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Connor Dugan, Melih Ustaoglu, Cindy X Zheng, Michael Lin, Stephen J Moster, Carina Sanvicente, Marlene R Moster; Outcomes of Ahmed glaucoma valve implantation modified with viscoelastic anterior chamber fill. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6641.
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© ARVO (1962-2015); The Authors (2016-present)
In trabeculectomy surgery, filling the anterior chamber with viscoelastic (1% sodium hyaluronate) may prevent post-operative complications related to hypotony, but the use of viscoelastic during Ahmed FP7 valve implantation has not been well studied. This retrospective clinical chart review evaluated early post-operative complication rates after a modified technique in which the anterior chamber is filled with viscoelastic at the beginning of Ahmed FP7 implantation surgery prior to conjunctival peritomy to prevent hypotony.
A retrospective clinical chart review was performed of eyes that underwent Ahmed FP7 implantation with viscoelastic fill to approximately 20 mmHg by finger tension before peritomy by a single surgeon (MRM) from January 2016 through July 2018. The anterior chamber was never allowed to shallow during surgery, and viscoelastic was also injected into the anterior chamber at the end of surgery to achieve a final intraocular pressure of approximately 20 mmHg.
101 eyes of 98 patients were included. Average patient age was 76.0±11.1 years, 52 patients (53.1%) were female, 60 patients (61.2%) were Caucasian, and 33 patients (33.7%) were African American. Types of glaucoma included primary open-angle in 59 eyes (58.4%), pseudoexfoliation in 21 eyes (20.8%), and chronic angle closure in 11 eyes (10.9%). Pre-operative mean IOP was 31.6±9.8 mmHg on 2.8±1.1 glaucoma medications. On postoperative day 1, IOP was <5 mmHg in 8 eyes (7.9%), >21 mmHg in 3 eyes (3.0%), and >30 mmHg in 0%. At 3-month follow-up, mean IOP was 15.3±5.7 mmHg on 1.6±0.9 glaucoma medications, 19 eyes (18.8%) had developed a shallow anterior chamber, 9 eyes (8.9%) had choroidal detachment (8 serous, 1 hemorrhagic), 2 eyes (2.0%) required anterior chamber reformation in the office, and 1 eye (1.0%) required drainage of choroidal effusion and anterior chamber reformation.
Routine viscoelastic fill at the beginning of Ahmed FP7 implantation surgery to prevent intraoperative anterior chamber shallowing may decrease post-operative risk of choroidal effusion and need for anterior chamber reformation without increasing early post-operative IOP. The rates of these post-operative complications were lower in this single surgeon study in comparison to those reported in the Ahmed Baerveldt Comparison Study and the Ahmed Versus Baerveldt Study, in which viscoelastic was used at surgeon discretion.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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