RESUMO
Purpose The purpose of this study was to evaluate the long-term efficacy and safety profile of the Ahmed glaucoma valve (AGV) implantation in cases of refractory glaucoma. Methods We conducted a retrospective audit of patients that underwent AGV implantation between 2006 and 2017 by two glaucoma surgeons in a tertiary glaucoma centre (Glasgow, UK). Primary outcome measures included the post-operative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity, complications, re-operation rates, and failure (defined as IOP > 21 mmHg or not reduced by 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma, removal of implant, or loss of light perception) at pre-defined time points (years 1 to 8). Results A total of 111 eyes of 94 patients were identified with a mean follow-up of 48.5 months (SD: 31.5); 60.3% of eyes had undergone at least one previous glaucoma surgery. Mean presenting IOP was 31.7 mmHg (SD: 11.4), and it reduced to 13.9 mmHg (SD: 4.2) in year 5 and 16.3 mmHg in year 8 (p<0.05). The number of glaucoma medications reduced from 3.8 (SD: 1.4) to 2.4 (SD: 1.4) and 2.6 (SD: 1.4) in the above time points (p<0.05 except year 8). The five-year success rate was 65.2%, and the five-year reoperation rate was 37% excluding cataract surgery. The most common early complications were hyphaema (12.6%) and transient hypotony (8.1%), whereas the most common late complication was an encapsulated bleb (15.1%). Conclusions AGV implantation is an effective procedure for controlling IOP in the long term in cases of refractory glaucoma.
RESUMO
The established teratogenicity of antiepileptic drugs raises important issues in women of child-bearing age. While the association between neural tube defects and antiepileptic drugs is well recognised, other congenital malformations are known to occur. We report two siblings with characteristic craniofacial features of Fetal Valproate Syndrome who also had associated ocular and neurodevelopmental problems which would benefit from early recognition and intervention.
