Treatment Stability Over 3–4 Years After Migs Plus Prostaglandin Therapy Versus Ahmed Valve Implantation In Advanced To End-Stage Glaucoma

To compare long-term intraocular pressure (IOP) control, medication burden, and treatment stability following minimally invasive glaucoma surgery (MIGS) combined with prostaglandin therapy versus Ahmed valve implantation in patients with advanced to end-stage glaucoma.

Single-center, retrospective study conducted at an ambulatory ophthalmology center.

This retrospective comparative study included patients with advanced to end-stage glaucoma who underwent either MIGS with postoperative prostaglandin therapy or implantation of the Ahmed Glaucoma Valve between 2021 and 2025. MIGS procedures were performed in selected patients where a lower-risk surgical approach was considered appropriate. Primary outcome measures included mean IOP reduction, medication burden, surgical success (defined as IOP 6–18 mmHg with or without medications), time to treatment instability, and postoperative complications over 36–48 months of follow-up.

Baseline demographic and clinical characteristics were comparable between groups. The Ahmed valve group achieved greater early IOP reduction (35–45%) compared with MIGS combined with prostaglandin therapy (25–30%). Patients undergoing Ahmed valve implantation also required fewer medications during the early postoperative period. However, higher rates of postoperative complications were observed in the Ahmed valve group, including transient hypotony and device-related events. The MIGS plus prostaglandin cohort demonstrated a more favorable safety profile but required continued topical therapy in most cases. Long-term qualified success rates were similar between groups, while complete success favored the Ahmed valve cohort.

Over 3–4 years of follow-up, Ahmed valve implantation achieved greater IOP reduction and higher medication-free success compared with MIGS combined with prostaglandin therapy in patients with advanced to end-stage glaucoma, although it was associated with increased complication risk. MIGS-based approaches may represent a safer surgical alternative for selected patients where moderate IOP reduction and long-term treatment stability are desired.