Anti-Vegf Intravitreal Injections Before Ahmed Valve Implantation In Patients With Neovascular Glaucoma.

The aim of this work was to analyze the course of the early postoperative period after Ahmed valve implantation in patients with refractory neovascular glaucoma with and without prior anti-VEGF therapy.

39 patients who underwent Ahmed valve implantation were divided into 2 groups: Group 1, n=20 - without anti-VEGF preparation, Group 2, n=19 - with anti-VEGF. Intravitreal injection of anti-VEGF (ranibizumab) was performed 4-14 days before Ahmed valve implantation. We estimated BCVA, IOP, number and type of complications, hospital length of stay. We applied the calculation of the t-criterion; Pearson's chi-squared test. 

The baseline data of the BCVA and IOP did not differ in the studied groups. Hypotensive result in the early postoperative period was achieved in 100% of cases in both groups. The mean IOP after Ahmed valve implantation in Group 1 patients increased by 7% after surgery and was 0.07±0.12. In Group 2 patients the visual outcome was significantly better, with a 34% increase to 0.08±0.12. Frequency of early postoperative complications significantly decreased from 75% (at Ahmed valve implantation without anti-VEGF preparation) to 26% (when using anti-VEGF preparation), p≤0.05.The mean number of hospital length of stay in group 1 was 6.60±2.98 days, in group 2: 4.16±1.68 (p<0.01).

Anti-VEGF preparation before Ahmed's valve implantation provides the best functional result: increase in BCVA by 34%, increase in the number of patients with VA more than 0.2; absence of patients with visual acuity deterioration after surgery; stabilization of initially elevated IOP in 100%. The usage of anti-VEGF preparation allows to minimize the number of postoperative hemorrhagic complications in the early postoperative period and significantly reduce the period of necessary hospital stay.