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Sukhumal Thanapaisal, jian wu, Ying Han; Risk of Hypotony in Uveitis Patients after Ahmed Tube Implantation. Invest. Ophthalmol. Vis. Sci. 2020;61(7):969.
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© ARVO (1962-2015); The Authors (2016-present)
Hypotony occurs in patients with uveitic glaucoma receiving Ahmed glaucoma valve (AGV). Intraoperative steroid use may control inflammation and prevent postoperative hypotony. This study is to describe incidence and risk factors of hypotony in patients with uveitic glaucoma when intraoperative steroid was used, and compared them to patients with non-uveitic glaucoma with AGV implantation.
A prospective comparative study of patients undergoing AGV implantation between February 2008 and March 2019 was performed at University of California, San Francisco. Patients with age out of range (18 - 85 years old), post-operative wound leakage and haze cornea were excluded. Incidence of post-operative hypotony (intraocular pressure < 6 mmHg) and risk factors for developing hypotony were analyzed.
A total of 587 eyes (519 patients) diagnosed uveitic (14.3%) and non-uveitic glaucoma (85.7%) were reviewed. The average age was 52.46 ± 20.7 (mean ± SD) and 67.6 ± 15.26 years old in uveitis and non-uveitis groups, respectively (P = 0.65). The incidence of developing hypotony between two groups showed no significance; 12.04% (uveitis) and 11.47% (non-uveitis) at month 1, 8.64% and 7.22% at month 3, 8.33% and 4.37% at month 6, 5.66% and 4.81% at year 1, and 4.35% and 1.57% at year 3, excepted for year 2; 0% and 2.97% (P = 0.023). Risk factors for development of hypotony appeared to be associated with aphakic lens status (odd ratio [OR], 8.6, P = 0.048), pre-operative anterior chamber (AC) inflammation (OR, 5.22, P = 0.048), prior glaucoma surgery e.g. trabeculectomy, tube and Ex-PRESS shunt implantation (OR, 3.95, P = 0.005), tube placement in sulcus (OR, 2.98, P = 0.002), and AC inflammation at 1 month post-operative (OR, 2.21, P = 0.01). Asian race (OR, 0.45, P = 0.049) and intra-operative antifibrotic injection (OR, 0.48, P = 0.024) were associated with lower risk of post-operative hypotony.
There is no significant rate of hypotony in uveitis patients after AGV implantation with intra-operative steroid injection. As pre-operative and post-operative AC inflammation associated with higher risk of hypotony, we suggest that intra-operative steroid with antifibrotic injections may reduce risk of hypotony in uveitis patient undergoing AGV implantation.
This is a 2020 ARVO Annual Meeting abstract.
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