Is Combined PhacoAhmed Less Effective than Ahmed Surgery Alone? A 5-Year Retrospective Study of Long-Term Effects

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Outcomes

Background:

• Combined trabeculectomy-phacoemulsification is associated with increased inflammation and reduced long-term efficacy compared to trabeculectomy alone.
• The impact of concurrent phacoemulsification on the efficacy and safety of Ahmed glaucoma valve implantation requires investigation.

Purpose of the Study:

• To evaluate whether combining phacoemulsification with Ahmed glaucoma valve implantation affects intraocular pressure (IOP), medication use, and the need for further surgery compared to Ahmed valve implantation alone.

Main Methods:

• Retrospective analysis of 51 eyes undergoing either Ahmed valve implantation alone (n=25) or combined Phacoemulsification-Ahmed valve surgery (n=26) over a 5-year period.
• Primary outcomes assessed included IOP, IOP-lowering medication use, and reintervention rates.
• Success defined as >20% IOP reduction and <21 mmHg without medication (absolute) or with medication (relative).

Main Results:

• Both surgical groups achieved significant IOP reduction with similar final mean IOPs (Ahmed-Alone: 14.02 mmHg; PhacoAhmed: 13.89 mmHg; p=0.99).
• Medication use reductions were comparable between groups (p=0.52).
• The PhacoAhmed group experienced fewer and later reinterventions (12% vs. 27.3%; median 27.1 vs. 12 months). Relative success rates were similar (83.3% vs. 81.4%; p=0.291).

Conclusions:

• Combining phacoemulsification with Ahmed glaucoma valve implantation does not appear to significantly compromise IOP control, medication requirements, or safety.
• The combined procedure may be associated with a lower rate of reintervention.
• Further prospective studies are recommended to confirm long-term outcomes.