Outcomes of Trabeculectomy and Ahmed Glaucoma Valve Implantation in Patients With Iridocorneal Endothelial Syndrome

Abstract

Precis: Our study highlights the long-term success of trabeculectomy or AGV surgery in subjects with glaucoma secondary to ICE syndrome. However, many of ICE syndrome cases may need multiple glaucoma surgeries to achieve controlled IOP, with/without concomitant corneal graft surgery. Purpose: To evaluate the long-term outcome of trabeculectomy and Ahmed glaucoma valve (AGV) implantation in iridocorneal endothelial syndrome (ICE). Methods: Patients with glaucoma secondary to ICE syndrome who underwent either trabeculectomy or AGV surgery with intraoperative adjunctive MMC from 2009 to 2020 were included in this study. All patients were followed for at least 6 months after initial surgery. The main outcome measures were intraocular pressure (IOP), number of IOP lowering medications and surgical success. Surgical success was defined as complete according to the levels of IOP (<18) and at least 20% reduction from preoperative IOP without medications and qualified as complete success but with medications, where the number of medications was less than preoperative numbers. Cumulative success was the sum of the qualified and complete success. Results: Twenty-nine eyes of 29 patients were included. Trabeculectomy was done in 13 patients (group A, 44.8%) and 16 patients underwent AGV surgery (group B, 55.2%). The median age was 50(42-56.50) and 47(36.75-52.75) years in groups A and B, respectively (P value=0.10). All patients completed at least 2 years of follow up. Mean IOP was not significantly different between groups preoperatively (P=0.70) and the effect of the type of surgery on IOP was not statistically significant at multiple follow-up time points (repeated measures ANOVA, P=0.44). The mean IOP decreased from 35.76±6.36 mmHg preoperatively to 16.00+3.10 in group A and from 36.12+8.11 mmHg to 17.00+3.75 in group B (P=0.449) at year 2 of follow-up. The effect of the type of surgery was not significant on the total number of IOP lowering medications used throughout the study (repeated measures ANOVA, P=0.81). Kaplan-Meier analysis show complete success in 14 patients (48.3%), 11 patients (37.9%) and 7 patients (24.1%) at 6-month, 1 year and 2 years follow-up, respectively. Cumulative success rate was 95% at two years follow-up for all patients. Conclusions: In 2 year follow up, trabeculectomy or AGV could significantly reduce the IOP in glaucoma patients secondary to ICE syndrome.