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F. A. Gusmao, D. Engel, L. Doi, R. Lobo, T. Prata, P. A. Mello, R. B. Mattos, Jr., A. Paranhos, Jr.; Ahmed Valve Implant Associated With a Surgical Cyclodialysis Approach in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3960.
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To evaluate the intraocular pressure (IOP), safety and postoperative complications related to Ahmed implant trough a cyclodialysis followed for at least 1 year.
20 eyes of 19 patients were submitted to Ahmed valvular implant by a cyclodialysis approach. A double mechanism of drainage at the same time was performed: one by the valve tube shunt itself, and the other by a cyclodialysis cleft where the silicone tube was placed to avoid the closure of the cyclodialysis, providing a direct communication between the anterior chamber and the suprachoroidal space. IOP reduction, visual acuity, number of glaucoma medications, and surgical complications were evaluated. Failure criteria was defined as IOP >=21 mmHg (with 2 antiglaucoma medications) in 2 consecutives returns after the second month of surgery.
Mean age was 52,8 years ( 20 - 75 years). Mean postoperative follow-up was 3.85 months (0 - 10 months). IOP was reduced from a preoperative mean of 23.2 mmHg (15- 44mmHg), on 3.4 antiglaucoma medications to 13.5 mmHg by postoperative month 4. The mean antiglaucoma medications until the fourth month was 1.0. We noticed few complications : Grade I hyphema (15%), flat anterior chamber with tube touching the peripheral cornea (10%), one eye with atalamia (5%) and one with uveal effusion with choroidal detachment(5%) after a ocular trauma. Hypotony (<4mmHg) was observed in 90% of the patients on the first postoperative week, associated with the cyclodialysis cleft. The complications related to flat anterior chamber and low grades of IOP during the immediate postoperative period resolved spontaneously between the first two postoperative weeks. Failure was verified in 3 patients due to high IOP levels.
Ahmed Glaucoma Valve implant in the management of refractory glaucoma after the surgical cyclodialyses approach had presented low rate of complications with good mean IOP control. This new method promises to be an effective surgical technique and presents a new therapeutic option in refractory glaucoma presenting low grades of IOP at late postoperative periods. Long term follow up is needed to ensure the viability of the procedure.
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