Abstract
Purpose :
Controversy exists regarding whether the Ahmed Glaucoma Valve combined with phacoemulsification (AGV-phaco) is as safe and effective as standalone AGV surgery. We sought to compare these techniques in an understudied, Black and Latino population.
Methods :
We reviewed charts of eyes from Latino or Black patients followed for 12 months after AGV-phaco or AGV surgery. A single surgeon conducted all procedures in the Bronx, NY from 2014-2019. Baseline demographics, intraocular pressure (IOP), number of glaucoma medications, and visual field mean deviation were compared using Pearson’s Chi-squared and Wilcoxon rank-sum tests. To evaluate postop outcomes, we used rank-sum tests or Chi-square tests on the following: 1-year change in IOP and number of medications, vision loss of 2 lines or more, slit lamp procedures, reoperation for glaucoma, shallow or flat anterior chamber, corneal complications, retinal or choroidal complications, and presence of hypertensive phase (HP). For any significant findings, we conducted linear or logistic regression and adjusted for preop IOP. HP described an IOP reading > 21 mmHg within the first 3 postop months after reduction of IOP to less than 22 in the first week, without tube malfunction. Sterling IRB deemed this study to be exempt.
Results :
We studied 78 AGVs and 125 AGV-phacos from 203 eyes. At baseline, mean IOP was 7.9 mmHg higher in standalones (p<0.0001). Mean change in IOP was greater for AGVs (-15.9 mmHg ± 10.9) than AGV-phacos (-8.9 mmHg ± 9.6; p<0.0001). However, surgery type did not predict change in IOP after adjusting for preop IOP (p=0.57). Medications decreased by approximately 1 in both groups (p=0.77). Vision loss occurred in 29.5% of AGVs and in 14.4% of AGV-phacos (p=0.015). HP occurred in 65.4% and 38.4%, respectively (p=0.00032). After preop IOP adjustment, surgery type did not predict vision loss (p=0.062), but it did predict HP. AGV-phacos were 53.6% less likely to undergo a hypertensive phase post-adjustment (p=0.017). Differences in other studied events were not significant (p>0.05).
Conclusions :
AGV-phaco in Black and Latino patients may be as effective in treating glaucoma as standalone AGV after adjusting for preop IOP. AGV-phaco may also be slightly safer, with lower odds of HP after preop IOP adjustment. This may be due to differences in AGV pocket pathophysiology in combined surgery.
This is a 2021 ARVO Annual Meeting abstract.