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Qi N Cui, Yen-Cheng Hsia, Nitisha Mehta, Naseri Ayman, Ying Han; The effect of mitomycin c and 5-flurouracil adjuvant therapy on the outcomes of Ahmed valve implantation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2708.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the effect of mitomycin c (MMC) and 5-flurouracil (5-FU) adjuvant treatments on intraocular pressure (IOP) control and treatment outcomes following Ahmed valve implantation.
Electronic medical records from patients who received Ahmed valve implantation from 1999 - 2014 in the San Francisco Veteran’s Administration hospital were reviewed. All valves implanted after 2011 received injections of MMC and/or 5-FU (+injection) postoperatively whereas none of the valves implanted before or during 2011 received adjunctive treatment (-injection). IOP, BCVA, and the number of glaucoma medications were examined at the preoperative visit, and at postoperative time points of one month, 3 months, 6 months, and one year. The number and types of early (occurring ≤ one month postoperation) and late (occurring > one month postoperation) complications were also recorded. The rates of treatment failure, defined as reoperation for glaucoma, or as two consecutive visits after 3 months in which the patient had inadequately reduced IOP (IOP > 21 mm Hg or < 20% reduction below preoperative baseline), were calculated for each group.
The +injection group included 38 patients and 44 eyes, and the -injection group included 21 patient and 22 eyes (Table 1). Preoperative IOP and the number of glaucoma medications were comparable between groups (Table 2). At postoperative month one, IOP and the number of glaucoma medications were significantly lower in the +injection compared to the -injection group (p = 0.04 and 0.002, respectively). IOP and the number of glaucoma medications were comparable at all other times points. The rates of early complications were comparable between the +injection and -injection groups, with 16 (36%) and 10 (45%) eyes, respectively. Five eyes (12%) experienced late complications in the +injection group, and a single (5%) late complication occurred in the -injection group (p < 0.05). For eyes with follow-up duration of ≥ 12 months, treatment failure occurred in 7 eyes in both groups (20 and 37%, for +injection and -injection groups, respectively; p < 0.05).
The use of anti-fibrotic was associated with: 1) blunting of the hypertensive phase, 2) fewer treatment failures, and 3) more late complications for a follow-up duration of ≥ 12 months. This study suggests that anti-fibrotics could play a role in Ahmed valve implantation surgery.
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