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Rodrigo Isaac Lozano Garza; Efficacy of surgical excision of encapsulated bleb in patients with Ahmed glaucoma valve implant. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2069.
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© ARVO (1962-2015); The Authors (2016-present)
Episcleral implants for the treatment of uncontrolled glaucoma continue to be an excellent choice. A complication that arises after its implantation is the formation of encapsulated blebs, leading to the malfunctioning of the device. The surgical removal of this blebs is considered a good treatment option after in clinic interventions fail. This study seeks to determine the postoperative efficacy of encapsulated bleb removal in patients with nonfunctioning Ahmed glaucoma valve implant in a Mexican population.
A retrospective review of 1859 digital records with the diagnosis of Glaucoma treated with Ahmed valve was done in search for patients who underwent surgical unroofing of encapsulated bleb in a reference center in Mexico City. To be included in this study, all patients had a minimum follow up of one year and underwent a complete ophthalmological examination and intraocular pressure measurement before surgery and in the following months. Complications, follow-up surgeries and number of antiglaucoma medications needed were recorded.
A total of 101 patients (105 eyes; 61 right eyes and 44 left eyes) that underwent surgical excision of encapsulated bleb from a pooled data of 1859 patients (5.43%) were studied. The proportion of female and male patients was similar (50.49%  vs 49.51% ) with a mean age of 52.91 and a range from 15 to 81 years old at the time of the intervention. Initially, intraocular pressure drops significantly thus resulting in the initial suspension of antiglaucoma medications. Although the patients continued with the need for topical medication, an overall decrease on the number of medications needed to achieve control was identified in this study with a statistical significance of p=0.0163. Some patients even had such a favorable evolution, that there was no need for them.
In conclusion, encapsulated bleb removal is an effective surgical technique in controlling patients with Ahmed glaucoma valve with cyst formation. Close to 45% of the patients that had a more than one year follow up had a recorded reduction on their total number of medications. However, larger multicenter studies with larger study populations are recommended due to the limitations of being a retrospective study.
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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