Ciliary Sulcus Implantation of Ahmed Glaucoma Valve in Patients with Corneal Decompensation Risk
Serhat Imamoglu1, Nimet Yesim Ercalik1, Buse Guneri Beser1
1Department of Ophthalmology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Insights
Ciliary sulcus implantation of the Ahmed glaucoma valve (AGV) effectively reduced intraocular pressure and medication use in patients at risk for corneal decompensation. This surgical approach demonstrates favorable short-term outcomes for glaucoma management.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Ocular Implants
Background:
- Glaucoma management often requires surgical intervention.
- Patients with corneal decompensation risk present unique challenges for glaucoma surgery.
- Ahmed glaucoma valve (AGV) implantation is a common surgical option.
Purpose of the Study:
- To evaluate the safety and efficacy of ciliary sulcus implantation of the Ahmed glaucoma valve (AGV).
- To assess outcomes in patients with a risk of corneal decompensation.
Main Methods:
- Retrospective study of patients undergoing AGV implantation in the ciliary sulcus.
- Comparison of preoperative and postoperative intraocular pressure (IOP), best corrected visual acuity (BCVA), and medication use.
- Success defined as postoperative IOP of 5-21 mmHg and no loss of light perception.
Main Results:
- Significant reduction in mean IOP from 33.6±9.1 mmHg to 16.9±5.1 mmHg (p=0.000).
- Mean medication use decreased from 3.5±1.3 to 1.7±1.4 (p=0.000).
- Overall success rate of 78%; one patient lost light perception; 4.3% experienced decreased corneal clarity.
Conclusions:
- Ciliary sulcus AGV implantation is effective for lowering IOP and reducing medication dependence short-term.
- This posterior chamber implantation technique is suitable for patients with corneal decompensation risk.
- The procedure offers a viable option for managing complex glaucoma cases.
Objectives:
The goal of this study was to examine the safety and efficacy of ciliary sulcus implantation of the Ahmed glaucoma valve (AGV; New World Medical, Inc., Rancho Cucamonga, CA, USA) in patients with a risk of corneal decompensation.
Methods:
Patients with a corneal decompensation risk who underwent AGV implantation at a single institution were included in this retrospective study. The patients' preoperative intraocular pressure (IOP), best corrected visual acuity (BCVA), and the number of anti-glaucomatous eye drop medications used was compared with postoperative values. The success criteria were defined as a postoperative IOP of 5 to 21 mmHg and no loss of light perception.
Results:
Twenty-three eyes of 23 (16 male, 7 female) patients were included in the study. The mean age of the patients was 64.6±14.6 years and the mean follow-up period was 15.8±8.3 months. The preoperative mean IOP was reduced from 33.6±9.1 mmHg to 16.9±5.1 mmHg at the last follow-up (p=0.000). The mean preoperative number of anti-glaucomatous eye drop medications used was 3.5±1.3. Postoperatively the mean was 1.7±1.4 at the last follow-up (p=0.000). The rate of total success was determined to be 78%. The postoperative mean BCVA did not change significantly. One patient lost light perception. A decrease in corneal clarity was observed in only 1 patient (4.3%). The postoperative complications observed were: bleb encapsulation (43%), hyphema (39%), tube occlusion (13%), choroidal detachment (8.7%), decompression retinopathy (8.7%), and corneal decompensation (4.3%).
Conclusion:
Ciliary sulcus implantation of an AGV was effective, both in terms of IOP and the decrease in anti-glaucomatous drug use in the short term. This technique may be a good choice in patients with a corneal decompensation risk due to the posterior chamber implantation.
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