PURPOSE To compare the late complications in the Ahmed Baerveldt Comparison Study during 5 years of follow-up. DESIGN Multicenter, prospective, randomized clinical trial. METHODS SETTINGS Sixteen international clinical centers. STUDY POPULATION Two hundred seventy six subjects aged 18 to 85 years with previous intraocular surgery or refractory glaucoma with intraocular pressure of > 18 mmHg. INTERVENTIONS Ahmed Glaucoma Valve FP7 or Baerveldt Glaucoma Implant BG 101-350. MAIN OUTCOME MEASURES Late postoperative complications (beyond 3 months), reoperations for complications, and decreased vision from complications. RESULTS Late complications developed in 56 subjects (46.8 ± 4.8 5 year cumulative % ± SE) in the Ahmed Glaucoma Valve group and 67 (56.3 ± 4.7 5 year cumulative % ± SE) in the Baerveldt Glaucoma Implant group (P = 0.082). The cumulative rates of serious complications were 15.9% and 24.7% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups respectively (P = 0.034) although this was largely driven by subjects who had tube occlusions in the two groups (0.8% in the Ahmed Glaucoma Valve group and 5.7% in the Baerveldt Glaucoma Implant group, P = 0.037). Both groups had a relatively high incidence of persistent diplopia (12%) and corneal edema (20%), although half of the corneal edema cases were likely due to pre-existing causes other than the aqueous shunt. The incidence of tube erosion was 1% and 3% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups, respectively (P = 0.04). CONCLUSIONS Long term rates of vision threatening complications and complications resulting in reoperation were higher in the Baerveldt Glaucoma Implant than the Ahmed Glaucoma Valve group over 5 years of follow-up.

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Purpose-To compare optic disc and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes.Design-Retrospective, cross-sectional study. Methods-Setting:Tertiary care academic glaucoma center. Ninety-two eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT), scanning laser polarimetry (GDx-VCC), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph III), and qualitative assessment of stereoscopic optic disc photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUC) and sensitivities at fixed specificities. Classification and Regression Trees (CART) analysis was used to evaluate combinations of quantitative parameters.Results-The average (±SD) visual field mean deviation for glaucomatous eyes was −4.0±2.5 dB. Parameters with largest AUCs (±SE) were: average RNFL thickness for StratusOCT (0.96±0.02), nerve fiber indicator for GDx-VCC (0.92±0.03), FSM discriminant function for HRT III (0.91±0.03), and 0.97±0.02 for disc photograph evaluation. At 95% specificity, sensitivity of disc photograph evaluation (90%) was greater than GDx-VCC (p=0.05) and HRT III (p=0.002), but not significantly different than that of StratusOCT (p>0.05). Combination of StratusOCT average RNFL thickness and HRT III cup/disc area with CART produced a sensitivity of 91% and specificity of 96% Conclusions-StratusOCT, GDx-VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disc stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup/disc area ratio provided a high diagnostic precision.

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To evaluate the long-term efficacy of intraocular pressure reduction and complications of Ahmed glaucoma valve (AGV) implantation in children with primary congenital glaucoma. Methods:The medical records of patients with primary congenital glaucoma who underwent AGV implantation with a minimum follow-up of 6 months were reviewed. The primary outcome measure was cumulative probability of success, defined as intraocular pressure greater than 5 mm Hg and less than 23 mm Hg and at least a 15% reduction from the preoperative intraocular pressure, without serious complications, additional glaucoma surgery, or loss of light perception.Results: Thirty eyes of 19 children with primary congenital glaucoma who underwent AGV implantation with a minimum follow-up of 6 months were reviewed. The children had a mean (SD) age of 1.8 (2.6) years, a mean (SD) preoperative intraocular pressure of 28.4 (6.7) mm Hg, and a mean (SD) follow-up time of 57.6 (48.0) months. The cumulative probability of success was 63% in 1 year and 33% in 5 years. After a second AGV implantation, the cumulative probability of success was 86% in 1 and 2 years and 69% in 5 years. Hispanic ethnicity (P=.02) and being female (P=.005) were associated with increased risk of failure.Conclusions: Thirty-three percent of AGV implantations in children with primary congenital glaucoma were successful after 5 years of follow-up. With the implantation of a second AGV, the 5-year success rate increased to 69%.