Long-term results of refractory glaucoma cases with ahmed glaucoma valve implantation

Abstract

To evaluate long- term effects of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma cases on intraocular pressure, visual acuity and cornea. The cases who had undergone AGV implantation between the years 2003 to 2014 with the diagnosis of refractory glaucoma were evaluated retrospectively. The cases with minimal light perception visual acuity and followed up for longer than 12 months were selected. Preoperative and postoperative corrected distance visual acuity levels (CDVA), intraocular pressure (IOP), number of medications and central corneal thickness (CCT) were recorded. Complications and additional surgeries were noted. The complete surgical cure was based on following considerations: no need for additional surgery, achievement of mean IOP level between 5-22 mmHg, stability of visual acuity and corneal transparency. Forty eight eyes of 47 refractory glaucoma cases with neovascular (n=13), aphasic (n=13), secondary to penetrating keratoplasty (PK) (n=7), congenital (n=4), traumatic (n=5) and primary refractory glaucoma (n=6) were evaluated. Mean age (50.40±22.80 years), mean follow-up period ( 32.33±20.78 (12-84) months), preoperative 1.50±0.61 LogMAR, and postoperative CDVA 1.60±0.57 LogMAR were determined. IOP values ( 39.22±9.47 vs 17.02±4.29 mmHg), number of medications (3.47±0.92 vs 1.52±1.09), CCT values (590.00±88.86 vs 655.25 ±170.88µm (p<0.05 were also estimated. Additional surgeries were performed including drainage of suprachoroidal hemorrhage (n=1), cleaning of AGV tip (n=5), anterior vitrectomy (n=5), AGV reposition (n=3), AGV tip shortening (n=6), corneal graft insufficiency related PK (n=3), and additional cyclodestructive procedures (n=5). Perfect surgical, total surgical success rates were detected as 46 % (n=22), and 89.4% (n=43),respectively. However surgery failed in 5 (10.6%) cases AGV was a considerable successful surgical option for decreasing the IOP in refractory glaucoma cases. However even there is not a significant AGV endothelial touch, endothelial insufficiency related corneal edema and eventual visual loss was seen. © 2018, Logos Medical Publishing. All rights reserved.