Comparison of Ahmed Glaucoma Valve Implantation and Trabeculectomy for Glaucoma: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo compare the efficacy and safety of Ahmed glaucoma valve implantation (AGV) with trabeculectomy in the management of glaucoma patients.MethodsA comprehensive literature search (PubMed, Embase, Google, and the Cochrane library) was performed, including a systematic review with meta-analysis of controlled clinical trials comparing AGV versus trabeculectomy. Efficacy estimates were the weighted mean differences (WMDs) for the percentage intraocular pressure reduction (IOPR %) from baseline to end-point, the reduction in glaucoma medications, and the odds ratios (ORs) for complete and qualified success rates. Safety estimates were the relative risks (RRs) for adverse events. All outcomes were reported with a 95% confidence interval (CI). Statistical analysis was performed using the RevMan 5.0 software.ResultsSix controlled clinical trials were included in this meta-analysis. There was no significant difference between the AGV and trabeculectomy in the IOPR% (WMD = -3.04, 95% CI: -8.36- 2.26; P = 0.26). The pooled ORs comparing AGV with trabeculectomy were 0.46 (0.22, 0.99) for the complete success rate (P = 0.05) and 0.97 (0.78–1.20) for the quantified success rate (P = 0.76). No significant difference in the reduction in glaucoma medicines was observed (WMD = 0.24; 95% CI: -0.27–0.76; P = 0.35). AGV was found to be associated with a significantly lower frequency of all adverse events (RR = 0.71; 95%CI: 1.14–0.97; p = 0.001) than trabeculectomy, while the most common complications did not differ significantly (all p> 0.05).ConclusionAGV was equivalent to trabeculectomy in reducing the IOP, the number of glaucoma medications, success rates, and rates of the most common complications. However, AGV was associated with a significantly lower frequency of overall adverse events.

Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months

“…During the 12-month follow-up, there were no cases of suprachoroidal hemorrhage, diplopia, severe corneal issues, retinal detachment, flat anterior chamber, choroidal effusion requiring drainage, loss of light perception, blebitis, iritis, endophthalmitis, hypotony maculopathy, or device obstruction, all of which have been reported with other glaucoma aqueous shunts. 29,[39][40][41][42][43][44][45][46][47][48][49] The AEs most commonly reported in this study were needling, BCVA loss of > _2 lines (of which 81% self-resolved), transient hypotony (requiring no surgical intervention but captured as AEs per protocol regardless of outcome), increased IOP, and glaucoma-related secondary surgical intervention. None, however, were unexpected in this population of patients with refractory glaucoma.…”

Aqueous shunts for glaucoma

“…Outside of Cochrane reviews, one systematic review compared the Ahmed implant to trabeculectomy with or without MMC for glaucoma (HaiBo 2015). This review included a combination of prospective and retrospective studies and analyzed six studies with a total of 507 eyes.…”

“…Unlike our present review, this review reported that the Ahmed implant was equivalent to trabeculectomy for reduction of IOP and reduction of glaucoma medication usage, and that the Ahmed implant was associated with a lower frequency of adverse events compared with trabeculectomy. The HaiBo 2015 review is limited by its inclusion of retrospective studies with variable duration of follow-up, and is also potentially biased by its inclusion of a study that only included participants with neovascular glaucoma, as these patients are known to have higher risks of complications and poorer outcomes overall compared with people with non-neovascular glaucoma.…”

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

“…23 Notwithstanding, this review compared studies investigating a heterogeneous group of patients, including primary surgeries, eyes with neovascular glaucoma, aphakic glaucoma, and postcyclophotocoagulation. In fact, the vast majority of studies evaluating the performance of drainage implants involve a mix of refractory cases, with few studies evaluating a homogeneous group of eyes with lower risk for surgical failure.…”