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Lauren Hennein, Jing Hou, Eugene Lowry, Jay M Stewart, Ying Han; Comparison of Surgical Outcome after Ahmed Valve Implantation for Glaucoma Patients With and Without Fluocinolone Intravitreal Implant (Retisert ®). Invest. Ophthalmol. Vis. Sci. 2014;55(13):3182.
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The effectiveness of glaucoma surgery is limited by the natural healing process of the eye. Glucocorticoids reduce scar formation and intraocular pressure (IOP) when administered post-operatively. These benefits may be greater if the time of exposure to steroid activity is increased. This study investigates whether long-term, slow-release exposure to glucocorticoids with Retisert promotes better surgical outcomes after Ahmed valve implantation in glaucoma patients.
Medical records were reviewed for 75 eyes (64 patients) who had an Ahmed valve implantation for medically uncontrolled glaucoma. Seventeen eyes (10 patients) were study eyes with uveitis requiring Retisert implantation, and 58 eyes (54 patients) were control eyes with uveitis and other types of glaucoma which did not receive Retisert. IOP, glaucoma eye drops, early complications (within the first month), and late complications (after the first month) were recorded at 1, 3, 6, and 12 months follow-up. Statistical analysis was done with a Fisher’s Exact Test for dichotomous outcomes and a Wilcoxon Rank-Sum Test for continuous outcomes.
The population receiving Retisert was younger, more likely to have uveitic glaucoma than the control population (P<0.01). Baseline IOPs were 32.62 mmHg for Retisert eyes and 30.16 mmHg for control eyes (P=0.29). The IOPs for Retisert eyes at 1, 3, 6, and 12 months were 13.59, 14.76, 15.38, and 12.24, respectively. The IOPs for control eyes at 1, 3, 6, and 12 months were 13.75, 17.16, 17.71, and 15.17, respectively. The Retisert eyes were found to have lower IOP at one-year follow-up (P=0.028). Baseline numbers of glaucoma drops were 4.1 for Retisert eyes and 4.2 for control eyes (P=0.85). At one-year follow-up, the number of glaucoma eye drops taken for the Retisert and control eyes were 1.4 and 2.3, respectively (P=0.011). There were no significant differences in early complications or late complications.
Patients who received a Retisert implantation had lower IOP and fewer glaucoma eye drops compared to control eyes at one-year post-Ahmed valve surgery. This study suggests that long-term, slow-release glucocorticoid medication may improve the surgical outcome for patients with an Ahmed valve implantation. Prospective studies comparing patients with better matched etiologies of glaucoma are indicated.
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