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Katherine Talcott, Heeyoon Cho, Lucia Sobrin, Ann-Marie Lobo, George N Papaliodis, Angela Turalba, Lucy Q Shen; A Retrospective Study on the Effects of Retisert Implant and Ahmed Valve in Patients with Uveitic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6144.
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Uveitic glaucoma can be managed with an Ahmed valve although there is a high incidence of elevated intraocular pressure (IOP) postoperatively, presumably from inflammation. Fluocinolone acetonide intravitreal implant (Retisert™) can control intraocular inflammation but causes steroid induced ocular hypertension. This study assesses IOP control in uveitic glaucoma patients undergoing Ahmed valve, Retisert implant, or combination of Ahmed/Retisert implantation.
A retrospective chart review identified uveitis patients at the Massachusetts Eye and Ear Infirmary who underwent Ahmed valve and/or Retisert implantation from 2002 to 2012. Data related to glaucoma were collected at the preoperative and final visit. IOP control was assessed at postoperative day 1, months 1, 2, 3 and 6, with IOP elevation defined as IOP>21mmHg, use of additional glaucoma drops, or surgery to treat IOP. Kaplan Meier survival curves compared the incidence of IOP elevation between the groups within the first 6 months after surgery.
31 eyes in 25 patients with uveitic glaucoma were included, with 13 eyes in the Ahmed, 10 in the Retisert and 8 in the Ahmed/Retisert group, and a mean postoperative follow-up time of 2 years (763±393 days). Preoperatively, the 3 groups were similar in mean logmar VA (1.00 ±0.74), but different in IOP (31.8, 15.1, 22.2 mmHg, respectively) and number of glaucoma drops (3.1, 0.2, 2.9, respectively). At the final visit, the 3 groups were similar in mean logmar VA (0.89±0.75) and IOP (15±7 mmHg). In the Ahmed/Retisert group, no glaucoma drops were used compared to 2 drops in the other groups (p=0.004), but 2 eyes (25%) developed tube erosions compared to none in the Ahmed group (p=0.062). Postoperative IOP was significantly better controlled in the Ahmed/Retisert group compared to Ahmed alone (p=0.0055) (Fig. A). The incidence of IOP elevation was slightly higher in the Retisert alone group compared to Ahmed/Retisert but not statistically significant (p=0.40) (Fig. B).
IOP control in uveitic glaucoma may be better when Ahmed valve surgery is combined with sustained inflammation management, such as with a Retisert implant. However, the higher incidence of tube erosion in the Ahmed/Retisert group should be considered. Additional studies are needed to confirm the role of aggressive inflammation control in the surgical management of uveitic glaucoma.
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