【In Press】 Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM: To evaluate the long-term results and complications of Ahmed glaucoma valve (AGV) implantation in a cohort of Egyptian patients. METHODS: A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure (IOP) measurement before surgery and at 1d, weekly for the 1, 3, 6mo, and 1y after surgery and yearly afterward for 5y. IOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as IOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS: Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery. IOP was reduced from a mean of 37.2±6.8 mm Hg to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes (41.1%), complicated cataract in 9 eyes (7.25%), recessed tube in 8 eyes (6.45%), tube exposure in 6 eyes (4.8%) and corneal touch in 6 eyes (4.8%). Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes (1.6%). CONCLUSION: Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful IOP control after AGV implantation. However, effective complications management can improve the rate of success.     

Long-term success of ahmed glaucoma valve in refractory glaucoma

AIM: To evaluate the long-term results and complications of ahmed glaucoma valve (AGV) implantation in refractory glaucoma. METHODS: A retrospective review of 13 patients (13 eyes) with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 18 months was performed. All patients underwent a complete ophthalmologic examination and intraocular pressure (IOP) measurement before surgery and at 1 month, 3 months, 6 months, 1 year after surgery and yearly afterwards. Complications and the number of antiglaucoma medications needed were recorded. RESULTS: Mean age was 27.3±16.0 years. All eyes (100%) had at least one prior incisional surgery. Mean follow-up was 61.3±30.8 months. IOP was reduced from a mean of 35.0 ±7.0mmHg to 18.2±7.9mmHg at 12 months and to 17.0±4.1mmHg at 96 months (P<0.05) with a lower number of medications from baseline, 76.9% patients required additional procedures to achieve the success criteria set by previously published series. The most common complications were encapculated cyst formation in eight eyes (61.5 %) and tube exposure in four eyes (30.8%). CONCLUSION: Encapsulated cyst formation was the most common complication which hindered succesful IOP control after AGV implant insertion for refractory glaucoma. Despite cyst excision with anti-fibrotic agents, successful IOP reduction was not achieved in 76.9% of the patients without antiglaucoma medication.     

Ahmed青光眼阀治疗难治性青光眼的长期疗效

目的：评估Ahmed青光眼阀（Ahmed glaucoma valve,AGV）植入治疗难治性青光眼的长期疗效及并发症。 方法：回顾性分析13例13眼接受Ahmed青光眼阀植入,最短随访18mo的难治性青光眼患者。所有患者均在术前及术后1,3,6mo,1a及1a以后行全面的眼科检查,眼压测量,记录并发症及抗青光眼的药物需求。 结果：患者平均年龄27.3±16.0岁。所有患眼（100%）接受至少一次前置小切口手术。平均随访61.3±30.8mo。在少量药物的作用下,12mo时眼压由35.0±7.0mmHg降至18.2±7.9mmHg,96mo时降至17.0±4.1mmHg,76.9%患者需其他辅助治疗以达到预期的成功疗效。最常见的并发症包括包裹性囊肿8眼(61.5%),置管脱出4眼(308%)。 结论：包裹性囊肿是最常见的并发症,阻碍了Ahmed青光眼阀植入治疗难治性青光眼。虽然囊肿被抗纤维化药物切除,但没有抗青光眼药物的治疗,眼压仍旧不能很好控制。     

Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5 (range 48 to 60)mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

【In Press】Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5mo (range 48 to 60mo). The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

AIM:To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR).METHODS: Twelve medically uncontrolled NVG with earlier 23-gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best-corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up.RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5±1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow-up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention.CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.     

Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma

Background: To report the outcome of intravitreal Bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma in a patient group with extended follow-up. Methods: The records of 16 patients (18 eyes) with neovascular glaucoma refractory to medical therapy who presented to a single surgeon between 2006–2008 were reviewed. Patients received pan-retinal photocoagulation and then intravitreal Bevacizumab followed by Ahmed valve implantation. The main outcome measures were: control of IOP (with or without additional medication), visual acuity (VA) and failure (IOP >21 mmHg or <6 mmHg, reoperation for glaucoma, or loss of light perception). Results: Pre-operatively, all patients received pan-retinal photocoagulation followed by IVB at a mean of 15.9 (range 4–60) days prior to AGV. The mean pre-operative IOP was 37.1 mmHg (±13.4) on 3.2 (±0.87) medications. Of the 18 eyes, 14 eyes (78%) were treated with AGV alone and 4 eyes (22%) with AGV combined with cataract extraction. Sixteen eyes (89%) received mitomycin C treatment intraoperatively. Post-operatively, the mean follow-up period was 63 months (24–84). At final follow-up, the success rate was 50% (33.3% complete, 16.7% qualified) with a mean IOP of 18.1 mmHg (±9.5) on a mean number of 1.5 (±1.6) medications. The failure rate was 50%, with five eyes (27.8%) not meeting the IOP criteria for success (of these, three eyes required additional surgery to lower the IOP) and five eyes (22.2%) lost light perception. Conclusion: Intravitreal Bevacizumab followed by AGV offers long-term control of IOP without additional surgical intervention in the majority of cases.     

穿刺巩膜隧道植入Ahmed青光眼阀治疗难治性青光眼的疗效

目的:观察用23G针头直接穿刺制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效及并发症。方法:观察44例44眼难治性青光眼患者,应用23G针头直接穿刺制作巩膜隧道,行青光眼阀植入术进行治疗。观察患者术后眼压、视力、并发症,并与术前进行对比。结果:本组患者成功率84.1%。术前眼压:52.1±10.1mm Hg,最后一次随访眼压15.6±6.9mm Hg。视力提高者11眼,视力无改变者27眼,视力降低者6眼。并发症包括:浅前房4例,脉络膜脱离3例,引流管移位1例,前房积血6例,引流管阻塞1例,脉络膜驱逐性出血1例,引流盘包裹5例。结论:直接穿刺巩膜隧道的方法植入青光眼阀,手术操作简单可行,避免了制瓣及异体巩膜移植,并简化了手术操作,防止术后房水管周渗漏,术后浅前房发生率低,为切实可行的手术方法。     

Ahmed阀门在青光眼手术中的疗效分析

目的：评价Ahmed青光眼阀门在多种类型青光眼中的治疗效果。方法：对研究期间住院94例102眼青光眼患者予Ahmed青光眼阀门植入术,新生血管性青光眼患者术后1～2wk予全视网膜光凝。术后随访6mo以上,了解各期眼压、视力情况。结果：平均眼压从术前48.52±6.42mmHg降到术后6mo11.20±3.34mmHg。术后各时期平均眼压均低于21mmHg,与术前相比差异有显著性（P〈0.01）。102眼手术完全成功者96眼,基本成功者2眼,总有效率为96.1%。术后并发症包括短暂性前房出血、早期低眼压、浅前房等。结论：尽管Ahmed阀门植入存在一些并发症,但是对于青光眼是一种新的有效治疗方法。     

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

AIM: To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo, reoperation for glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (P<0.0001). Crude failure rates were 16.1%, n=5/31 in the Ex-PRESS group and 24.2%, n=8/33 in the AGV group. The cumulative proportion of failure was similar between the groups, P=0.696. The proportion of eyes that experienced postoperative complications was 32.3% in the Ex-PRESS group and 60.1% in the AGV group (P=0.0229). CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates. The AGV group had more post-operative complications, but also included more complex cases with higher baseline mean IOP, worse baseline mean VA, and more previous glaucoma surgeries. Therefore, the results are limited to the cohort included in this study.     

Intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma

AIM:To explore the efficacy of preoperative intravitreal bevacizumab (IVB) injection combined with Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG).METHODS: This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure (IOP) number of anti-glaucoma medications, visual acuity (VA), surgical success rates, and complications were recorded.RESULTS: After AGV implantation, IOP was 18.2±4.0 mm Hg, 15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36mo, significantly decreased compared with pre-IOP (P<0.01). The number of anti-glaucoma medications was 0.9±0.5, 0.8±0.9 and 0.8±0.6 at 6, 12 and 36mo, significantly decreased compared to pre-treatment (P<0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%, 74.1% and 71.0% at 12, 24 and 36mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400 (P<0.05). Post-operative complications occurred in 8 eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION: The procedure of preoperative IVB and AGV implantation should be one of treatments for NVG because of its safety and effectiveness.     

Ahmed引流阀植入联合玻璃体腔注射Bevacizumab治疗NVG

目的：观察Ahmed引流阀植入联合玻璃体腔注射bevacizumab(贝伐珠单抗)治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。

方法：对22例22眼新生血管性青光眼患者先进行玻璃体腔注射bevacizumab 0.1mL(2.5mg),待虹膜新生血管消退后行Ahmed青光眼阀门植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症,随访6～36(平均24)mo。

结果：玻璃体腔注药后1wk内22眼虹膜新生血管均有不同程度消退,Ahmed引流阀植入术后随访22眼中仅有3眼联合使用1～3种抗青光眼药物,眼压控制在21mmHg之内,1眼因眼压失控而行睫状体光凝术(810激光),其余18眼均无需加用抗青光眼药物眼压控制在正常范围内,最后一次随访,平均眼压15.59±3.21mmHg,与术前平均眼压(45.36±8.13mmHg)相比,差异有统计学意义(P<0.05)。视力提高者9眼(41%),保持术前视力者13眼。全部病例在玻璃体腔注射bevacizumab及Ahmed引流阀植入术中术后均未观察到严重手术并发症。

结论：Ahmed引流阀植入联合玻璃体腔注射bevacizumab治疗NVG安全有效,手术成功率高,并发症少,有利于保护残留视功能。     

改良Ahmed青光眼引流阀植入术治疗难治性青光眼

目的 观察改良Ahmed青光眼引流阀植入术治疗难治性青光眼的临床疗效。方法 回顾性系列病例研究。收集2011年1月至2013年12月采用改良Ahmed青光眼引流阀植入术治疗难治性青光眼患者46例（47眼）的临床资料,术中将引流盘置入筋膜下间隙,无需缝线固定,距离角膜缘约5 mm处以及角膜缘处各做一放射状浅层巩膜隧道（长约6 mm）,将引流管穿入浅层巩膜隧道并遮盖。患者随访时间为术后1周、1个月、6个月以及以后每6个月复查一次,直至末次复查,随访内容主要包括患者术后眼压、最佳矫正视力（BCVA）、并发症、应用抗青光眼药物种类等。手术后不同时间点的眼压比较采用重复测量资料的方差分析,手术前后应用抗青光眼药物种类比较采用秩和检验,术前与末次随访视力比较采用等级资料秩和检验。结果 术前与末次复查视力比较,差异无统计学意义。术前眼压为（43.3±8.1）mmHg,术后末次随访眼压为（15.3±5.9）mmHg,差异有统计学意义（F=12.16,P<0.05）。术前、术后末次随访抗青光眼药物使用种类分别为4、1种,比较差异有统计学意义（Z=7.32,P<0.05）。Ahmed青光眼引流阀植入术完全成功率为72%,条件成功率为87%。术后并发症主要包括前房出血、引流管口堵塞、浅前房、引流盘周围包裹性囊状泡,对症处理后眼压均可控制。结论 改良Ahmed青光眼引流阀植入术治疗难治性青光眼,操作简便,手术时间短,术后并发症少,是治疗难治性青光眼的有效方法。     

Safety and efficacy of Ahmed glaucoma valve implantation in refractory glaucomas in Northern Indian eyes

Purpose

To evaluate the safety and efficacy of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma in Northern Indian eyes.

Background

The success rate of trabeculectomy remains low in cases of refractory glaucoma even with the use of antifibrotics. Glaucoma drainage devices have proven to be more efficacious in reducing intraocular pressure (IOP) in these glaucomas.

Methods

Retrospective records of 55 consecutive patients who underwent AGV implantation at Dr. Shroff’s Charity Eye Hospital, New Delhi, India from January 2003 to December 2012 were reviewed. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications, number of prior incisional surgeries, visual acuity and IOP on medical treatment. Postoperative data included visual acuity and IOP on day one, 1 week, 1 month, 3 months, 6 months, 1 year and yearly thereafter, number of anti-glaucoma medications, any complication or additional surgical intervention required. Success was defined as IOP >5 and <22 mmHg with or without treatment.

Results

Mean IOP decreased from 39.71 ± 8.99 pre-operatively to 17.52 ± 5.72 mmHg at last follow-up (p < 0.001) and number of medications reduced from 3.27 ± 0.84 to 1.25 ± 0.88 (p < 0.001). Visual acuity remained within one Snellen line or improved at last follow-up in 47 cases (85.4%). The cumulative probability of success was 85.45% at 1 year and 79.63% at 3 years. The incidence of post-operative complications was 25.45%.

Conclusion

AGV implantation has proven to be safe and is effective in controlling IOP in refractory glaucoma in Northern Indian eyes.     

两种不同型号的Ahmed阀治疗难治性青光眼的疗效评价

目的 探讨两种不同型号Ahmed青光眼阀治疗难治性青光眼的有效性和安全性。设计 回顾性病例对照研究。研究对象 2010年7月至2015年7月行Ahmed阀植入术治疗难治性青光眼的患者106例。方法 根据患者植入Ahmed青光眼阀的型号分为FP8组（睑裂相对小的患者,46例）和FP7组（睑裂相对大的患者,60例）。患者接受FP8或者FP7Ahmed 房水引流物植入术。术后1天,1周,1、3、6、12个月随访,观察并比较两组患者眼压,术后抗青光眼用药的数目,手术成功率,术后最佳矫正视力以及并发症。主要指标 眼压,术后抗青光眼用药的数目,手术成功率,术后最佳矫正视力以及并发症。结果 FP8组和FP7组术前眼压分别为（39.78±7.37）mmHg和（41.68±9.60）mmHg,术后随访各时间点平均眼压分别为（15.13±7.41）mmHg和（16.32±6.94）mmHg。FP8组和FP7组术后每个随访时间点分别与术前比较,眼压均明显下降（P均<0.001）。两组之间比较,每个随访时间点差异均无统计学意义。FP8组、FP7组术前抗青光眼用药数目分别为（3.44±0.78）种和（3.35±0.66）种,术后随访各时间点用药数目均明显下降,平均分别为（0.28±0.67）种和（0.33±7.36）种（P均<0.001）。随访结束时,FP8组末次检查22眼视力不同程度提高,19眼视力不变,5眼视力下降;FP7组术后30眼视力改善,22眼视力不变,8眼视力下降。两组术后随访一年视力比较,差异无统计学意义（χ2=0.049, P=0.824）。Kaplan-Meier生存曲线显示,随访1年时,FP8组和FP7组手术总成功率分别为69.6%和78.3%,差异无统计学意义（P=0.499）。结论 Ahmed青光眼阀植入是治疗难治性青光眼安全有效的方法。不同型号的Ahmed青光眼阀治疗难治性青光眼有效性和安全性相当。（眼科, 2018, 27： 367-371）     

两种术式植入Ahmed青光眼阀治疗难治性青光眼的疗效比较

目的：：探讨两种不同术式植入Ahmed青光眼阀治疗难治性青光眼的有效性和安全性。方法：采用回顾病例对照研究,收集2011-06/2014-09在我院行Ahmed 阀植入术的难治性青光眼患者资料。根据引流管进入前房的术式不同分为直接巩膜隧道穿刺组和自体巩膜瓣组。观察并比较两组患者手术持续时间、术后手术成功率、眼压、术后抗青光眼用药的数目、术后最佳矫正视力以及并发症。结果：两组患者随访1a时,两组患者在术后眼压,术后抗青光眼药物数目在所有随访时间点均较术前明显降低,差异有显著统计学意义(P<0.01)。术后各个随访时间点两组之间在眼压,抗青光眼用药数目,最佳矫正视力方面,差异均无统计学意义。卡普兰-迈耶( Kaplan-Meier)生存曲线显示：在随访1a时,直接巩膜隧道穿刺组和自体巩膜瓣组手术总成功率分别为79%和80%,差异无统计学意义(P=0.932)。在并发症方面,直接巩膜隧道穿刺组浅前房的发生率(6%)明显低于自体巩膜瓣组(24%),差异有统计学意义(P=0.032)。结论：Ahmed青光眼房水引流阀植入是治疗难治性青光眼安全有效的方法,两种不同术式有相似的疗效,但直接巩膜隧道穿刺组发生浅前房的机会更低,耗时更短。     

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM:To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation surgery for refractory glaucoma.METHODS:This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure (IOP) greater than 21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation, data were collected on IOP, the best corrected visual acuity (BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56wk postoperatively. Logarithm values of IOP were calculated and compared.RESULTS: The study group was comprised of 30 patients (30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg, 19.6±12.8 mm Hg and 13.9±14.2 mm Hg at 12, 24 and 56wk respectively. BCVA was ≥ 6/60 in 11 eyes preoperatively, and five eyes had BCVA≥6/60 at 56wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At 12wk postoperatively, no medications were required to control IOP in 20 eyes. At 56wk postoperatively, at least one medication was required to control IOP in 10 eyes. Over the entire follow up period, four eyes were treated with yttrium aluminium garnet (YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.     

Ahmed青光眼阀植入术治疗青少年难治性青光眼疗效观察

目的：：研究Ahmed青光眼阀( AGV)植入术治疗青少年难治性青光眼的临床效果。方法：选取2012-10/2014-10期间在我院眼科进行Ahmed青光眼阀植入术的青少年难治性青光眼患者27例27眼,随访12 mo。观察手术成功情况,术后眼压、视力以及并发症等。结果：本组试验手术成功率85%。经过随访数据统计27例患者平均眼压由术前48.3±8.3 mmHg 下降到21.4±8.1mmHg,差异具有统计学意义(P<0.05);视野缺损：术前平均为-23.7±4.1dB,术后12mo -27.5±4.7dB,平均下降3.9dB,差异具有统计学意义(P<0.05)。视力提高和不变者占85%。术后早期并发症：浅前房5眼(19%),一过性高眼压3眼(11%),前房出血4眼(15%),引流管内口阻塞1眼(4%),前房硅胶管位置欠佳1眼(4%),未出现复视、引流管侵蚀与外露、引流盘脱出、脉络膜脱离、巩膜植片发生免疫排斥反应等并发症。术后中远期并发症：瞳孔欠圆8眼(30%),后部盘周包裹3眼(11%),并未出现因单纯植入引流阀而导致角膜变性的严重并发症。结论：Ahmed青光眼阀植入术具有成功率高、手术操作简单、并发症少等特点,是治疗难治性青少年青光眼有效手段。     

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes

Aim:

To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes.

Settings and Design:

Retrospective interventional case series study.

Materials and Methods:

Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months

Results:

Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV.

Conclusion:

The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.     

Ahmed青光眼阀植入治疗难治性青光眼

目的：探讨Ahmed青光眼阀植入治疗难治性青光眼的临床疗效。 方法：回顾性研究我院Ahmed青光眼阀植入术治疗21例21眼难治性青光眼的临床疗效并进行总结分析。 结果：术前平均眼压为44.6±7.2mmHg,术后6mo末次随访平均眼压15.4±5.3mmHg;视力提高4眼,无改变14眼,降低3眼;手术并发症主要包括术后前房形成迟缓2眼、持续高眼压1眼、引流管暴露1眼、角膜失代偿1眼、引流盘纤维包裹3眼;手术成功率为86％。 结论：Ahmed青光眼阀植入术是治疗难治性青光眼有效和安全的方法。