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R.W. Kuchtey, C.Y. Lowder, S.D. Smith; Comparison of Trabeculectomy With Mitomycin–C and Ahmed Glaucoma Valve Implantation for the Treatment of Uveitic Glaucoma . Invest. Ophthalmol. Vis. Sci. 2005;46(13):81.
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Purpose: To compare the safety and efficacy of trabeculectomy with mitomycin–C (MMC) and Ahmed Glaucoma Valve implantation in the treatment of uveitic glaucoma. Methods: We performed a retrospective chart review of patients with uveitic glaucoma who underwent trabeculectomy with mitomycin C or Ahmed glaucoma implant during a four year period. Patients were identified from a computerized database of patients who underwent trabeculectomy with MMC or implantation of an Ahmed valve and had been treated for anterior or posterior uveitis of any etiology in our Uveitis Service. Charts were abstracted to identify the patients’ demographic and clinical characteristics. Failure of glaucoma surgery was defined by an intraocular pressure (IOP) > 21 mm Hg with glaucoma medications, loss of light perception, or the need for re–operation to control the IOP. Results: A total of 38 eyes of 27 patients with at least 12–months follow–up were identified. The average length of follow–up was 28.7 months. Twenty–six eyes underwent trabeculectomy with MMC, and 12 eyes underwent Ahmed Valve implantation. There were no statistically significant differences in age, sex, race, baseline IOP or number of glaucoma medications between the two groups. No significant differences in mean IOP were observed between the two groups at any point during follow–up. The cumulative success rates for trabeculectomy and Ahmed valve implantation were 77% and 100% respectively, a difference that was not statistically significant (p>0.1). The number of glaucoma medications required by patients in the Ahmed implant group was higher than that in trabeculectomy group at 6–months (0.9 for Ahmed group and 0 for trabeculectomy group respectively, p=0.0013). A similar difference in need for glaucoma medications was seen at 12–month follow–up. However, there was no statistically significant difference in the number of glaucoma medications at final follow–up (0.7 for Ahmed group and 0.9 for trabeculectomy group respectively, p>0.5). The rates of hypotony and other complications did not differ between the two groups. Conclusions: At medium–term follow–up, Ahmed Valve implantation and trabeculectomy with MMC have comparable efficacy and safety in the management of uveitic glaucoma. However, a greater need for postoperative glaucoma medications is required following placement of an Ahmed implant.
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