Abstract
Purpose :
Previous randomized control trials have reported that early aqueous suppression therapy (EAS) when intraocular pressure (IOP) ≥ 10 mmHg led to improved outcomes after glaucoma drainage device surgery (GDD) with Ahmed Glaucoma Valve (AGV). The purpose of this retrospective study was to elucidate the potential benefits of EAS after AGV in eyes with IOP in the 10–15 mmHg range when the first observed IOP was ≥ 10 mmHg.
Methods :
All patients who underwent AGV implantation with follow-up from 1/2010 to 10/2020 at the Northwestern Medical Group were identified. Patients with <1 month follow-up, uveitic glaucoma, or prior GDD were excluded. To focus on whether early initiation of ocular hypotensive treatment is beneficial, only eyes with a post-operative IOP between 10–15 mmHg at their first visit with an IOP ≥ 10 mmHg were included. EAS was defined as initiation of therapy when post-operative IOP was first 10–15 mmHg. Standard therapy (ST) was initiation of therapy at all other times.
Failure was defined as IOP >21 mmHg, <5 mmHg, or <20% reduction in IOP from baseline after 3 months for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥2 visits spanning ≥30 days. Hypertensive phase was defined as IOP >21 mmHg in the first 3 months.
Results :
Sixty-three eyes of 62 subjects met the inclusion criteria. Thirty-two eyes of 31 patients in the EAS group and 31 eyes of 31 patients in the ST group were included. Baseline characteristics were similar between groups, including IOP (EAS 30.5 ± 13.3 mmHg; ST 31.1 ± 10.8 mmHg; p=0.23). Mean follow-up time was 18.9 ± 15.5 months for EAS and 17.6 ± 15.1 months for ST.
Overall success rates were similar between groups: EAS 64.3%; ST 67.9%; p=0.78. No difference was observed in the need for additional glaucoma surgery: EAS 15.6%; ST 16.1%; p=0.99. Hypotony did not occur in any eyes.
Fewer EAS eyes experienced hypertensive phase compared to ST eyes, though the difference was not statistically significant (EAS 28.1%; ST 41.9%; p=0.26).
Conclusions :
Early treatment with aqueous suppressants when the IOP was first in the 10–15 mmHg range after AGV implantation was not associated with improved outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.