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Clinical outcomes of trabeculectomy vs Ahmed glaucoma valve implantation in patients with penetrating keratoplasty

Poster Details

First Author: M.Akdemir TURKEY

Co Author(s):    B. Torun Acar   F. Kokturk   S. Acar        

Abstract Details



Purpose:

To compare the visual outcomes, intraocular pressure (IOP) and endothelial cell loss of trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation surgeries in patients with previous penetrating keratoplasty (PKP).

Setting:

Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. Bulent Ecevit University, Faculty of Medicine, Department of Ophthalmology, Zonguldak, Turkey.

Methods:

Eighteen eyes of 18 patients with previous PKP who underwent AGV implantation surgery (8 eyes) and TRAB surgery (10 eyes) were included in this retrospective study. There was no statistically significant difference between ages (AGV group: 54 years, TRAB group: 60 years) and genders of two groups (p=0.696, p=1.000).The patients were evaluated on postoperative 1st day, 1 month, 3 months, 6 months, 9 months, 12 months and more often if needed. In all visits complete ophthalmological examination included; visual acuity with Snellen chart, intraocular pressure measurement with applanation tonometry, biomicroscopy, gonioscopy, endothelial cell count (ECC), fundus and visual field examinations. Time between PKP and glaucoma surgeries, visual acuity results, IOP results, endothelial cell counts before the surgery, at 1, 6 and 12 month of surgery were recorded. Differences between two groups were evaluated.

Results:

Mean loss of endothelial cell count (ECC) was 315.50cells/mm2 in the AGV group and 197.20cells/mm2in TRAB group at 12 months of glaucoma surgery. The difference between endothelial cell loss at 12 months of surgery was statistically significant (p=0.000). In the AGV group mean endothelial cell loss was highest in the 1st month of surgery and lowest at 6-12 month period (ECC loss at 1st month: 185 cells/mm2, 1-6months 68.75cells/mm2, 6-12 months: 61.75cells/mm2). In the TRAB group mean endothelial cell loss was highest in 6-12 months period and lowest at 1-6 moths period (ECC loss at 1st month: 57.90cells/mm2, 1-6months 41.90cells/mm2, 6-12 months: 97.40cells/mm2). Mean visual acuity results in the AGV and TRAB groups at 1, 6, and 12 months were 0.27/0.24logMAR, 0.28/0.24logMAR and 0.32/0.27logMAR respectively. There was no statistically significant difference between mean visual acuity results between groups at 1, 6, and 12 months of the surgery (p=0.360, p=0.274, p= 173) . The decrease in IOP was 63.93% in AGV group and 46.48% in TRAB group at 12 months of surgery. The decrease in IOP was 68.51% in AGV group and 51.77% in TRAB group at 6 months of surgery. Both differences were statistically significant between 2 groups (p=0.001, p=0.001).

Conclusions:

Although intraocular pressure decrease was more prominent in AGV implantation than TRAB, mean endothelial cell loss was significantly lower in TRAB group. Therefore, TRAB surgery is an appropriate surgical option in patients who have undergone prior penetrating keratoplasty. FINANCIAL INTEREST: NONE

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