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Ernesto Jose Vidaurre Mora, Cindy Anahi Haro Zuno, Jesus Jimenez Roman, Nallely Ramos Betancourt; Comparison of clinical results of placement of Ahmed Valve in anterior chamber versus ciliary sulcus.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2068.
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The loss of endothelial cells is a known complication of anterior chamber tube placement in Ahmed valve implant surgery. Risk factors are aqueous humour turbulence, peripherical anterior synechiae and tube contact between either the cornea or uveal tissue. We performed a retrospective, comparative and analytic study to learn about the effect that the placement of the tube would have on endothelial cells, if the tube is placed in theanterior chamber or the ciliary sulcus.
We performed a block randomized sample of seventeen patients who were either pseudophakic undergoing an Ahmed valve implant surgery, or phakic patients undergoing phacoemulsification, IOL implantation and Ahmed Valve implant surgery. Ten patients had an anterior chamber tube placement, and seven a ciliary sulcus tube placement. We compared the endothelial cell count with specular microscopy before the procedure, and then one month and three months after the procedure. The data recorded included reduction of intraocular pressure (IOP), the rate of complications and the reduction in hypotensive medication.
The mean age of the anterior chamber group was 59.65 ± 4.19 and in the ciliary sulcus group was 59.40 ± 3.87. The most common diagnosis in the study was neovascular glaucoma (76,5%). The difference in IOP reduction between the two groups was not significant 13.33 ± 1.73 for anterior chamber group, and 13.88 ± 1.36 for the ciliary sulcus group (P= 0.49). The difference in reduction of hypotensive medication was not significant, 0.33±0.71 for the anterior chamber group, and 0.25± 0.46 (P = 1) for the ciliary sulcus group. Four patients (23.5%) presented hyphema after surgery, two in the anterior chamber group and two in the ciliary sulcus group. Two patients of the anterior chamber group had a shallow anterior chamber (11.8%). One patient in the ciliary sulcus group had a tube block by iris incarceration (5.9%) and it was resolved with Yag laser. There is no significant difference between the two groups in endothelial cell count 1921.56 ± 197.84 and 1895.5 ± 149.89 (P= 0.54).
IOP reduction, complications, and reduction in hypotensive medication were similar in both groups. The endothelial cell count remains similar in both groups without significant statistical difference
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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