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Nucharee Parivisutt, Reza Alizadeh, grace ang, Esteban Morales, Nima Fatehi, Joseph Caprioli; Long-Term Outcome of Second Ahmed Valves in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4972.
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To evaluate the long-term outcomes of second Ahmed valve implants in eyes with glaucoma.
A retrospective review of the success rates of patients who have had a second Ahmed valve implanted in one eye from 1994 to 2016 was conducted. Success was defined with three criteria: (A) IOP ≤21 mmHg and IOP reduction of 30%; (B) IOP≤18 mmHg and IOP reduction of 20%; and (C) IOP ≤15mm Hg and IOP reduction of 25%. The primary outcome was a 5-Year Kaplan-Meier survival rate for each criterion. Other failure criteria were loss of light perception, requirement for additional glaucoma surgery, hypotony, and serious complications.
148 eyes from 140 patients (58 males and 82 females) were included with a median follow-up of 3.5 years (interquartile range [IQR] 0.9 to 6.6 years). The median age was 74.0 years (IQR: 41.5 to 86.6 years). The interval between first and second surgeries was 2 weeks to 11.3 years (median 1.9 years, with IQR: 0.6 to 3.9 years. Diagnoses were POAG (26%), congenital glaucoma (16%), secondary ACG (12%), uveitic glaucoma (11%) and NVG (10%). The 5-year Kaplan-Meier survival rates were 35.4% (±4.1%), 18.5% (±3.8%) and 10.2 % (±3.6%) for criteria A, B and C, respectively (Figure 1).
A second AGV is effective in reducing IOP in patients who require additional IOP lowering after a first AGV. The success rates are comparable to primary AGV implantation in POAG patients and are higher than in patients with secondary glaucoma, such as uveitic glaucoma or silicone oil induced glaucoma. The success rate is higher than in patients who had prior failed trabeculectomy. A second AGV is a viable option in eyes with inadequate IOP control after GDD along with.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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