Ahmed valve implantation in glaucoma secondary to chronic uveitis

Abstract

Ahmed valve implantation in glaucoma secondary to chronic uveitis PÇ Ö zdal, RNG Vianna and J Deschê nes AbstractPurpose To evaluate the efficacy of Ahmed valve (AV) implantation in patients with uveitic glaucoma. Methods In total, 18 patients (19 eyes) with glaucoma secondary to chronic uveitis, who underwent AV implantation were retrospectively reviewed. Visual acuity, intraocular pressure (IOP), and glaucoma medications at the most recent examination prior to surgery, were compared with those of last postoperative examination. The surgical success was defined as IOP less than 21 mmHg and greater than 4 mmHg without loss of light perception and visually devastating complications at the last postoperative examination. Decrease in the number of glaucoma medications was also a criterion for surgical success. Results The mean follow-up period was 2679.7 months. The mean preoperative and postoperative IOPs were 33.379.7 (range, 20-57) mmHg and 17.3710.8 (range, 6-40) mmHg respectively (Po0.0001). The mean number of antiglaucoma medications was 3.570.8 (range, 2-5) preoperatively and 1.471.3 (range, 0-4) postoperatively (Po0.0001). Valve occlusion (five eyes, 26.3%) was the most commonly observed complication. Surgical success was achieved in 13 eyes (68.4%). The cumulative probability of success was 94.4% at 1 year and 60% at 2 years. Five eyes (26.3%) with IOP greater than 21 mmHg and one (5.3%) with corneal decompensation requiring penetrating keratoplasty were considered as failures. Conclusions The implantation of AV is an effective surgical procedure for the management of uveitic glaucoma. The inflammatory background might contribute to the occurrence of valve occlusion, which is the most common complication. Prevention of this complication is an essential factor for improving the surgical outcome.

Deep sclerectomy and trabeculectomy in uveitic glaucoma

“…However, the total strength of the patients included was high, because uveitic glaucomas are much less frequent than primary open-angle glaucomas. The number of eyes treated in our study (41) was larger than in most other investigations of uveitic glaucomas (for instance, Ho reported 31 eyes, 21 Auer, 14, 9 Ozdal, 19 22 and Obeidan, 13 10 ), but was similar to the 44 and 40 eyes in the series studied by Ceballos et al 1 and Molteno et al, 3 respectively.…”

A retrospective study on the outcomes of Ahmed valve versus Ahmed valve combined with fluocinolone implant in uveitic glaucoma

“…This baseline difference is a poor prognostic factor for AGV + fluocinolone, because inflammation is associated with worse IOP outcome and higher failure rates after glaucoma drainage device surgeries. 26,27 Hence, the lack of difference in HP and IOP control postoperatively between groups is suggestive of a beneficial effect of AVG + fluocinolone.…”

Long Term Results Of Refractory Glaucoma Cases With Ahmed Glaucoma Valve Implantation

“…Ahmed glokom valvi, içerdiği valf mekanizması nedeniyle, dirençli glokom vakalarının cerrahi tedavisinde oldukça sık tercih edilen bir materyaldir [6][7][8][9][10] . Çünkü valf içermeyen diğer implantlarda erken dönemde hipotoni riski daha yüksektir 5,6,11 .…”

“…Ancak belli bir basınçta drenaj sistemini devreye sokan bir valf sistemi içeren ve böylece kontrollü GİB düşüşü sağ-layan Ahmed glokom valfi ve Krupin implantları hipotoniyi engelleyerek bu cerrahiyi daha güvenilir hâle getirmişlerdir 6,7 . Ahmed glokom valvinin dirençli glokom vakalarında başarıyla kullanıldığını destekleyen birçok çalışma mevcut olmak ile birlikte uzun dönem klinik sonuçlarını bildiren çalışma sayısı kısıtlıdır [8][9][10] . Hastaların yaş, cinsiyet gibi demografik bilgileri, glokomun tipi, daha önce geçirdikleri göz cerrahileri, ameliyat öncesi ve sonrası en iyi düzeltilmiş görme keskinliği, göz içi basıncı (GİB), medikasyon sayısı, merkezi kornea kalınlığı (MKK) değerleri kaydedildi.…”