Abstract
Purpose:
To report the efficacy and safety of Ahmed Glaucoma Valve TM (AGV) implantation in the management of refractory pediatric glaucoma.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 568 intraocular pressure