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SIRISHA Senthil, Paaraj Dave, Avik Roy, Harsha Rao, Anil K Mandal, Chandra S Garudadri; Outcomes of Ahmed glaucoma valve implantationTM in refractory pediatric glaucoma.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3185.
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To report the efficacy and safety of Ahmed Glaucoma Valve TM (AGV) implantation in the management of refractory pediatric glaucoma.
We retrospectively reviewed 45 eyes of 38 subjects with age ≤16 years who underwent implantation of AGV between 2009 and 2013 for refractory pediatric glaucoma by a single surgeon and had a minimum follow up of 6 months. Primary outcome measure was cumulative probability of success, defined as intraocular pressure (IOP) >5 and ≤21 mm Hg on 2 consecutive visits, 3 months after surgery, in the absence of vision threatening complications related to surgery or loss of light perception.
The median age at AGV implantation was 3.5 years (inter quartile range, IQR: 2, 12). There were 25 male and 13 female subjects. The median follow up was 14 months (IQR, 8, 23 months). The mean IOP significantly reduced from 31.6±7.3 mm Hg before surgery to 14.8±5.2 mm Hg at last follow up (P<0.0001). The number of topical antiglaucoma medications reduced from a mean of 3.3±0.8 before surgery to 1.7±1.3 at last follow up (P<0.0001). Visual acuity remained stable or improved in 77% of the eyes. The cumulative probability of success was 87% at one year and 83% at 2 years. Twenty-three eyes (51%) developed hypertensive phase (HP), median time to development of HP was 42 days (31, 92) after surgery. Tube related complications requiring intervention, were noted in 9 (20%) eyes. One eye with recurrent tube erosion developed endophthalmitis needing tube removal and vitrectomy with intraocular antibiotics. Among the risk factors studied, the height of IOP in hypertensive phase (hazard ratio: 1.22, p=0.05), number of previous intraocular surgeries (hazard ratio: 2.79, p=0.009) was significantly associated with failure.
The cumulative probability of success following AGV implantation in refractory pediatric glaucoma was 87% and 83% at the end of one and two years respectively. One third of the eyes had complications; half of these requiring interventions and one eye had a vision threatening complication.
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