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G. Trope, J. Flanagan, Y. Buys, M. Chipman, R. Rachmiel; Intermediate Outcome of Superior versus Inferior Ahmed Glaucoma Valve Implantation: Surgical Success and Complications . Invest. Ophthalmol. Vis. Sci. 2006;47(13):35.
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© ARVO (1962-2015); The Authors (2016-present)
To reanalyze data presented at ARVO 2004 using different criteria to determine the success rates, post–operative complications and visual outcome of superior versus inferior Ahmed Glaucoma Valve (AGV) implantation in refractory glaucoma patients.
A retrospective review of the medical records of patients who underwent AGV implant surgery from January 1,1997 to July 31, 2004. Only patients who fulfilled the inclusion and exclusion criteria were enrolled in the study. Demographic, preoperative and postoperative data including: intraocular pressure (IOP), visual acuity (VA) and number of medications and complications, were recorded. Success was defined as postoperative IOP between 5 – 21mmHg and at least a 20% reduction in IOP from preoperative levels with or without medication use at or after 1 year.
Eighty–three eyes of 77 patients were included in this study. Thirty–one eyes had superior insertion (SI) versus 52 eyes with inferior insertion (II). There were no significant differences between the groups in respect to: age (p=0.38), gender (p=0.213), duration of glaucoma (p=0.733), number of prior glaucoma surgeries (p=0.40), number of preoperative medications (p=0.11), preoperative IOP (p=0.38) and preoperative VA (p=0.52). Postoperativly there was no significant difference between the groups with respect to: IOP, VA and the number of glaucoma medications.
The success rates were 74.2% versus 69.2% (p=0.63); 68.1% versus 62.2% (p=0.63); 63.4% versus 25% (p=0.025) and 66.7% versus 70.9% (p=1.0) for SI versus II at 12, 18, 24 and 30 months, respectively.
There were more complications in the II versus SI: Wound dehiscence (28.8% vs. 9.75%), corneal touch (13.55 vs. 3.2%), Hyphema (17.3% vs. 9.75%), uveitis (23.07% vs. 9.7%), transient diplopia (21.15% vs. 0%) and need for re–operation (13.5% vs. 0%).
There was no significant difference in terms of success between II and SI over 30 months. Complication rates were higher in the inferior insertion group and this should be taken into account before considering this approach.
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