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Ingrid T. Chang, Babak Eliassi-Rad; Comparison of the Ahmed versus Molteno-3 Drainage Device Implant for Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3705.
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To compare the surgical outcome of Ahmed and Molteno-3 glaucoma drainage implant (GDI) in the treatment of refractory glaucoma.
Retrospective case review of 29 eyes in 27 patients who underwent GDI (20 Ahmed, 9 Molteno-3) performed by a single surgeon (BER) from March 2006 to March 2011. Outcome measures included intraocular pressure (IOP), glaucoma medication use, visual acuity (VA), complications and additional glaucoma treatments. The IOP goal was 6 mmHg to 21 mmHg inclusive with greater than 30% IOP reduction from baseline.
Prior to surgery, the Ahmed glaucoma valve (AGV) group had a mean IOP (±SD) of 32.3 ±9.97 mmHg on a mean of 3.9 ±0.85 glaucoma medications with a median Snellen VA of 20/400. The Molteno-3 group had a mean IOP of 29.7 ±16.5 mmHg on a mean of 3.3 ±1.32 glaucoma medications with a median Snellen VA of 20/200. At 1-year, mean IOP was 15.1 ±6.46 mmHg in the AGV group and 17.6 ±2.4 mmHg in the Molteno-3 group (p=0.42). Mean number of glaucoma medications required was 2.1 ±1.53 in the AGV group and 1.8 ±1.78 in the Molteno-3 group (p=0.75). Median Snellen VA was 20/400 in the AGV group and 20/200 in the Molteno-3 group (p=0.79).IOP goal was achieved in 80% of the patients with AGV implant and 60% of patients with Molteno-3 implant at 1-year after surgery (p=0.397). More patients in the AGV group achieved IOP goal at POD 1 (p=0.0004) and POW 1 (p=0.024). Complications, including choroidals, hypertensive phase, hypotony, hyphema and exposed tube, occurred in 7 (39%) patients with AGV and 2 (22%) patients with Molteno-3 implants (p=0.51). Further treatment with transcleral cyclophotocoagulation was required in 3 (17%) patients in the AGV group and none of the patients in the Molteno-3 group at 1-year (p=0.23).
AGV exhibited better control of IOP in the early post-operative period (1 day and 1 week). At 1-year, both Ahmed and Molteno-3 GDI have similar rates of achieving adequate IOP control. The two groups have comparable VAs, mean IOPs, similar number of complications and further interventions.
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