Clinical outcomes of Ahmed glaucoma valve in anterior chamber versus ciliary sulcus

Abstract

PurposeTo evaluate the outcomes of Ahmed glaucoma valve (AGV) tube insertion through the anterior chamber angle (ACA) or through the ciliary sulcus (CS).Patients and methodsIn this case-control study, we retrospectively reviewed the charts of consecutive glaucoma patients who had undergone AGV implantation either through the ACA or the CS between March 2009 and December 2014. The main outcome measures were intraocular pressure (IOP), number of glaucoma medications prescribed, best corrected visual acuity (BCVA), glaucoma type, success rate, complications, and survival ratios. Statistical analysis was carried out using SPSS.ResultsThere were 68 eyes in the ACA group and 35 eyes in the CS group. There were no significant differences between the groups for age, sex, laterality, IOP, preoperative glaucoma medication number, BCVA or glaucoma type (P>0.05). The postoperative follow-up period was 27.2±16.5 months and 30.2±17.7 months for the ACA and the CS groups (P=0.28); IOP values were significantly reduced at the last visit to 16.4±7.2 mm Hg and 14.4±6.8 mm Hg. The difference in the last-visit IOP between the groups was not significant (P=0.06), but the IOP reduction ratio was higher in the CS group (P=0.03). There was no significant difference in the number of postoperative medications (P=0.18). Postoperative complications were similar, but the incidence of flat anterior chamber was higher in the ACA group (P=0.05).ConclusionsThe use of an AGV can control IOP in the majority of cases whether placed in the ACA or the CS. The IOP reduction ratio seemed to be higher in the CS group.

Beyoglu Eye J. Ahead of Print: BEJ-00710 | DOI: 10.14744/bej.2019.00710 Ciliary sulcus implantation of Ahmed glaucoma valve (AGV) in patients with corneal decompensation risk

“…In the literature, hyphema has been reported to occur in 8% to 16.9% of patients after implantation of the AGV tube in the anterior chamber angle or pars plana (18)(19)(20)(21). In their study of AGV tube implantation in the ciliary sulcus, Bayer et al (10) found a ratio of hyphema of 14.3%. The greater vascularization of the ciliary sulcus compared with the anterior chamber angle or pars plana may have contributed to these findings (13).…”

“…Several studies have reported a rate of between 7% and 27% (6)(7)(8)(9). Tube implantation into the pars plana or ciliary sulcus has been investigated as a possible means of reducing contact in cases with a risk of corneal decompensation or peripheral anterior synechiae (PAS) (4,(10)(11)(12). AGV insertion into the ciliary sulcus has been proposed as a more advantageous option because AGV insertion into the pars plana is thought to be associated with more posterior segment complications and more additional inflammation following vitrectomy (13).…”

A Novel Technique for Recurrent Tube Exposure Repair

“…In fact, this technique may not only be used to treat tube exposure but may also be considered during primary implantation to avoid any future tube exposure. In a paper comparing outcomes of Ahmed GDD with tube insertion in the AC versus the CS, tube/plate exposure was reported in 2.9% in the AC group, compared to 0% in the CS group [20]. Although this difference did not reach statistical significance due to a limited sample size, it suggests a trend towards decreased exposure with posterior insertion.…”

“…Insertion of GDD tubes in the CS has been shown to be safe and effective in the past [18][19][20][21]. In fact, this technique may not only be used to treat tube exposure but may also be considered during primary implantation to avoid any future tube exposure.…”

Comparison of surgical outcomes between sulcus and anterior chamber implanted glaucoma drainage devices

“…Recent studies have shown that tube implantation through the ciliary sulcus is safe and efficacious for the Ahmed and Baerveldt GDDs. [ 15 16 17 18 19 20 ] Two of these studies describe a similar technique which requires an inferotemporal paracentesis with placement of viscoelastic superiorly to inflate the sulcus. [ 14 19 ] These studies report a 26–28% risk of early postoperative hyphema and 8–9% risk of flat/shallow anterior chamber complications, both of which may place the corneal endothelium at risk for further injury.…”