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Raymond Thach, Elena Bitrian, Dennis Mock, Anne L. Coleman, Joseph Caprioli; Ahmed Glaucoma Valve Revision Outcomes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3714.
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To report the long-term outcomes after repair of Ahmed glaucoma valve tube exposure.
This is a non-comparative retrospective case series of Ahmed glaucoma valve exposure that underwent a primary revision between January 2002 and December 2010 by a single surgeon. Patients with less than 3 months of follow-up or that underwent a prior revision were excluded. Surgery involved conjunctival dissection, pericardium patch graft sutured with four 10/0 nylon sutures and conjunctival closure with vicryl 9/0.
Twenty-eight eyes of 28 patients (age 50.25 ± 28.01, range 5- 92 years old) that presented with Ahmed glaucoma valve tube exposure and underwent revision, were included. Right eyes were 53.6%, 57.1 % females, 23 patients were Caucasian, 3 African American, and 2 Asian. 17 patients had open angle glaucoma, 6 angle closure glaucoma, 3 uveitic and 2 congenital. The conjunctival defect appeared at 28.15 ± 24.21 months after the Ahmed glaucoma valve surgery. Before revision IOP was 14.04 ± 7.29 mmHg and average IOP after revision follow-up was 14.81 ± 4.68 mmHg (p=0.711). VA before revision was 0.31 ± 0.33 and average VA after revision follow-up was 0.26 ± 0.31 (p=0.126). Mean time of follow-up was 53.48 ± 41.20 months. The mean number of Ahmed glaucoma valve implants was 1.36 ± 0.64 (4 eyes had 2 valves and 2 eyes had 3 valves). 3 of the exposures were in superonasal location, while the other 25 were superotemporal. A total of 25% of the eyes underwent trabeculectomy prior glaucoma valve implant. Two eyes had Boston keratoprosthesis, one had Peter’s anomaly, and one had congenital iridodysgenesis. Three eyes had recurrent exposed implants.
Surgical repair of Ahmed valve exposure was associated with good outcomes. The number of glaucoma valve implants in the eye and the presence of concomitant ocular disease are risk factors for the development of conjuctival defects and valve implant exposure.
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