Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

Abstract

Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP ( P = 0.001) and CPC surgery ( P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.

Factors Affecting the Results of Ahmed Glaucoma Valve Implantation in Diabetic Neovascular Glaucoma With or Without Previous Pars Plana Vitrectomy

“…Several risk factors for failure after AGVI including age, ( 33 ) baseline IOP, ( 34 ) presence of NVI before surgery, ( 22 ) the presence of SO, ( 28 ) no PRP before AGVI, ( 9 ) and bleb encapsulation ( 30 ) have been reported in NVG eyes. In our series, the eyes filled with SO were excluded and PRP was performed before AGVI in all enrolled eyes.…”

“…Univariate analysis showed that preoperative high IOP and the history of intravitreal anti-VEGF treatment were related with surgical failure; however, in multivariate analysis, the only factor associating with failure was anti-VEGF therapy before AGVI. The results about the effect of previous intravitreal anti-VEGF injection on the outcomes of glaucoma surgery for the treatment of NVG are controversial (9,(34)(35)(36)(37). It has been reported that pre-operative intravitreal anti-VEGF injection in NVG patients could increase the success rate of AGVI in some studies, (35,36) while others have not been demonstrated any difference between the groups between eyes with and without anti-VEGF pretreatment (9,34).…”

“…The results about the effect of previous intravitreal anti-VEGF injection on the outcomes of glaucoma surgery for the treatment of NVG are controversial (9,(34)(35)(36)(37). It has been reported that pre-operative intravitreal anti-VEGF injection in NVG patients could increase the success rate of AGVI in some studies, (35,36) while others have not been demonstrated any difference between the groups between eyes with and without anti-VEGF pretreatment (9,34). Kwon and Sung (35) demonstrated that injection of anti-VEGF agents before AGVI improves the prognosis of AGVI when PAS is <½.…”

Defining the role of ab externo Xen gel stent in glaucomatous eyes with prior failed surgical intervention

“…It should be noted that in published studies of predictors of surgical failure or success, baseline IOP, visual field mean deviation, and glaucoma staging have not been found to be predictors of success in primary Xen implantation [ 25 ], but are significant in primary tube shunt surgery [ 26 , 27 ]. In CPC, baseline IOP was found to be a significant predictor of failure in neovascular glaucoma [ 28 ]. It should be noted that these studies have variable definitions of success and failure, some of which include a maximum allowed IOP and others which only define failure as reoperation.…”

Neovaskularisationsglaukome – Pathogenese, Diagnose, Therapie und Prophylaxe

“…Allerdings haben die Autoren in der zitierten Studie relativ hohe Energieeinstellungen gewählt. In einer rezenten Studie aus dem Jahr 2022 trat eine Hypotonie nach Zyklophotokoagulation nur bei 1 von 51 Patienten auf [50]. Entsprechend ist bei der Anzahl der Applikationen bzw.…”