Outcomes of Silicone Ahmed Glaucoma Valve Implantation in Refractory Pediatric Glaucoma

Senthil, Sirisha; Turaga, Kiranmaye; Mohammed, Hasnat A; Krishnamurthy, Rashmi; Badakere, Swathi; Dikshit, S. K.; Choudhari, Nikhil S.; Mandal, Anil K.; Garudadri, Chandra S.

doi:10.1097/ijg.0000000000001032

Cited by 17 publications

(24 citation statements)

References 25 publications

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“…15 Of note, our conventional Ahmed survival rates are lower than the corresponding survival rates of 88%-95% at 1 year and 36%-73% at 5-10 years reported elsewhere. 9,24,25 This may reflect our former practice patterns from 2012 to 2020, where Baerveldt GDD were favored by 4:1, and conventional Ahmed devices were reserved for eyes with extremely elevated pressures and/or concern for optic neuropathy progression, where an immediate pressurelowering effect was required.…”

Section: Discussionmentioning

confidence: 99%

Ologen augmentation of Ahmed valves in pediatric glaucomas

Jacobson

Bohnsack

2022

Journal of American Association for Pediatric Ophthalmology and

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Section: Discussionmentioning

confidence: 99%

Ologen augmentation of Ahmed valves in pediatric glaucomas

Jacobson

Bohnsack

2022

Journal of American Association for Pediatric Ophthalmology and

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“…Success rates vary from 55 to 90% depending on the age, follow‐up duration, definition of success and the type of device used. The best results are obtained in older patients (Molteno et al 1984; Billson et al 1989; Hill et al 1991; Netland et al 1993; Coleman et al 1995; Eid et al 1997; Wallace et al 1998; Rolim De Moura et al 2005; Senthil et al 2018; Pakravan et al 2019). Severe complications such as supra‐choroidal haemorrhages, choroidal detachments, hypotony, retinal detachments (especially in case of scleral perforation) and the tube‐cornea contact causing a decrease in VA in 4–28% of cases.…”

Section: Cw‐tscpc and Ecpmentioning

confidence: 99%

“…These complications are increased in aphakic or very young (<2 years) patients or in patients who underwent multiple surgical procedures (Hill et al 1991; Netland et al 1993; Coleman et al 1995; Eid et al 1997; Wallace et al 1998). The type of underlying glaucoma to be treated does not affect the efficacy or safety of the procedure, at least for the Ahmed's valve (Senthil et al 2018). Revision surgery is unfortunately frequent after implementation of a GDD, mainly for tube extrusion and scleral graft or tube revision in case of displacement.…”

Section: Cw‐tscpc and Ecpmentioning

confidence: 99%

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

Souissi¹,

Mer²,

Metge³

et al. 2020

Acta Ophthalmologica

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Purpose Continuous‐wave cyclophotocoagulation (CW‐CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW‐CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP‐TLT) that uses repetitive micropulses of diode laser energy in an off‐and‐on cyclical fashion. Methods A literature review was conducted on transscleral CW‐CPC (CW‐TSCPC), endoscopic CPC (ECP) and MP‐TLT. Relevant series of adult and paediatric patients were included for assessing the procedures. Results Regarding CW‐TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow‐up duration and retreatment rates. CW‐CPC often needs to be repeated, especially in paediatric patients. CW‐CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW‐TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long‐term follow‐up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP‐TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW‐TSCPC in the medium term. Conclusion Although they may lead to sight‐threatening complications, both CW‐TSCPC and ECP seem effective. ECP appears to be superior to CW‐TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW‐TSCPC and MP‐TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP‐TLT is superior to that of CW‐CPC, robust prospective comparative studies including homogeneous and well‐defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.

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“…Thus, despite the fact that trabeculectomies are generally able to achieve lower eye pressures, GDDs have become the mainstay of angle-bypass surgery in children. [82][83][84][85][86][87][88][89][90]…”

Section: Glaucoma In Arsmentioning

confidence: 99%

“…10 GDDs tend to be favored in children but may need to be combined with cycloablation for optimal pressure control. [82][83][84][85][86][87][88][89][90] Trabeculectomy with anti-fibrotics is also highly effective but is typically reserved for adolescents and adults. Further, in children, there is a great need for maximizing surgical options for the future given the life-long need for treatment.…”

mentioning

confidence: 99%

Ophthalmological Manifestations of Axenfeld-Rieger Syndrome: Current Perspectives

Michels¹,

Bohnsack²

2023

OPTH

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Axenfeld-Rieger syndrome (ARS) is a rare congenital disease that is primarily characterized by ocular anterior segment anomalies but is also associated with craniofacial, dental, cardiac, and neurologic abnormalities. Over half of cases are linked with autosomal dominant mutations in either FOXC1 or PITX2, which reflects the molecular role of these genes in regulating neural crest cell contributions to the eye, face, and heart. Within the eye, ARS is classically defined as the combination of posterior embryotoxon with iris bridging strands (Axenfeld anomaly) and iris hypoplasia causing corectopia and pseudopolycoria (Rieger anomaly). Glaucoma due to iridogoniodysgenesis is the main source of morbidity and is typically diagnosed during infancy or childhood in over half of affected individuals. Angle bypass surgery, such as glaucoma drainage devices and trabeculectomies, is often needed to obtain intraocular pressure control. A multi-disciplinary approach including glaucoma specialists and pediatric ophthalmologists produces optimal outcomes as vision is dependent on many factors including glaucoma, refractive error, amblyopia and strabismus. Further, since ophthalmologists often make the diagnosis, it is important to refer patients with ARS to other specialists including dentistry, cardiology, and neurology.

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Outcomes of Silicone Ahmed Glaucoma Valve Implantation in Refractory Pediatric Glaucoma

Abstract: AGV implantation had good success rate in refractory pediatric glaucoma. The success rates were similar in PCG and SPG as were the complications. Number of prior intraocular surgeries was a risk factor for failure.

Cited by 17 publications

References 25 publications

Ologen augmentation of Ahmed valves in pediatric glaucomas

Ologen augmentation of Ahmed valves in pediatric glaucomas

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

Ophthalmological Manifestations of Axenfeld-Rieger Syndrome: Current Perspectives

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