Supra-Tenon Capsule Implantation of the Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma
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Published on: January 26, 2018
Eman M Elhefney1, Hossam T Al-Sharkawy, Hanem M Kishk
1Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
Supra-Tenon Ahmed glaucoma valve (AGV) implantation effectively reduced intraocular pressure (IOP) in children with refractory glaucoma. This surgical approach demonstrated significant IOP control with a low complication rate, offering a promising treatment option.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Surgery
Background:
- Refractory glaucoma in children presents significant challenges for intraocular pressure (IOP) management.
- The fibrotic potential of the Tenon capsule can impede bleb formation and compromise glaucoma surgery outcomes.
- Ahmed glaucoma valve (AGV) implantation is a recognized treatment for refractory glaucoma.
Purpose of the Study:
- To assess the efficacy of supra-Tenon capsule implantation of the Ahmed glaucoma valve (AGV).
- To evaluate the impact of this technique on Tenon capsule fibrotic potential and bleb formation.
- To determine the subsequent effect on intraocular pressure (IOP) control in pediatric refractory glaucoma.
Main Methods:
- A prospective interventional study involving 22 eyes of 12 children with refractory glaucoma.
- Supra-Tenon capsule implantation of the AGV was performed.
- Ophthalmic examinations, including IOP measurement, were conducted preoperatively and at multiple postoperative intervals for at least 18 months.
Main Results:
- Mean preoperative IOP of 30.7±2.88 mm Hg decreased significantly to 16.1±3.60 mm Hg postoperatively (47.6% reduction).
- The mean number of antiglaucoma medications decreased significantly from 1.86±0.4 to 1.0±0.9.
- Total success was achieved in 81.9% of eyes, with complications including tube exposure/slippage (10%), hypotony (10%), and hyphema (5%).
Conclusions:
- Supra-Tenon capsule implantation of the AGV is a successful method for IOP control in pediatric refractory glaucoma.
- The technique offers a favorable safety profile with a low incidence of postoperative complications.
- This approach effectively manages refractory glaucoma in children, potentially mitigating Tenon capsule fibrosis.
Purpose:
To evaluate the efficacy of supra-Tenon capsule implantation of an Ahmed glaucoma valve (AGV) as a measure to decrease the fibrotic potential of the Tenon capsule on bleb formation and its subsequent effect on intraocular pressure (IOP) control in children with refractory glaucoma.
Setting:
Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt.
Design:
A prospective interventional study.
Patients And Methods:
Twenty-two eyes of 12 children with refractory glaucoma underwent supra-Tenon capsule implantation of AGV. Ophthalmic examinations under general anesthesia including measurement of the corneal diameter and the IOP with Perkin's tonometer were performed preoperatively, on the first postoperative day, the first postoperative week, weekly for the first month, 2-weekly for the following 3 months, and monthly for at least 18 months. Postoperative complications and the number of glaucoma medications used preoperatively and postoperatively were recorded. The paired Student t test was used to compare preoperative and postoperative data.
Results:
There were 12 eyes (54.6%) with refractory congenital glaucoma, 7 eyes (31.8%) with refractory pseudophakic glaucoma, and 3 eyes (13.6%) with refractory aphakic glaucoma. Patients included 10 male (83.3%) and 2 female (16.7%) children with a mean age of 16.3±9.7 months. The mean follow-up duration was 24.1±4.3 months. There was a statistically significant difference between the mean preoperative IOP (30.7±2.88 mm Hg) and the mean postoperative IOP (16.1±3.60 mm Hg) (t=16.22 and P=0.000, with a mean decrease in the IOP by 47.6%). The difference between the mean number of antiglaucoma medications before surgery (1.86±0.4) and after surgery (1.0±0.9) was also statistically significant (t=4.31 and P=0.000). Total success was achieved in 18 eyes (81.9%). Postoperative complications included tube exposure and slippage (10%), hypotony (10%), and hyphema (5%).
Conclusions:
Supra-Tenon capsule implantation of the AGV was successful in controlling the IOP with few postoperative complications in the management of children with refractory glaucoma.
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