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Kyle A Den Beste, Fredric J. Gross; Visual and Intraocular Pressure Outcomes of Combined Phacoemulsification and Ahmed Valve Implantation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4963.
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© ARVO (1962-2015); The Authors (2016-present)
Studies of visual outcomes following combined cataract and tube-shunt surgery are limited. We performed a retrospective chart review to evaluate improvement in best-corrected vision and intraocular pressure following combined cataract and Ahmed valve surgery, and identified co-morbidities that reduce the visual prognosis in this population.
All patients undergoing combined cataract and Ahmed valve surgery performed by a single surgeon over a 4-year period were analyzed. Patients lost to follow-up prior to a 2-month post-operative visit were excluded. Patient demographic data, glaucoma diagnosis, intraocular pressure (IOP), number of medications, and visual acuity (VA) were recorded at the pre-operative visit and at 3-6 months follow-up. Student’s t-test was used for statistical analysis.
84 eyes from 72 patients met inclusion criteria for the study. Patients were predominately African-American (50%), and the mean age was 70.2 ± 12.3 years. 70 eyes (83.3%) had primary open-angle glaucoma (POAG), 6 eyes (7.1%) had neo-vascular glaucoma, 4 eyes (4.7%) had uveitic glaucoma, 3 eyes (3.6%) had angle-closure glaucoma (ACG), and one eye (1.2%) had pigmentary glaucoma. At the last follow-up visit, the average IOP was reduced from a pre-operative mean of 20.2 ± 9.5 mmHg to 12.4 ± 3.0 mmHg (p< 0.001), whereas the number of glaucoma medications decreased from a mean of 2.5 ± 1.1 to 1.2 ± 1.1 (p< 0.001). VA improved in 60 eyes (71.4%), was maintained in 16 eyes (19%), and deteriorated in 8 eyes (9.5%). Causes of decreased vision were end-stage POAG (3 eyes), proliferative diabetic retinopathy (3 eyes), end-stage ACG (1 eye), and corneal edema (1 eye). 94.3% of POAG eyes improved or maintained their pre-operative VA, as opposed to 71.4% of eyes with other types of glaucoma. 65.5% of all eyes achieved ≥ 20/40 VA. In eyes presenting with ≥ 20/400 VA and no co-morbidities, 86% achieved ≥ 20/40.
Combined cataract and Ahmed valve surgery is an effective procedure for managing patients with glaucoma and cataracts. Post-operatively, patients have significant reductions in intraocular pressure and required medications. Good visual outcomes can be expected in patients with mild to moderate POAG and no other ocular co-morbidities. However, visual outcomes are limited in patients with advanced glaucoma and retinal pathology.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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