular Pressure Control after Implantation of an Ahmed Glaucoma Valve in Eyes with a Failed Trabeculectomy

AIM

To evaluate the results of Ahmed glaucoma valve (AGV) in eyes with a failed trabeculectomy.

MATERIALS AND METHODS

This retrospective study evaluated 61 eyes with a failed trabeculectomy that underwent implantation of an AGV due to uncontrolled intraocular pressure (IOP) on maximal medical therapy. Success was defined as IOP ≤ 21 mm Hg (criterion 1) or 20% reduction in IOP (criterion 2) with or without antiglaucoma medications. Persistent hypotony, loss of light perception, and reoperation for IOP control were defined as failure.

RESULTS

Mean preoperative IOP and mean lOPs at 6, 12, and 24 months were 21.93 ± 6.32 mm Hg (n = 61), 14.15 ± 4.33 mm Hg (n = 59), 13.21 ± 4.44 mm Hg (n = 56), and 13.60 ± 3.27 mm Hg (n = 25) respectively. Mean number of antiglaucoma medications preoperatively and at 6, 12, and 24 months was 3.95 ± 0.85, 2.19 ± 1.38, 2.48 ± 1.44, and 2.40 ± 1.32 respectively. The reductions in the number of medications and IOP measurements were statistically significant at all time intervals (p < 0.001, Wilcoxon signed rank test). According to criterion 1, the Kaplan-Meier survival curve disclosed success rates of 75% at 12 and 24 months. According to criterion 2, the success rates were 57% at 12 months and 55% at 24 months. The most frequent complications were hypertensive phase (18%) and shallow anterior chamber (16.4%).

CONCLUSION

The AGV may effectively reduce IOP in eyes that had a failed trabeculectomy.

CLINICAL SIGNIFICANCE

The AGV is an alternative in eyes with a failed trabeculectomy.

HOW TO CITE THIS ARTICLE

Schimiti RB, Abe RY, Tavares CM, Vasconcellos JPC, Costa VP. Intraocular Pressure Control after Implantation of an Ahmed Glaucoma Valve in Eyes with a Failed Trabeculectomy. J Curr Glaucoma Pract 2016;10(3):97-103.

The Results of the Use of Ahmed Valve in Refractory Glaucoma Surgery

The treatment of refractory glaucoma (RG) is challenging. The commonly adopted strategy in RG treatment is a glaucoma drainage device (GDD) implantation, which despite its radical nature may not always provide the desired intraocular pressure (IOP) levels for a long term. This review is based on the scientific literature on Ahmed glaucoma valve (AGV) implantation for refractory glaucoma. The technique of AGV implantation is described and data for both the types, FP7 and FP8 performance are presented. The outcome with adjunct antimetabolite and anti-VEGF drugs are also highlighted. An insight is given about experimental and histological examinations of the filtering bleb encapsulation. The article also describes various complications and measures to prevent them.

How to cite this article: Bikbov MM, Khusnitdinov II. The Results of the Use of Ahmed Valve in Refractory Glaucoma Surgery. J Curr Glaucoma Pract 2015;9(3):86-91.

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM

To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation surgery for refractory glaucoma.

METHODS

This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure (IOP) greater than 21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation, data were collected on IOP, the best corrected visual acuity (BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56wk postoperatively. Logarithm values of IOP were calculated and compared.

RESULTS

The study group was comprised of 30 patients (30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg, 19.6±12.8 mm Hg and 13.9±14.2 mm Hg at 12, 24 and 56wk respectively. BCVA was ≥ 6/60 in 11 eyes preoperatively, and five eyes had BCVA≥6/60 at 56wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At 12wk postoperatively, no medications were required to control IOP in 20 eyes. At 56wk postoperatively, at least one medication was required to control IOP in 10 eyes. Over the entire follow up period, four eyes were treated with yttrium aluminium garnet (YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.

CONCLUSION

AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.