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L.-S. B. Leung, T. Flynn, J. C. Tsai, P. J. G. Maris, Jr., L. A. Al-Aswad; The Effect of Systemic Immunosuppression on the Hypertensive Phase in Uveitic Glaucoma Patients Undergoing Ahmed Valve Implantation (Preliminary Study). Invest. Ophthalmol. Vis. Sci. 2008;49(13):4739.
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To compare the incidence of postoperative hypertensive phase in uveitic glaucoma patients on systemic immunosuppressive therapy to those on no systemic immunosuppressive therapy following Ahmed valve implantation.
Retrospective chart review of 37 patients (40 eyes) with glaucoma secondary to chronic uveitis who underwent Ahmed valve implantation at a tertiary referral center from 2002 to 2007. Twelve patients (thirteen eyes) had been on systemic immunosuppressive therapy (IT group), with 3 patients (3 of the 13 eyes) receiving a postoperative systemic prednisone taper for 1-2 weeks only; 25 patients (27 eyes) had received no systemic therapy (NT group). The incidence of postoperative hypertensive phase (intraocular pressure (IOP) ≥ 21 mmHg at any postoperative visit from week 2 to month 6) was compared between the IT and NT groups. Also compared was the incidence of postoperative hypotony (IOP < 5), the number of postoperative glaucoma medications, complications, and any interventions required (including 5-fluorouracil (5-FU) injections and surgical revision).
Nine of 13 eyes in the IT group experienced a hypertensive phase, as compared to 16 of 27 eyes in the NT group (69.2% vs. 59.3%). The mean preoperative and postoperative IOP was not significantly different in the two groups (24.78 IT versus 25.89 NT preoperatively, p=0.73; 14.42 IT versus 14.26 NT postoperatively, p=0.91 ). The mean number of postoperative glaucoma medications was similar (1.69 IT versus 1.52 NT, p=0.67). Five of 13 IT eyes (38.4%) experienced postoperative hypotony, compared with 10 of 27 NT eyes (37.0%). Four of 13 IT eyes received postoperative 5-FU injections, compared to 13 of 27 NT eyes (30.8% vs. 48.1%, p=0.33). The mean number of 5-FU injections given was 1.75 in IT and 1.92 in NT eyes. One IT eye required revision secondary to strabismus, while 2 NT eyes required revision for conjunctival retraction and tube exposure.
Our preliminary results indicate that systemic immunosuppression does not appear to be associated with a decreased incidence of postoperative hypertensive phase after Ahmed valve glaucoma drainage implant surgery. Patients on immunosuppression may require fewer interventions, but not fewer medications, to maintain an acceptable IOP. This study does, however, confirm the effectiveness of Ahmed valve implantation in lowering IOP in uveitic glaucoma patients.
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