Five-Year Treatment Outcomes of Resident-Performed Ahmed Valve Implantation for Glaucoma.

PRCIS: Ahmed Glaucoma valve implantation by residents showed similar complications, success, and failure rates, regardless of their level of expertise. Training programs must encourage ophthalmologists to perform this surgery to enhance competence in their future practices. PURPOSE: To describe outcomes of resident-performed Ahmed Valve implantation over a 5-year period. METHODS: In this cross-sectional observational study we retrospectively reviewed the medical records of patients who underwent resident-performed Ahmed Glaucoma Valve implantation over a 5-year period. The main outcomes were the number of surgeries performed by first, second, and third-year residents, intraoperative and postoperative complications, and the association of level of training with outcomes and complications. RESULTS: 160 eyes were included, with a mean age of 53.8±15.4 years, 63% were men. The most frequent type of glaucoma was neovascular glaucoma (67.5%). Mean follow-up was 23.2±19.6 months. Residents of higher years performed more surgeries and no relationship was found between the surgeon's level of training and type of glaucoma operated on. After the surgical procedure, significant changes in best-corrected visual acuity were noted in surgeries performed by third-year residents (P=0.04). Intraocular pressure and number of medications were significantly reduced in all groups (P=0.01). Complications were registered in 60 eyes; the most frequent being the presence of a transient flat anterior chamber (27.45%). CONCLUSIONS: There were no significant differences in terms of IOP control and the number of complications in the three groups. There was no significant association between the resident's experience and the outcomes of the surgery. The Ahmed valve implant is a procedure that appears to have similar results in surgeons with different levels of training.

Short-term Evaluation of Negative Pressure Applied by the Multi-Pressure Dial System to Lower Nocturnal IOP: A Prospective, Controlled, Intra-subject Study.

INTRODUCTION: The purpose of this study was to investigate the short-term safety and feasibility of negative pressure application by the Multi-Pressure Dial (MPD) System to lower nocturnal intraocular pressure (IOP) in subjects with open-angle glaucoma (OAG). METHODS: A prospective, controlled, intra-subject study of 22 eyes from 11 subjects at a single site was performed. All subjects had a history of OAG and were currently using a topical prostaglandin. For each subject, the eye with the highest IOP in the supine position was selected as the treatment eye (TE) and the contralateral eye served as the control eye (CE). The negative pressure for the TE was set to 60% of the baseline IOP value with no negative pressure in the CE. IOP measurements were collected at three prespecified time points overnight in the supine position with active negative pressure. The primary outcome measure was mean IOP with the application of negative pressure. RESULTS: At the three overnight time points, the mean (± standard deviation) baseline IOP prior to negative pressure application was 22.2 ± 2.5 mmHg in the TE and 21.8 ± 2.5 mmHg in the CE. With the application of 60% negative pressure to the TE and no active negative pressure to the CE, the mean IOP was 14.2 ± 2.2 and 19.5 ± 2.4 mmHg, respectively. The mean percentage IOP reduction in the TE was 35% (p < 0.001). There were two minor adverse events, both unrelated to device wear, and there were no IOP spikes ≥ 10 mmHg. CONCLUSION: The MPD can safely and effectively lower nocturnal IOP in the supine position. The MPD holds promise as a potential new, non-invasive treatment option for the control of nocturnal IOP.

Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma.

PURPOSE: To describe clinical results of Ahmed glaucoma valve implantation in Mexican patients with neovascular glaucoma (NVG). MATERIALS AND METHODS: We reviewed records of 60 eyes of 60 patients with NVG who underwent Ahmed valve implantation, with a follow-up period of 1 year. We identified successful and failed cases and compared baseline and follow-up characteristics to identify possible differences between both groups. RESULTS: We classified 36 eyes (60%) as successful and 24 (40%) as failed cases. We found a significant difference in success rate in patients who had a hypertensive phase at any time during the follow-up period (OR = 5.15, CI = 1.49-20.15, p = 0.004). Patients in the success group showed a statistically significant decrease in the number of glaucoma medications 1 year after surgery (p <0.0001). We found a statistically significant difference in success rate in patients who had preoperative best corrected visual acuity (BCVA) better than logmar 0.70 (odds ratio 4.31, CI = 1.1-19.3, p = 0.03086). CONCLUSION: A hypertensive postoperative phase and a preoperative BCVA worse or equal to 20/100 seem to be risk factors for Ahmed valve surgical failure in patients with NVG. How to cite this article: Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez-Roman J, Hernandez-Garciadiego C. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma. J Curr Glaucoma Pract 2014;8(3):86-90.