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S. J. Lee, L. Riansuwan, J. C. Tsai, L. A. Al-Aswad; Comparison of Ahmed Tube Shunt Surgery Alone and Ahmed Combined With Pars Plana Vitrectomy in Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3963.
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To compare and evaluate the outcomes for Ahmed tube shunt surgery (AS) alone versus combined Ahmed tube shunt surgery and pars plana vitrectomy (AS-PPV) in patients with neovascular glaucoma.
A retrospective chart review of consecutive patients with neovascular glaucoma who underwent either Ahmed tube shunt surgery (AS) alone or combined Ahmed tube shunt surgery and pars plana vitrectomy (AS-PPV) between June 2001 to June 2006 at Columbia Presbyterian Hospital with a minimum follow-up period of 6 months was performed. Data including age, gender, intraocular pressure (IOP), number of antiglaucoma medications, and complications were recorded. The mean decrease in IOP between the AS and AS-PPV patients were compared using Student’s T-test.
11 eyes underwent AS and 7 eyes underwent AS-PPV. 6 (54.5%) were pseudophakic in the AS group and 6 (85.7%) were pseudophakic and 1 (14.3%) aphakic in the AS-PPV group. The mean age in the AS and AS-PPV group was 63.2±21.2 and 74.3±13.1 years, respectively. There was no statistically significant difference in age between the two groups. The mean baseline IOP (AS 41.3±9.3mmHg, AS-PPV 39.0±17.5mmHg) and number of preoperative glaucoma medications (AS 3.9±1.0, AS-PPV 3.7±1.3) were also similar in the two groups. There was no statistically significant difference in the postoperative IOP between the AS and AS-PPV groups at 1 day (17.8±15.6 vs. 14.9±10.2mmHg), 1 week (13.7±12.8 vs. 17.9±19.2mmHg), 1 month (19.1±12.8 vs. 16.3±6.5mmHg), 3 months (18.6±15.8 vs. 16.8±11.1mmHg), and 6 months (19.2±16.8 vs. 14.5±3.1mmHg). The number of postoperative glaucoma medications also did not differ between the two groups. One patient in the AS group had the implant removed due to tube exposure. 4 (36.4%) in the AS group (mean 4.5 days postoperatively, lasting 6.5 days) and 2 (28.6%) in the AS-PPV group (mean 5.5 days postoperatively, lasting 15.5 days) developed choroidal effusion not requiring drainage. One patient in the AS developed a retinal detachment 6 months postoperatively. Three patients were lost to follow-up during the study period.
Both AS and AS-PPV are equally effective in controlling IOP in patients with neovascular glaucoma in the short term. Larger randomized prospective studies are needed to examine the long term effects of both surgical methods on intraocular pressure control in this subset of patients.
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