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Outcomes of Ahmed glaucoma valve implantation in patients with refractory glaucoma

Poster Details

First Author: K.Eltutar TURKEY

Co Author(s):    S. Cilsim   T. Akcetin   S. Aktaş   N. Dincer     

Abstract Details



Purpose:

To evaluate the clinical results of silicone and polypropylene Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma who do not respond intensive medical therapy and/or conventional filtration surgery.

Setting:

Istanbul Education and Research Hospital, Istanbul. Turkey

Methods:

56 eyes of 54 patients who underwent AGV implantation in the Ophthalmology Department of Istanbul Education and Research Hospital between the years of 2006-2012 were retrospectively analyzed. Male/Female ratio was 32/22 , mean age was 55 ± 7.07. Polypropylene AGV was implanted to 28 eyes, silicone AGV to 26 eyes. The causes of refractory glaucoma were found to be uveitic glaucoma in 16 patients, neovascular glaucoma in 30 patients, previously failed trabeculectomy in 5 patients, aphakic glaucoma in 1 patient and pseudophakic glaucoma in 2 patients. Visual acuity, intra ocular pressure (IOP) and the number of antiglaucomatous medications that we recorded pre-operatively were compared with the results in the post-operative period. The surgery was deemed successful if the number of antiglaucomatous medications decreased and post-operative IOP levels were kept low (between 9 to 21 mmHg) without loss of light perception and without visual complications.

Results:

The mean follow-up period was 18.1 ± 3.1 months. The mean pre-operative IOP was 37.27 ± 8.2 mmHg. The mean post-operative IOP in the polypropylene group was 17.3 ± 5.2 mmHg and in the silicone group it was 16.73 ± 6.5 mmHg. The number of antiglaucoma medications decreased from a mean of pre-operatively 2.80 ± 0.77 to post-operatively 0:53 ± 0.66 , respectively. In the first post-operative day there was shallow anterior chamber and hypotony in 6 eyes (%10.7). Anterior chamber was created with viscoelastic agents in these cases. In the first post-operative week, a transient rise of IOP was observed in 22 eyes (39.3%). The IOP was controlled by topical anti glaucoma therapy. Minimal hyphema was observed in 15 eyes (26.8%) which was resolved spontaneously. Fibrin membrane was seen in 4 eyes (7%) which was resorbed with intensive topical corticosteroid treatment. Choroidal detachment developed in an eye with silicone-AGV. Success rates at the end of the year were found to be 80% in the silicone group and 56% in the polypropylene group. This difference between the success rates is statistically significant (p ˂ 0.05). The visual acuity and complications between the two groups did not differ significantly.

Conclusions:

In patients with refractory glaucoma, both silicone and polypropylene AGV are safe and effective, but silicone AGV was observed to be more effective in controlling the IOP. FINANCIAL INTEREST: NONE

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