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The Ahmed valve in refractory pediatric glaucoma
J A Englert1, S F Freedman, T A Cox
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA.
Insights
The Ahmed Glaucoma Valve implant effectively reduces intraocular pressure in pediatric patients with refractory glaucoma. This surgical option shows a high success rate, offering a valuable treatment for complex cases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Refractory glaucoma in pediatric patients presents significant challenges in intraocular pressure (IOP) management.
- Standard treatments may be insufficient, necessitating advanced surgical interventions.
- The Ahmed Glaucoma Valve (AGV) implant is a potential option for these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of the Ahmed Glaucoma Valve implant in pediatric patients diagnosed with refractory glaucoma.
- To assess the long-term outcomes, including IOP control and complication rates.
- To investigate the influence of prior cycloablation procedures on surgical success.
Main Methods:
- Retrospective chart review of 27 eyes from 23 pediatric patients (<18 years) with refractory glaucoma.
- Primary outcome measure: time to surgical failure.
- Success defined as IOP ≤ 21 mm Hg without devastating complications or further glaucoma surgery.
Main Results:
- Mean preoperative IOP of 32.8 mm Hg reduced to 16.7 mm Hg at 18 months postoperatively.
- Overall success rate of 85.2% at last follow-up; 90.6% at 12 months and 58.3% at 24 months.
- Previous cycloablation was associated with lower postoperative IOP and reduced medication dependence.
Conclusions:
- Ahmed Glaucoma Valve implantation is an effective therapy for pediatric refractory glaucoma.
- The AGV implant can be safely used in eyes with uncontrolled IOP despite prior cycloablation.
- This surgical approach offers a viable solution for managing complex pediatric glaucoma cases.
Purpose:
To evaluate the efficacy of the Ahmed Glaucoma Valve implant in pediatric patients with refractory glaucoma.
Methods:
A retrospective chart review was conducted of 27 eyes from 23 consecutive pediatric patients (younger than 18 years) with refractory glaucoma treated with Ahmed Glaucoma Valve implant placement. The main outcome measure was time after surgery without failure. Success was defined as an intraocular pressure of 21 mm Hg or less without visually devastating complications or additional glaucoma surgery (exclusive of tube revision). Previous cycloablation, which was present in a subset of eyes, was examined as a possible influence on postoperative intraocular pressure control, glaucoma medication dependence, and surgical success.
Results:
The median patient age was 4.8 years (range, 0.3 to 16.8 years), with a follow-up of 3 to 31 months (mean, 12.6 +/- 8.2 months). Intraocular pressure was reduced from a preoperative mean of 32.8 +/- 7.5 mm Hg to 16.7 +/- 5.4 mm Hg at 18 months postoperatively, with an overall success rate of 85.2% at last follow-up. Cumulative probabilities of success by Kaplan-Meier analysis were 90.6% at 12 months and 58.3% at 24 months. Compared with those that did not undergo previous cycloablation, eyes that had undergone previous cycloablation had a lower mean postoperative intraocular pressure at 3- and 6-month follow-up (P < .001 and P = .057, respectively) and required fewer glaucoma medications at postoperative examination time points up to 18 months (P < or = .01 at each time point). Fifteen eyes (56%) required glaucoma medications after surgery. The most common complication was corneal-tube contact, which occurred in five eyes (18.5%). One eye with a wound leak required anterior chamber reformation. Retinal detachment occurred in one aphakic eye 2 years postoperatively, resulting in loss of vision. One eye with neovascular glaucoma required enucleation after an enlarging (presumably preexisting) medulloepithelioma was discovered.
Conclusions:
Ahmed Glaucoma Valve implantation is a useful therapy for the treatment of refractory pediatric glaucoma, and it may be safely used in a subgroup of eyes with uncontrolled intraocular pressure despite previous cycloablation procedures.