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Purpose: To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure. Methods: A cross?sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow?up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors. Results: A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found. Conclusion: A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group
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Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.
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Purpose: Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts had been used to cover the tube. Methods: Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared. Results: Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01). Conclusion: There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.
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AIM: To evaluate the efficacy of Ahmed glaucoma valve implanting through the ciliary sulcus in the treatment of intraocular lens(IOL)glaucoma.METHODS: Retrospective case series study. The clinical data of 18 patients(18 eyes)with IOL glaucoma from February 2020 to February 2022 in Liuzhou Red Cross Hospital were collected. All patients underwent Ahmed glaucoma valve implanting through the ciliary sulcus. The visual acuity, intraocular pressure, corneal endothelial cell density, corneal endothelial cell loss rate and complications were observed before operation and 1, 3, 6 and 12mo after operation.RESULTS: The mean intraocular pressure before operation was 43.41±5.33 mmHg. The mean intraocular pressure at 1, 3, 6 and 12mo after operation were 12.11±3.26, 13.82±4.12, 13.54±3.83 and 15.80±4.35 mmHg respectively. The mean intraocular pressure at each follow-up point after operation was significantly lower than that before operation(F=203.40, P<0.01). The corneal endothelial cell density at each time point after surgery was lower than that before surgery(F=6.18, P<0.01), but there were no significantly differences in the density and loss rate of corneal endothelial cell at 1, 3, 6 and 12mo after surgery(P>0.05). Furthermore, the overall surgery success rate was 83%.CONCLUSIONS: Ahmed glaucoma valve implanting through the ciliary sulcus is safe and effective in the treatment of IOL glaucoma, and the damage to corneal endothelial cells is mild. The corneal endothelial cells density doesn't decrease with time after surgery.
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The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post?AGV silicone oil tube occlusion was treated with semi?conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral “vent and flush” offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow?ups.
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Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single?center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ?6 months of follow?up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 � 0.8 vs. 1.9 � 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.
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Purpose: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. Methods: A retrospective study was done between April 2016 and April 2018 on patients with ?12 months of follow?up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. Results: The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti?glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow?up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan–Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8–33.5%) at 3 months, 18.7% (95% CI; 8.9–37.0%) at 6 months, and 25.0% (95% CI; 13.4–43.8%) at 12 months. Conclusion: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti?glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology
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@#AIM: To observe the clinical therapeutic efficacy of Ahmed glaucoma valve(AGV)implantation with intravitreal injection of aflibercept or ranibizumab in patients with neovascular glaucoma(NVG). <p>METHODS: A retrospective study. The clinical data of 33 cases(33 eyes)with NVG angle-closure glaucoma who were received intravitreal injection of aflibercept or ranibizumab with AGV implantation from January 2018 to August 2020 in our hospital were involved in this study. There were 18 eyes in the aflibercept group and 15 eyes in the ranibizumab group. All patients were followed-up for 6mo. The best-corrected visual acuity(BCVA), intraocular pressure, neovascularization, and postoperative complications were recorded and evaluated.<p>RESULTS: Before the first intravitreal injection and 1wk after intravitreal injection, the differences of intraocular pressure and BCVA in two groups were not statistically significant(<i>P</i>>0.05); The changes of intraocular pressure and BCVA before the first intravitreal injection and after AGV implant 1wk, 1, 3, 6mo were statistically significant in two groups(<i>P</i><0.01), but there were no statistically significant differences intraocular pressure and BCVA between the two groups at each follow-up time point(<i>P</i>>0.05). There were no significant differences in average number of injections between aflibercept group(1.61±0.98)and ranibizumab group(1.80±0.86)(<i>P</i>>0.05). The differences of neovascular recurrence rate, incidence of early and late complications and surgical success rates were not statistically significant(<i>P</i>>0.05).<p>CONCLUSION: Intravitreal aflibercept or ranibizumab injection combined with AGV implantation is an effective treatment for NVG. The clinical efficacy of aflibercept and ranibizumab were similar.
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Objective:To investigate the effectiveness and safety of the allogeneic corneal stromal flap in reducing the exposure of the drainage catheter in the implantation of Ahmed glaucoma valve.Methods:Fifty-three patients(61 eyes) with refractory glaucoma treated by Ahmed glaucoma valve implantation from January 2017 to April 2019 were retrospectively analysed. The patients were divided into sclera tunnel group(routine group) and sclera tunnel with allogeneic corneal stroma flap covering(improved group). The cumulative success rate of surgery, preoperative intraocular pressure(IOP), IOP at the last outpatient follow-up, the best-corrected visual acuity(BCVA), BCVA at the last outpatient follow-up, drainage catheter exposure and other surgical complications were collected from both groups at 6, 12 and 24 months after surgery. The data between the 2 groups were statistically analyzed, P<0.05 was statistically significant. Results:The cumulative success rates of 6, 12 and 24 months after operation were 89.7%, 86.2% and 69.0% in the routine group, and 90.6%, 90.6% and 71.8% in the improved group, respectively. There was no significant differences between the 2 groups( P>0.05). The IOP and BCVA at the final follow-up were significantly improved in both groups, with a statistical significant difference( P<0.05). In the conventional group, the exposure of drainage catheter occurred in 4 eyes(13.8%). Further surgeries were carried out to cover the exposed drainage catheters with allogeneic corneal stroma flaps and amniotic membrane and all had good recovery. There was no drainage catheter exposure in the improved group. The difference between the 2 groups was statistically significant( χ2=4.724, P=0.030). There was no significant difference in other surgical complications between the 2 groups( χ2=0.160, P=0.689). No intraoperative or postoperative complications regarding the corneal stromal flap were observed. Conclusion:Implantation of Ahmed glaucoma valve with allogeneic corneal stromal flap sealing can effectively reduce the exposure of the drainage catheter. It is a safe method.
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@#AIM:To assess the efficacy of Ahmed glaucoma valve implantation combined with lens extraction for neovascular glaucoma(NVG)with cataract.<p>METHODS: A retrospective comparative study was designed. 93 patients with NVG were enrolled. All patients received preoperative anti-vascular endothelial growth factor(VEGF)injections, 41 eyes underwent Ahmed glaucoma valve(AGV)implantation only, and 52 eyes underwent AGV implantation and lens extraction by phacoemusification. The best corrected visual acuities(BCVA), intraocular pressure(IOP), and surgical complications were evaluated.<p>RESULTS: Postoperative visual acuity was improved in 16 eyes(39%), decreased in 14 eyes(34%), unchanged in 11 eyes(27%)in group 2, and 15 eyes(29%)improved,24 eyes(46%)decreased, 13 eyes(25%)unchanged in group 1 respectively(<i>P</i>>0.05). The group 2 demonstrated an 51% complete and 22% qualified success rate and 27% failure rate, and the 44% complete and 25% qualified success rate and 31% failure rate in group 1(<i>P</i>>0.05). Among the complications, fibrous exudation(56%)was the first, hyphema(46%)came second in group 2, while shallow anterior chamber(35%)was the most, fibrous exudations(31%)and anterior chamber hyphema(25%)followed in the group 1. And no tube extrusion serious complication had occurred in both groups(<i>P</i><0.05). No significant differences in postoperative complications were observed between the groups(<i>P</i>>0.05).<p>CONCLUSION: For NVG with cataract, AGV implantation with lens extraction is a priority for reduction of IOP and improvement of visual acuity.
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We describe a case of 34-year-old male with post penetrating keratoplasty glaucoma, post trabeculectomy with aphakia in the only seeing eye, in which a modified surgical technique of inserting Ahmed glaucoma valve (AGV) tube in vitreous cavity was done to reduce the risks associated with pars plana incision during pars plana vitrectomy (PPV). A hybrid 20-25 gauge PPV was done concurrently, implant fixed to sclera, and tube inserted through the 25 gauge sclerotomy port in supero-temporal quadrant. Visual acuity and intraocular pressure remained stable during 1-year follow-up.
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@#AIM: To evaluate the effectiveness and safety of intravitreal injection of ranibizumab combined with Ahmed drainage valve implantation compared to pure Ahmed drainage valve implantation in the treatment of NVG.<p>METHODS: Computers were used to search PubMed, EMbase, Cochrane Library, American Scientific Citation Index Database(SCI), China Knowledge Network(CNKI), Chinese Science and Technology Journal Database(VIP), Wanfang Database, China Biomedical Document Service System(CBM), and to find literature about ranibizumab and Ahmed drainage valve implantation in the treatment of NVG. At the same time, relevant references were consulted. The search time limit was establishment until March 20, 2020. Quality evaluation and data extraction on the included studies were performed. RevMan 5.3 and STATA 12.0 software were used for Meta-analysis.<p>RESULTS: The included 7 clinical studies included 346 patients(349 eyes), and the quality was evaluated as medium to high quality. The homogeneity of the basic characteristics of various studies was better. Compared with the pure Ahmed drainage valve implantation group(the control group), the ranibizumab combined with Ahmed drainage valve implantation group(the experimental group)had lower intraocular pressure at 1wk and 1mo after surgery. There was no statistical difference at 6mo after surgery. The BCVA of the experimental group was better than that of the control group at 1mo and 3mo, and there was no significant difference at 6mo after surgery. There was no significant difference in the rate of anterior chamber bleeding and the number of anti-glaucoma drugs used between the two groups.<p>CONCLUSION: Compared with pure Ahmed drainage valve implantation, ranibizumab combined with Ahmed drainage valve implantation has better postoperative intraocular pressure and best corrected visual acuity in the early stage in the treatment of NVG, and the difference in the late postoperative period is not significant. It cannot reduce the rate of postoperative anterior chamber bleeding, and cannot reduce the use of anti-glaucoma drugs. This conclusion needs to be further confirmed by more high-quality clinical randomized controlled studies.
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@#AIM: To compare the clinical efficacy of two methods for treating refractory glaucoma.<p>METHODS: A total of 30 patients with refractory glaucoma(32 eyes)selected from our hospital from January 2014 to September 2018 were retrospectively analyzed. According to the treatment methods, they were divided into experimental group(16 eyes treated by modified Ahmed glaucoma valve implantation)and control group(16 eyes treated by traditional Ahmed glaucoma valve implantation). The visual acuity, intraocular pressure, number of anti-glaucoma drugs, the success rate, complications and average length of hospitalization were compared between the two groups, during follow-up at post operative 1d, 1wk, 1mo, 3mo and 6mo.<p>RESULTS:There was no significant difference in intraocular pressure between the two groups at post-operative 1d, 1wk, 1mo, 3mo, 6mo(all <i>P</i>>0.05). The total success rate was 87%(14/16)in experimental group while 75%(12/16)in control group(<i>P</i>=0.654). BCVA did not improve significantly at post operative 6 mo compared with baseline in both groups(<i>P</i>>0.05). The average length of hospital stay in the experimental group(4.50±1.37d)was significantly lower than that in the control group(7.63±3.69d)(<i>P</i>=0.003). The incidece of shallow anterior chamber was 31% in control group, while in experimental group, it was 0, which showed significant difference.<p>CONCLUSION: Modified Ahmed drainage valve implantation is an effective method for treating refractory glaucoma, with more simple operations, shorter hospitalizing time and lower incidence of shallow anterior chamber.
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@#AIM: To observe the clinical efficacy of intravitreal injection of conbercept combined with trabeculectomy and conbercept combined with Ahmed glaucoma valve implantation in treatment of neovascular glaucoma(NVG).<p>METHODS: Totally 40 cases(40 eyes)of NVG patients selected from our hospital from February 2016 to June 2017 were retrospectively analyzed. According to the treatment methods, they were divided into group A(conbercept with trabeculectomy+ panretinal photocoagulation)and group B(conbercept combined with Ahmed glaucoma valve implantation+ panretinal photocoagulation), 20 cases(20 eyes)in each group. The visual acuity, intraocular pressure, intraocular pressure control rate, neovascularization were observed after 6mo follow-up.<p>RESULTS: Before treatment, there was no significant difference in intraocular pressure between the two groups(<i>P</i>>0.05). The intraocular pressure in group B was lower than that in group A(<i>P</i><0.05)at 6mo after treatment, but there was no significant difference in visual acuity, intraocular pressure control rate and the regression of neovascularization between the two groups(All <i>P</i>>0.05).<p>CONCLUSION: Intravitreal injection of conbercept combined with Ahmed glaucoma valve implantation and conbercept combined with trabeculectomy for NVG are safe and effective, but the former is more effective in reducing intraocular pressure.
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Purpose: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. Methods: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ?5–?18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. Results: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). Conclusion: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.
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We present a case of tube endothelial touch where a suture technique for repositioning of the Ahmed glaucoma valve was performed. Advantage of this technique is that it is minimally invasive and anterior chamber stability is maintained during the procedure.
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·AIM: To study the influence of Ahmed glaucoma valve implantation on eyesight, intraocular pressure and corneal endothelial cell density of patients with traumatic angle recession glaucoma. ·METHODS: Totally 33 cases (35 eyes) of patients with traumatic angle recession glaucoma admitted to our hospital since June 2014 to June 2016 were selected and treated with Ahmed glaucoma valve implantation. The clinical data of all patients were retrospectively analyzed, so as to evaluated to success rate of surgery. Non-contact tonometer was applied to surveying intraocular pressure before treatment and at 1wk, 1,3,6mo and 1a post treatment. Specular microscope was adopted to examine and calculate the corneal endothelial cell density before treatment and at 1wk, 1, 3, 6mo and 1a post treatment. All affected eyes were compared for visual acuity before surgery and in 1a after surgery, moreover, patients were followed - up, received the further consultations and the complications were recorded. ·RESULTS: As for 35 affected eyes, the absolute success rate of surgery was 54% , while the relative success rate was 40% , and the total successful rate and failure rate were 94% and 6% respectively. In terms of the number of people who had no light sensation before surgery, or who had light sensation, ≤0. 01, 0. 01-0. 10 or >0. 10-0. 20, there was no significant difference (Z=-0. 132, P=0. 362). The intraocular pressure before treatment was 43. 43 ± 3. 65mmHg, at 1wk after surgery was 13. 50 ± 2. 54mmHg, at 1mo was 15. 93 ± 2. 61mmHg, at 6mo was 16. 00 ± 2. 18mmHg and at 1a was 16. 45 ± 2. 21mmHg, and the difference among different time points had statistical significance (F= 887. 82, P<0. 01). After treatment the intraocular press decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other ( P> 0. 05 ). Before treatment, the corneal endothelial cell density was 2443. 35 ± 343. 12 pieces/mm2, in 1wk after the surgery was 2231.67±334.45 pieces /mm2, in 1mo after the surgery was 2065. 47 ± 336. 45 pieces /mm2, in 3mo after surgery was 2031. 47 ± 345. 76 pieces/mm2, in 6mo was 2001. 72±337. 18 pieces /mm2and in 1a after the surgery was 1979. 65 ± 301. 32 pieces /mm2, and the difference among different time points had statistical significance ( F = 13. 49, P<0. 01 ). After treatment the corneal endothelial cell density decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other (P>0. 05). After surgery, there were 4 cases (4 eyes) of ocular hypotension, 3 cases (3 eyes) of hyphema, 2 cases ( 2 eyes) of drainage tube plugging and 2 cases ( 2 eyes ) of intraocular hypertension, which were all quickly relieved after basic intervention treatment. · CONCLUSION: Treating traumatic angle recession glaucoma with Ahmed glaucoma valve implantation can dramatically optimize the state of intraocular hypertension and protect the retaining visual acuity, and visual acuity can be optimized in some cases. It causes little complication that can be relieved with basic prognosis, but postoperative corneal endothelial cell loss exists in some cases.
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PURPOSE: To evaluate the outcome of Ahmed glaucoma valve (AGV) implantation in eyes with refractory secondary glaucoma following pars plana vitrectomy (PPV) and the associated prognostic factors. METHODS: A total of 146 eyes in 146 patients who underwent AGV implantation after PPV (followed up for ≥1 year) were included. AGV implantation was considered successful when the intraocular pressure (IOP) was 6 to 21 mmHg regardless of using IOP-lowering medication. The hazard ratios (HRs) associated with surgical failure were determined with Cox proportional analysis. RESULTS: The most common cause for PPV was complications of proliferative diabetic retinopathy (50%). The mean and peak IOPs between PPV and AGV implantation were 26.9 ± 6.6 and 35.9 ± 10.2 mmHg, respectively. AGV implantation was performed on average 18.7 months after PPV, and its overall success rate was 80.1% during a mean follow-up period of 43.6 months. In multivariate analyses, rubeosis observed before AGV implantation (HR, 4.07; 95% confidence interval, 1.57 to 10.6; p = 0.004) and higher peak IOP before AGV (HR, 1.04; 95% confidence interval, 1.00 to 1.07; p = 0.034) were predictive of failure. However, no PPV-related factors were associated with the surgical outcome of AGV implantation. CONCLUSIONS: The outcome of AGV implantation is good in refractory glaucoma following PPV. Rubeosis after PPV and higher peak IOP before AGV are risk factors for poor outcomes. Patients who undergo PPV should be followed for the development of rubeosis and IOP control.
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Humans , Diabetic Retinopathy , Follow-Up Studies , Glaucoma , Intraocular Pressure , Multivariate Analysis , Risk Factors , VitrectomyABSTRACT
Objective To evaluate and compare the efficacy and safety of intravitreal ranibizumab injection combined trabeculectomy and intravitreal ranibizumab injection combined Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma (NVG).Methods A retrospective case-control study was designed.The clinical data of seventy-six eyes of seventy-six patients with NVG who received intravitreal ranibizumab injection combined trabeculectomy or Ahmed glaucoma valve implantation were collected in Jingmen NO.2 People's Hospital between May 2013 to May 2015.The eyes were divided into two groups according to different surgical methods:intravitreal ranibizumab injection combined trabeculectomy group (40 patients 40 eyes) and intravitreal ranibizumab injection combined Ahmed glaucoma valve implantation group (36 patients 36 eyes).The surgical success rate,intraocular pressure (IOP),number of antiglaucoma medications used,best correct visual acuity and postoperative complications were analyzed between the two groups.Results Compared with preoperative IOP,the postoperative IOPs in the two groups were all significantly decreased,with significant differences between them (P＜0.001).The postoperative IOP,mean number of postoperative antiglaucoma medications,and best correct visual acuity were not significant different between the two groups at all follow-up intervals.Kaplan-Meier survival curves showed that,the successful rate was 57.5％ for the ranibizumab injection combined trabeculectomy group and 72.2％ for the ranibizumab injection combined Ahmed glaucoma valve implantation group at follow-up endpoint,with no significant difference between the two groups (P =0.287).No statistically significant differences were found between the two groups when the complication rates were compared (P ＞ 0.05).Conclusions Intravitreal ranibizumab injection combined trabeculectomy and intravitreal ranibizumab injection combined Ahmed glaucoma valve implantation are both the effective method in managing NVG.The two different methods have a similar efficacy.