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Alejandro Guerrero-León, Carlos Francisco Navas Villar, Janet Stephany Silva Ortiz, Curt Hartleben Matkin; Clinical characteristics of children with Ahmed glaucoma valve implantation in a reference center in Mexico.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):174.
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The purpose of this study is to report the clinical characteristics of children who underwent Ahmed glaucoma valve (AGV) implantation, their preoperative conditions as well as complications associated with the procedure.
Medical records of patients with AGV implantation 18 years of age or younger from January 2010 to October 2017 in a reference center in Mexico were reviewed. Clinical preoperative data regarding age, gender, best corrected visual acuity (BCVA), intraocular pressure (IOP), type of glaucoma and cup/disc ratio were analyzed and categorized.
A total of 47 patients (one eye each) under 18 years of age with AGV implantation were counted, of which 28 (59.6%) were male and 19 (40.4%) were female. Mean age was 10.4 ± 4.7 years. Twenty-four right eyes and 23 left eyes underwent AGV implantation. The mean pre-operative IOP was 30.5 ± 7.3 mmHg. Thirty eyes had secondary glaucoma (57.5%), of which 15 were trauma related (31.9%), 6 were uveitic (12.8%), 4 were associated with surgical aphakia (8.5%), 3 were associated with penetrating keratoplasty (6.4%) and 2 were steroid-induced (4.2%). Thirteen of the treated eyes had primary open-angle glaucoma: 12 were congenital (25.5%), 4 were juvenile-onset (8.5%), and one had primary infantile glaucoma (2.1%). Mean pre-operative BCVA was 1.07 ± 0.66 logMAR. No intra operative complications were reported. Twenty-one eyes had post-operative complications (44.7%), the most frequent complication was corneal decompensation in 10 eyes (21.3%) followed by valve or tube extrusion and Tenon’s cyst both with 4 cases each (8.5%) and phthisis in two cases (4.2%). The mean preoperative cup/disc ratio was 63.6 ± 23.9.
The treatment of pediatric glaucoma remains a challenging task. Ahmed glaucoma valve implantation in children is uncommon, this procedure is reserved for cases of advanced glaucoma with severely high IOP levels that are hard to control medically. Even though AGV implantation technique is well known, complication rates in children are higher than in adults. Surgical procedures should be carefully studied to reduce visual disability in children.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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