Comparision of surgical outcomes of Express Shunt and Ahmed Valve in Neovascular Glaucoma

Abstract

 

Purpose

 

Neovascular glaucoma is potentially devastating form of secondary glaucoma, which have a guarded visual prognosis. In the advanced stages of neovascular glaucoma surgical management is often required to manage elevated intraocular pressure.The use of express shunt and glaucoma drainage implant are two procedures often considered in managing patients who are refractory to medical therapy.IOP outcomes , decrease in need for glaucoma drops and surgical complications for with either procedure were explored.

 

Methods

 

A retrospective comparative case series of Ahmed Valve and Ex-Press Shunt performed by three glaucoma surgeons. Patients with less than 3 post operative visits or more than one glaucoma surgery have been excluded. Pre-operative visual acuity (VA), intra- and post-operative complications, pre and post surgical IOP and glacuoma medications have been recorded.

 

Results

 

21 Neovascular glaucoma patients with Ahmed Valve vs. 6 Ex-Press Mini shunt were included in the study.Mean patient age was 70 yearsMean follow up time was 14 months for Ahmed Valve and 9.4 months for Ex-Press Mini Shunt. 2 out of 23 Ahmed Valve patients required repeat excisional surgery but no Ex-Press Mini Shunt patients required repeat surgery. These patients have been excluded from study. 2 out of 21 Ahmed Valve patients had hyphema, 1 Ahmed Valve patient had chroidal effusion.Ex-Press shunt patients required less glaucoma drops than Ahmed Valve patients(p=0.011) Figure 1. Mean IOP decrease in Ahmed Valve vs. Express Shunt was statistically not different. (p=0.22) Figure 2.

 

Conclusions

 

Our data suggests that Ex-Press shunt might be as or even more efficous in the treatment of neovascular glaucoma. Ex-Press shunt and Ahmed Valve lowered the IOP similarly. In addition, Ex-Press shunt patients required less glaucoma medications overall. Further research including recruitment of more patients and data points is required to confirm the role of express shunt in neovascular glaucoma.

 

 

Mean number of pre- and postoperative glaucoma medications after Ahmed Valve and Ex-Press Mini Shunt. Ex-Press shunt required less number of medications (p=0.011)

 

 

Mean (IOP) before and after surgery in both the Ahmed Valve and Ex-Press Mini shunt(p=0.22).

 

Keywords: 568 intraocular pressure • 421 anterior segment • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials