Early Aqueous Suppressant Therapy on Hypertensive Phase Following Glaucoma Drainage Device Procedure

Law, Simon K.; Kornmann, Helen L.; Giaconi, JoAnn A.; Kwong, Allen; Tran, Eric K.; Caprioli, Joseph

doi:10.1097/ijg.0000000000000131

Cited by 48 publications

(51 citation statements)

References 20 publications

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“…3839 In fact, the treatment with aqueous suppressant has been suggested by two recent prospective studies in the early postoperative period, while IOPs were still in the low-teens to reduce the incidence of IOP spikes associated with the hypertensive phase and improve the success rate. 4041 Despite being the most frequent early complication in our study, hypertensive phase was not a risk factor for surgical failure, both in the univariate and multivariate analyses.…”

Section: Discussionmentioning

confidence: 46%

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

Schimiti¹,

Abe

Tavares

et al. 2016

Journal of Current Glaucoma Practice

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AimTo evaluate the results of Ahmed glaucoma valve (AGV) in eyes with a failed trabeculectomy.Materials and methodsThis retrospective study evaluated 61 eyes with a failed trabeculectomy that underwent implantation of an AGV due to uncontrolled intraocular pressure (IOP) on maximal medical therapy. Success was defined as IOP ≤ 21 mm Hg (criterion 1) or 20% reduction in IOP (criterion 2) with or without antiglaucoma medications. Persistent hypotony, loss of light perception, and reoperation for IOP control were defined as failure.ResultsMean preoperative IOP and mean lOPs at 6, 12, and 24 months were 21.93 ± 6.32 mm Hg (n = 61), 14.15 ± 4.33 mm Hg (n = 59), 13.21 ± 4.44 mm Hg (n = 56), and 13.60 ± 3.27 mm Hg (n = 25) respectively. Mean number of antiglaucoma medications preoperatively and at 6, 12, and 24 months was 3.95 ± 0.85, 2.19 ± 1.38, 2.48 ± 1.44, and 2.40 ± 1.32 respectively. The reductions in the number of medications and IOP measurements were statistically significant at all time intervals (p < 0.001, Wilcoxon signed rank test). According to criterion 1, the Kaplan-Meier survival curve disclosed success rates of 75% at 12 and 24 months. According to criterion 2, the success rates were 57% at 12 months and 55% at 24 months. The most frequent complications were hypertensive phase (18%) and shallow anterior chamber (16.4%).ConclusionThe AGV may effectively reduce IOP in eyes that had a failed trabeculectomy.Clinical significanceThe AGV is an alternative in eyes with a failed trabeculectomy.How to cite this articleSchimiti RB, Abe RY, Tavares CM, Vasconcellos JPC, Costa VP. Intraocular Pressure Control after Implantation of an Ahmed Glaucoma Valve in Eyes with a Failed Trabeculectomy. J Curr Glaucoma Pract 2016;10(3):97-103.

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Section: Discussionmentioning

confidence: 46%

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

Schimiti¹,

Abe

Tavares

et al. 2016

Journal of Current Glaucoma Practice

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“…Two trials compared early aqueous suppression versus a standard medication regimen for postoperative increases in IOP (Law 2016; Pakravan 2014). Four trials evaluated an anti-vascular endothelial growth factor (VEGF) agent, with one trial using ranibizumab, Desai 2013, and three trials using bevacizumab (Arcieri 2015; Mahdy 2013; Rojo-Arnao 2011).…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative hypotony also can occur, likely due to leaking around the tube in limbal tissues or failure of flow-restricting devices to maintain sufficient resistance. Several reports have described a postoperative hypertensive phase that necessitates resumption of topical antiglaucoma medications for many weeks, though it has been suggested that early initiation of postoperative aqueous suppression may improve long-term IOP control (Law 2016). Postoperative dynamic movement of the Ahmed valve has also been reported and is likely due to long-term dissociation of the fibrovascular capsule and the valve plate from rotation of the globe (Law 2009).…”

Section: Introductionmentioning

confidence: 99%

Aqueous shunts for glaucoma

Tseng¹,

Coleman²,

Chang³

2017

Cochrane Database of Systematic Reviews

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“…The definition of HP in this study was not based on IOP parameter alone, because glaucoma medications were started at lower IOP in an effort to prevent significant IOP spikes. 25 This is particularly true for patients who developed HP in the contralateral eye (cases 1, 5, 11; Table 1). Although we did Table 4.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Purpose-To compare the intraocular pressure (IOP) outcomes of Ahmed glaucoma valve (AGV) surgery alone versus AGV with fluocinolone implant in uveitic glaucoma patients.Methods-We identified uveitic glaucoma patients with AGV surgery alone and AGV surgery combined with fluocinolone implant from the Massachusetts Eye and Ear Ocular Inflammation Database. Demographic information, visual acuity, and IOP were recorded at preoperative visits and 1, 6, and 12 months after surgery. Incidence of hypertensive phase, defined as an IOP of >21 mm Hg or use of additional treatment to lower IOP occurring any time between 7 days to 6 months postoperatively, was investigated. Multilevel mixed effects models were performed to compare the outcomes between groups.Results-Eighteen eyes of 13 uveitic glaucoma patients with 1-year follow-up data were included. There were 11 eyes of 9 patients (mean age, 56.5 years; 63.6% male) in the AGV group and 7 eyes of 4 patients (mean age, 61.3 years; 71.4% male) in the AGV + fluocinolone group. There was no significant difference in visual acuity change at 1 year after surgery between groups (P = 0.25), although visual acuity improvement was significant in the AGV group (P = 0.01). The hypertensive phase occurred in 91% of AGV patients and 43% of AGV + fluocinolone patients (P = 0.30), with onset of 8-40 days (mean, 18 days) after surgery. IOP and number of glaucoma medications decreased at the 1-year postoperative visits in both the AGV group (P < 0.0001, P < 0.0001) and the AGV + fluocinolone group (P = 0.001, P < 0.0001). Compared to the AGV group, the AGV + fluocinolone group used fewer glaucoma medications (0.28 vs 1.30 [P = 0.01]) and had better inflammation control (P = 0.02). The surgical complication rates were similar between groups.Conclusions-In uveitic glaucoma, AGV with fluocinolone achieves a similar, desired IOP control but with fewer glaucoma medications than AGV alone.

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Early Aqueous Suppressant Therapy on Hypertensive Phase Following Glaucoma Drainage Device Procedure

Abstract: Aqueous suppression initiated in the early postoperative period while IOPs were still in the low-teens and was able to reduce the incidence of IOP spike associated with the HP without an increased complication rate.

Cited by 48 publications

References 20 publications

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

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

Aqueous shunts for glaucoma

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

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