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Clinical Outcomes After Ahmed Glaucoma Valve Implantation for Pediatric Glaucoma After Congenital Cataract Surgery
Orna Geyer1, Adi Segal, Alina Melamud
1Department of Ophthalmology, Carmel Medical Center, Haifa, Israel.
Insights
Ahmed valve implantation offers sustained intraocular pressure control for pediatric glaucoma after congenital cataract surgery. This procedure demonstrates long-term success, with most cases maintaining efficacy over several years.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Management
Background:
- Congenital cataract surgery can lead to secondary glaucoma in pediatric patients.
- Effective intraocular pressure (IOP) management is crucial to prevent further vision loss in these cases.
Purpose of the Study:
- To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in children with glaucoma following congenital cataract surgery.
Main Methods:
- A retrospective review of 41 pediatric eyes (27 patients) that underwent AGV implantation between 2007 and 2018.
- Surgical success was defined as IOP ≤22 mmHg without reoperation or significant complications.
- Follow-up duration averaged 61.1 months.
Main Results:
- The cumulative probability of surgical success was 95.1% at 1 year, decreasing to 72.6% by 7 years.
- Mean IOP decreased significantly from 35.8 mmHg to 18.7 mmHg (51.4% reduction; P<0.0001).
- Complications occurred in 34% of eyes, with most remaining successful; early hypotony was most common (19.5%).
Conclusions:
- Ahmed glaucoma valve implantation is a viable option for IOP control in pediatric glaucoma secondary to congenital cataract surgery.
- While success rates decrease over time, the procedure offers significant IOP reduction and manageable complications.
- Long-term efficacy is demonstrated, with success lasting over 5 years in most cases.
Prcis:
Ahmed valve success for glaucoma following congenital cataract surgery lasts at least 5 years in most eyes, and >10 years in some cases. The procedure is a valuable option for these patients.
Purpose:
The aim of the study was to report on the results of Ahmed valve implantation in children with glaucoma following congenital cataract surgery.
Patients And Methods:
Medical records were reviewed for 41 pediatric eyes (27 patients) with glaucoma after congenital cataract surgery with Ahmed glaucoma valve (AGV) implantation between 2007 and 2018. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) ≤22 mm Hg (with or without glaucoma medications) on 2 consecutive follow-up visits, without glaucoma reoperation, and without significant visual complications during the follow-up period.
Results:
Median age at the time of AGV implantation was 80 months (range: 14 to 146 mo) and the mean follow-up period was 61.1±46.5 months. The cumulative probability of surgical success was 95.1%, 89.8%, 83.1%, and 72.6% at 12, 24, 60, and 84 months, respectively. IOP significantly decreased from 35.8±7.4 mm Hg before valve implantation to 18.7±6.5 mm Hg at the last recorded visit (51.4% decrease; P<0.0001). Most eyes (79%) required medications for pressure control. Complications occurred in 14 eyes (34%), with 12 of these remaining successful. Early hypotony was the most common complication (19.5%). Retinal detachment occurred in 1 eye.
Conclusions:
Despite a decrease in surgical success over time, AGV implantation was successfully used for IOP control in the majority of our pediatric eyes with glaucoma after congenital cataract surgery. Most complications were managed effectively and surgical success was maintained.
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