Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome

Abstract

Objectives To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. Methods Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. Results The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = −3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. Conclusions Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.

Achieving Inner Aqueous Drain in Glaucoma Secondary to Iridocorneal Endothelial Syndrome: One Year Results of Penetrating Canaloplasty

“…9 In Kim's study, the aqueous shunt survival at 1, 3 and 5 years were 70%, 40% and 40%. 11 Most recently, Gebremichael 23 and Mao 24 reported higher GDI survival in two independent studies (92.3±7.4%, 66.1±11.0%, and 50.5%±17.3% at 1, 3, and 4 years, respectively and 94.4%, 88.1% and 73.5% at 1, 2 and 3 years, respectively). However, the complete success rates in both studies at the last follow-up further fell to 11.1% and 27.8%, respectively.…”

“…A strength of this study was its prospective design and 100% follow up, whereas the studies cited on trabeculectomy and GDI interventions in GS-ICE were retrospective. 9,11,12,24 Patients lost to follow up were not included in those studies and tube revisions were usually considered as success, which may have led to an overestimation of success.…”

“…It is also consistent with previous observations that tube placement in the ciliary sulcus was recommended in pseudophakic ICE eyes to prevent obstruction of the lumen by ICE membrane migrating from the iridocorneal angle , and to decrease the risk of corneal endothelial density loss. 9,11,16,24,26,27 However, tube implants are not generally inserted into the posterior chamber in phakic eyes. The effect of the present procedure on corneal endothelial cell loss needs further study.…”

Nanofiber‐based glaucoma drainage implant improves surgical outcomes by modulating fibroblast behavior

“…Glaucoma drainage implants (GDIs), which can be classified into those with and without a reservoir for aqueous drainage, are among the most widely used ocular biomaterials 7 . However, implantation of GDIs for IOP reduction often leads to post‐operative complications, including hypotony and fibrosis 8–12 . Conventional subconjunctival GDIs have a modest median functional lifespan of 5 years due to fibrosis, and revision or repeat procedures are burdensome for patients and have an increased risk of failure 13–15 .…”

“… 7 However, implantation of GDIs for IOP reduction often leads to post‐operative complications, including hypotony and fibrosis. 8 , 9 , 10 , 11 , 12 Conventional subconjunctival GDIs have a modest median functional lifespan of 5 years due to fibrosis, and revision or repeat procedures are burdensome for patients and have an increased risk of failure. 13 , 14 , 15 Additionally, the aqueous humor draining into the subconjunctival space contains soluble factors implicated in fibroblast recruitment and activation, such as transforming growth factor‐beta (TGF‐β), platelet‐derived growth factor (PDGF) and vascular endothelial growth factor (VEGF).…”