Comparison of 1-year outcomes after Ahmed glaucoma valve implantation with and without Ologen adjuvant

Abstract

BackgroundMany studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively. The aim of this study was to compare the 1-year outcomes of AGV implantation with and without Ologen adjuvant for the treatment of refractory glaucoma.MethodsThis retrospective study included a total of 20 eyes of 20 glaucoma patients, who were followed for at least 1-year after undergoing AGV implantation. In 12 eyes of 12 patients, conventional AGV (CAGV) surgery was performed, while in 8 eyes of 8 patients, Ologen-augmented AGV (OAGV) implantation was performed. The outcomes were evaluated according to intraocular pressure (IOP) and the number of IOP-lowering medications. Complete success was defined as IOP ≤ 21 mmHg without medications throughout the 1-year follow-up period, and qualified success was defined as IOP ≤ 21 mmHg with or without medications throughout the 1-year follow-up period.ResultsThe rate of complete success was significantly higher in the OAGV group (50.0%) than in the CAGV group (8.3%) (p = 0.035). There were no significant differences between the two groups in terms of qualified success or incidence of the early hypertensive phase. The IOP changes were similar between the groups within 1-year postoperatively, though the number of IOP-lowering medications was significantly lower in the OAGV group during the early hypertensive phase (p = 0.031, 0.031, and 0.025 at postoperative months 1, 2, and 3, respectively). When subjects were divided into groups according to the occurrence of the early hypertensive phase, the group with early hypertensive phase was more likely to use IOP-lowering medications at postoperative 6 months and 1 year (p = 0.002 and 0.005, respectively).ConclusionsOAGV surgery shows encouraging results for patients with refractory glaucoma, specifically with respect to the achievement of complete success and the reduction of the number of IOP-lowering medications during the early hypertensive phase. Furthermore, our results suggest that occurrence of the early hypertensive phase is predictive of which patients will require IOP-lowering medications at postoperative 6 months and 1 year.

Ologen augmentation of Ahmed glaucoma drainage devices in pediatric glaucomas

“…Interestingly, the second study found that after 6 months, there were difference in glaucoma medication requirement between the two groups. This late-onset requirement for glaucoma medications may be due to the biodegradation of the Ologen implant [14]. The third study, a randomized prospective clinical trial, reported no difference in incidence of hypertensive phase or rate of AGV success at 1-year follow-up [23].…”

“…12 Months 0 (6 Eyes) p = 0.0008 2.1 ± 1.4 (9 Eyes) p = 0.7 p = 0.002 Final 0.2 ± 0.4 (6 Eyes) p = 0.001 2.0 ± 1.0 (5 Eyes) p = 0.6 p = 0.003 of GDD implantation has predominantly fallen out of favor as studies have either shown an increase in bleb leaks and complications secondary to hypotony or no significant difference in IOP or number of glaucoma medications [22]. More recently, studies have utilized Ologen in conjunction with AGV implantation in adult glaucomas [13,14,23].…”

“…To date, three studies have reported the use of Ologen as an adjuvant for AGVs in adults [13,14,23]. The first showed that increased AGV success correlated with the thickness of the Ologen disc.…”

“…The third study, a randomized prospective clinical trial, reported no difference in incidence of hypertensive phase or rate of AGV success at 1-year follow-up [23]. Importantly, these studies excluded children, although the study by Kim et al included two patients with a history of primary congenital glaucoma who underwent AGV implantation after the age of 18 years [14].…”

“…Ologen is safe and effective in enhancing trabeculectomy surgery in adults and children [9][10][11][12]. Reports in adult patients have shown that Ologen may increase AGV success and decrease hypertensive phase incidence [13,14]. In the current study, we compare success and survival of Ologen augmentation of AGV (OAGV) to conventional AGV (CAGV) implantation in children.…”