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Elisabeth P. Aponte, Jonathan A. Eisengart; Surgical Outcomes Of Ahmed Glaucoma Valves With And Without Subtenon Triamcinolone Injection During Implantation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3707.
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To determine if intraoperative subtenon triamcinolone improves the outcome of Ahmed glaucoma valve implantation for refractory glaucoma.
We retrospectively reviewed the medical records of all patients who underwent Ahmed glaucoma valve implantation by a single surgeon since 2009. Patients were divided into 2 groups, those with subtenon triamcinolone injected near the plate during Ahmed valve surgery and those without. Failure was defined as intraocular pressure (IOP) greater than 21 mmHg or less than 6 mmHg at final examination. Valves that required additional glaucoma surgery for device-related complications or uncontrolled eye pressure were also considered to have failed.
Complete records were found for 40 patients and a total of 44 eyes. Subtenon triamcinolone was used in 28 eyes of 26 patients with the following types of glaucoma: 7 uveitic/steroid-induced glaucoma, 5 neovascular glaucoma, 5 chronic angle closure glaucoma (CACG), 4 primary open angle glaucoma (POAG), 2 mixed mechanism glaucoma (MMG), 1 pigmentary, 1 pseudoexfoliation and 1 secondary open angle glaucoma. The non-triamcinolone group was comprised of 16 eyes of 15 patients, among which 9 were found with uveitic/steroid-induced glaucoma, 2 with POAG, 1 with pseudoexfoliation, 1 with chronic angle closure glaucoma, 1 with MMG and 1 with neovascular glaucoma. The average preoperative IOP in the triamcinolone group was 36.4 mmHg on an average of 2.68 glaucoma medications while that of the non-steroid group was 34.8 mmHg on 2.8 glaucoma medications. While 3 of the 28 eyes with subtenon triamcinolone (10.7%) experienced valve failure, 6 of the 16 valves without subtenon triamcinolone failed (37%). The "hypertensive phase" typically occurs between 1 and 2 months post-operatively. The mean IOP in mmHg at 1 month were 15.9 (range, 1 to 38) in the triamcinolone group compared to 18.3 (range, 6 to 38) in the non-triamcinolone group (P = 0.47). At 2 months, the mean IOP in the triamcinolone and non-triamcinolone group were 17.5 (range, 1 to 44) and 13.5 (range, 10 to 41), respectively (P = 0.75). In addition, mean IOP at 12 months were 16.6 (range, 6 to 35.5) and 15.1 (range, 9 to 28) for the triamcinolone and non-triamcinolone group, respectively (P = 0.65).
In our patient population, subtenon triamcinolone during Ahmed valve implantation was associated with a lower rate of valve failure. Although the lower mean IOP at 1 and 2 months in the triamcinolone group suggest possible blunting of the "hypertensive phase" associated with Ahmed valves, the difference was not found to be statistically significant. In addition, subtenon triamcinolone did not seem to improve the IOP outcome at 1 year.
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