Evaluation of machine learning approach for surgical results of Ahmed valve implantation in patients with glaucoma.

BACKGROUND: Ahmed valve implantation demonstrated an increasing proportion in glaucoma surgery, but predicting the successful maintenance of target intraocular pressure remains a challenging task. This study aimed to evaluate the performance of machine learning (ML) in predicting surgical outcomes after Ahmed valve implantation and to assess potential risk factors associated with surgical failure to contribute to improving the success rate. METHODS: This study used preoperative data of patients who underwent Ahmed valve implantation from 2017 to 2021 at Ajou University Hospital. These datasets included demographic and ophthalmic parameters (dataset A), systemic medical records excluding psychiatric records (dataset B), and psychiatric medications (dataset C). Logistic regression, extreme gradient boosting (XGBoost), and support vector machines were first evaluated using only dataset A. The algorithm with the best performance was selected based on the area under the receiver operating characteristics curve (AUROC). Finally, three additional prediction models were developed using the best performance algorithm, incorporating combinations of multiple datasets to predict surgical outcomes at 1 year. RESULTS: Among 153 eyes of 133 patients, 131 (85.6%) and 22 (14.4%) eyes were categorized as the success and failure groups, respectively. The XGBoost was shown as the best-performance model with an AUROC value of 0.684, using only dataset A. The final three further prediction models were developed based on the combination of multiple datasets using the XGBoost model. All datasets combinations demonstrated the best performances in terms of AUROC (dataset A + B: 0.782; A + C: 0.773; A + B + C: 0.801). Furthermore, advancing age was a risk factor associated with a higher surgical failure incidence. CONCLUSIONS: ML provides some predictive value in predicting the outcomes of Ahmed valve implantation at 1 year. ML evaluation revealed advancing age as a common risk factor for surgical failure.

Comparison between primary Ahmed valve implantation and primary trabeculectomy with mitomycin C in pseudophakic patients with exfoliative glaucoma.

PURPOSE: To compare the efficacy and safety of primary Ahmed valve implantation (AVI) and primary trabeculectomy with mitomycin C (MMC) in patients with pseudophakic exfoliative glaucoma (XFG). METHODS: All enrolled patients were divided into two groups: the TRAB group, comprising patients who underwent trabeculectomy with MMC, and the AVI group, comprising patients who underwent AVI. Intraocular pressure (IOP), mean deviation (MD), endothelial cell density of cornea (ECD), and the number of topical anti-glaucoma agents used during study period were retrospectively analyzed. Surgical success rates were compared between two groups using Kaplan-Meier survival analysis. Three levels of surgical success were defined as follows: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% without medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% without medication; and (3) IOP ≤ 18 mmHg and an IOP reduction of 20%, irrespective of medication. RESULTS: The TRAB and AVI groups comprised 40 and 36 patients, respectively. At 36 months postoperatively, IOP was 15.7 ± 2.8 mmHg in the TRAB group and 16.9 ± 3.3 mmHg in the AVI group (p = 0.140). Surgical success rates in the TRAB group were 47.5, 37.5, and 77.5% and those in the AVI group were 41.6, 33.3, and 75.0% at 36 months for surgical criteria 1, 2, and 3, respectively. There were no statistically significant differences in the success rates between the two groups. However, regarding surgical criteria 2, the success rate of the AVI group at 1 year was significantly better than that of the TRAB group (p = 0.030). CONCLUSIONS: Primary AVI was not inferior to primary trabeculectomy with MMC in medically uncontrolled patients with XFG.

Vision outcomes in dogs with primary glaucoma surgically treated with lensectomy and endolaser cyclophotocoagulation after an Ahmed valve gonioimplantation failure.

OBJECTIVE: The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure. PROCEDURE: Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months. RESULTS: Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months. CONCLUSIONS: Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.

Posterior segment complications of Ahmed valve implantation.

BACKGROUND: To assess the time, incidence, and outcome of posterior segment complications of Ahmed valve implantation (AVI). METHODS: 248 eyes that underwent AVI were reviewed retrospectively. Visual acuity, preoperative characteristics, and postoperative posterior segment complications were assessed. RESULTS: The incidence of posterior segment complications of AVI was 31.4% (78/248). The mean follow-up period was 97.4 ± 53.5 months. The mean time to occur posterior segment complication was 1.5 months. The most common posterior segment complication was choroidal detachment (17.7%) and others included ocular decompression retinopathy (3.2%), hypotonic maculopathy (2.8%), vitreous hemorrhage (2.0%), retinal detachment (1.2%), endophthalmitis (1.2%), suprachoroidal hemorrhage (1.2%), epiretinal membrane (0.8%), cystoid macular edema (0.8%), and proliferative vitreoretinopathy (0.4%). Older age, hypertension, and postoperative hypotony had an increased risk of posterior segment complications of AVI. CONCLUSIONS: The overall incidence of posterior segment complications of AVI was 31.4%. Older age, hypertension, and postoperative hypotony were significantly associated with posterior segment complications of AVI.

Foreign body in the eye of a patient with developmental delay.

Foreign body in the eye is a relatively common emergency department (ED) chief complaint which does not usually lead to ophthalmologic intervention. We report a case of a 35-year-old male with a history of developmental delay who presented to our ED for evaluation of ocular foreign body. His reported foreign body was removed, and subsequently identified as an Ahmed Valve, a device used in the management of glaucoma. After removal in the ED, an exam under anesthesia was performed by ophthalmology the next morning with injection of antibiotics. Even patient presentations for seemingly simple, straightforward chief complaints deserve critical appraisal by emergency clinicians. When suspicions are raised or there is any doubt, specialty consultation should be obtained to ensure patients receive appropriate care and necessary follow up. This is especially true when history and exam are limited by other factors such as developmental delay, incomplete medical history, or altered mental status.

Various modalities for management of secondary angle closure neovascular glaucoma in diabetic eyes: 1-year comparative study.

PURPOSE: To compare outcome of 4 methods for management of angle closure neovascular glaucoma (NVG) in diabetic eyes. METHODS: Prospective comparative study, on 40 eyes (40 patients) with NVG. Patients were randomly assigned to group A (Trabeculectomy with MMC), B (Ahmed valve), C (Ex-Press Minishunt with MMC) or D (Diode cyclophotocoagulation). Patients were followed regularly for 1 year. MAIN OUTCOME MEASURES: intraocular pressure (IOP), best corrected visual acuity (BCVA), central foveal thickness (CFT), intraoperative bleeding, postoperative complications and 2ry intervention. RESULTS: Preoperative data were not significantly different between 4 groups. Postoperatively, there was significant drop in IOP in each group at each follow-up. Ahmed valve group showed least mean postoperative IOP and highest mean drop of the IOP at 1 day and 1 week postoperatively, while Ex-Press minishunt group had least mean postoperative IOP at 1 month and 3 months postoperatively. At 6 months and 1 year, there was no significant difference between 4 groups. BCVA was not significantly different between 4 groups. At 1 year, CFT was significantly lower in each of the 4 groups, and it was significantly the least in group A and highest in group D. Highest intraoperative bleeding was observed with trabeculectomy. Success rate was not significantly different among the 4 groups. CONCLUSION: The 4 management options showed a significant long-term effect on IOP, and on long-terms there was no significant difference between them for IOP and BCVA. Trabeculectomy showed highest incidence of intraoperative bleeding, while cyclophotocoagulation showed none.

Long-term results of glaucoma drainage device surgery.

BACKGROUND: To evaluate long-term results of eyes with glaucoma drainage device (GDD). METHODS: We retrospectively reviewed medical records of all patients who underwent GDD placement at our institution between 2001 and 2014. A total of 110 eyes of 90 patients were studied. Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Surgical procedures before and during the study period, and their complications were evaluated. RESULTS: The mean follow-up was 78.3 ± 44.0 months. The mean preoperative intraocular pressure was 30.8 ± 6.9 mmHg with 3.5 ± 1.1 glaucoma medications. At last postoperative follow-up, the mean IOP decreased to 14.3 ± 5.4 mmHg with 1.6 ± 1.5 glaucoma medications. GDD implantation successfully controlled glaucoma in 86, 85, 81, 78, 79, 76 and 73% of eyes at 1, 2, 3, 4, 5, 7 and 10 years, respectively. At last follow-up IOP was successfully controlled in 67% of eyes. Clinical complications occurred in 56.4% of eyes during the follow-up period. CONCLUSIONS: A glaucoma drainage device can successfully control intractable glaucoma even after a very long period of time.

Management and Systemic Implications of Diabetic Neovascular Glaucoma.

OBJECTIVES: To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular disease or death. METHOD: This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered. RESULTS: 30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis. CONCLUSIONS: Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.

Ahmed glaucoma valve implantation with Ologen® Collagen Matrix for the surgical treatment of feline glaucoma.

An Ahmed valve implantation with an Ologen® Collagen Matrix (Ologen® CM, Aeon Astron, Leiden, the Netherlands) was performed for the treatment of uncontrolled glaucoma in a cat. This cat was a 5-year-old castrated Russian Blue male with a 12-week history of conjunctival hyperemia and mydriasis of the left eye. During the ophthalmic examination, the intraocular pressure (IOP) oculus sinister (OS) was 52 mmHg, and a narrow iridocorneal angle (ICA) was detected by gonioscopy. Medical treatment with Cosopt® (2% dorzolamide and 0.5% timolol) failed to decrease the IOP. The left eye still had vision, and an Ahmed valve implantation was performed. During the gonioimplantation, Ologen® CM was used to inhibit scar formation around the valve. Following the operation, the IOP was stable at an approximate average of 15 mmHg during the 7-month follow-up period, and vision in the left eye was retained without medication. An adequate subconjunctival filtering bleb was formed after 140 days. This is the first case report in which an Ahmed valve gonioimplant with an Ologen® CM has been used for the surgical treatment of glaucoma in a cat.

[Ahmed valve in glaucoma surgery]. / Klapan Akhmeda v khirurgii glaukomy.

This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications.

BACKGROUND: Researches have shown anti-vascular endothelial growth factor (VEGF) agent is effective in treating neovascular eye diseases. The purpose of this study is to evaluate the efficacy and safety of intravitreal ranibizumab (IVR) injection combined trabeculectomy in the treatment of neovascular glaucoma (NVG), and compared it with Ahmed valve surgery. METHODS: Thirty-six NVG patients (37 eyes) from the First Affiliated Hospital of Zhejiang medical college, between January 1, 2014 and January 31, 2015, were included in this prospective, interventional clinical study. Eighteen NVG eyes were given IVR injection one week before trabeculectomy. Ahmed valve implantation surgery was performed in nineteen eyes. Ocular pain, best corrected visual acuity (BCVA), intraocular pressure (IOP) and surgical complications were evaluated before and after the surgery. RESULTS: IOP was significantly decreased following IVR injection combined trabeculectomy treatment (baseline 57.1 ± 8.9 mmHg; week 1, 15.2 ± 4.3 mmHg p = 0.000; month 1, 16.9 ± 2.1 mmHg p = 0.000; month 3, 20.3 ± 7.7 mmHg p = 0.000; month 6, 19.7 ± 7.3 mmHg p = 0.000). There was a significant, though modest, BCVA improvement in sighted eyes of IVR group (baseline 2.42 ± 0.68, W1 1.80 ± 0.91, P = 0.013; M1 1.77 ± 0.93, p = 0.011). IVR injection combined trabeculectomy had less postoperative complications and lower failure ratio than Ahmed surgery (IVR 5.6 %, Ahmed 31.6 %). CONCLUSIONS: The study revealed that IVR injection combined trabeculectomy was an effective and safe treatment for NVG. Compared with Ahmed surgery, IVR injection combined trabeculectomy had less complications and higher success ratio. (Chinese Clinical Registry, TRN ChiCTR-OPN-16008147, 3/24/2016, retrospectively registered).

Modified ex-PRESS technique versus Ahmed glaucoma valve as primary glaucoma surgery for hereditary transthyretin amyloidosis glaucoma.

BACKGROUND: To compare the efficacy of modified Ex-PRESS technique (ExP) versus Ahmed Glaucoma Valve (AGV) as primary surgery in hereditary transthyretin amyloidosis (ATTRv) secondary glaucoma. METHODS: Retrospective study at the national amyloidosis centre. Success was defined as an IOP ≥ 6 mmHg and ≤ 21 mmHg with no need for further glaucoma surgery or laser trabeculoplasty and without loss of light perception at the time of the last follow-up. Secondary outcomes included surgical complications, need for hypotensive drugs, and endothelial cell loss. Patients submitted to previous glaucoma surgery were excluded. RESULTS: We included 180 eyes of 150 patients, 121 in AGV and 59 in ExP group. No significant baseline differences were found between groups. At the time of last follow-up, both groups exhibited significant intraocular pressure (IOP) reduction (p < .001) and number of glaucoma medications (p < .001). Kaplan-Meyer analysis showed higher cumulative probability of success for AGV group (80.1% vs. 41.1%, p < .001) and higher mean time to failure (54.5 vs. 36.9 months, respectively, p < 0.001) at 60 months follow-up. AGV showed lower hazard (HR 0.21, 95% CI [0.111-0.407], p < .001) for failure. CONCLUSION: AGV and ExP are safe and effective techniques in the treatment of ATTRv secondary glaucoma. However, AGV's efficacy seems to be more durable.

Challenges of Secondary Glaucoma Management Following Congenital Cataract Surgery, Penetrating Keratoplasty and Vitreoretinal Surgery.

Glaucoma is one of the world's leading causes of irreversible vision loss. It is often asymptomatic until it reaches an advanced stage, which can have a significant impact on patients' daily lives. This paper describes the case of a 50-year-old female patient who presented with acute onset of ocular pain, photophobia, and loss of visual acuity in her right eye (RE). The patient's medical history includes congenital cataracts, surgical aphakia, nystagmus, strabismus, amblyopia, and secondary glaucoma. Ophthalmological examination showed BCVA RE-hand movement, left eye (LE)-0.08 with an intraocular pressure (IOP) of 30 mmHg in RE and 16 mmHg in LE. Biomicroscopic examination of RE showed corneal graft, epithelial and endothelial edema, endothelial precipitates, corneal neovascularization, aphakia, and Ahmed valve superotemporally. Despite maximal topical and systemic treatment, Ahmed valve, and trabeculectomy, secondary glaucoma in the right eye remained refractory. Reimplantation of an Ahmed valve was performed. This resulted in a favorable outcome with increased visual acuity and controlled intraocular pressure. The combination of aphakia, penetrating keratoplasty, and secondary glaucoma is a challenge for any surgeon. It is important that both the perioperative risks and the possible complications are carefully assessed in each patient, especially if associated pathology is present.

Case report: Introduction of an Ahmed valve implant tube into the ciliary sulcus using a guide-wire.

BACKGROUND: Glaucoma is a progressive optic neuropathy and it is the main cause of irreversible blindness worldwide. Intraocular pressure (IOP) is the only modifiable one and trabeculectomy is commonly considered the surgical "gold standard" to decrease IOP. In particular cases, other kind of surgeries, as the Ahmed Glaucoma Valve (AGV) implant, are a reliable alternative. Usually, the silicone tube of AGV surgery is inserted into the anterior chamber. Sometimes it is necessary to place the AGV silicone tube in the ciliary sulcus, especially in cases of endothelial decompensation. This surgical procedure is not always easy to perform. CASE PRESENTATION: This article describes and presents a technique for inserting the AGV tube into the posterior chamber using a guide-wire, in a total of 12 cases are reported. This procedure has been mostly applied in a group of pseudophakic patients who need AGV placement to control elevated IOP. In exceptional situations, this procedure was applied in pseudophakic patients previously with AGV tube implanted in the anterior chamber and with loss of endothelial cells or in phakic patients with previously implanted AGV anterior chamber tube, simultaneously to cataract surgery. CONCLUSION: The purpose of these cases presentations attended at our service is to demonstrate the passage of the AGV silicone tube was performed with the aid of a guide wire.

Effectiveness of pars plana Ahmed® valve implantation in patients with refractory glaucoma.

PURPOSE: To evaluate the success rate and complications of the Ahmed FP7 valve implanted via Pars Plana in a group of vitrectomized patients with refractory glaucoma and anterior segment abnormalities from January 2018 to June 2023. METHODS: Quasi-experimental, prospective study. Eleven eyes with refractory glaucoma were included. Participants underwent a comprehensive ophthalmic examination, including assessment of intraocular pressure (IOP) reduction, visual acuity, characterization of glaucoma type, and number of antiglaucoma medications. RESULTS: The mean baseline IOP was 37.3 ±â€¯11 mmHg, which decreased to 13.5 ±â€¯3.0 mmHg after one year. The qualified success rate was 63.7%, while the complete success rate was 36.3%. The most common diagnosis was neovascular glaucoma in 36.4% of cases. The most frequent postoperative complications were choroidal detachment and hypotony. CONCLUSIONS: Our data suggest that implantation of the Ahmed FP7 valve via pars plana is an effective and safe option for patients with refractory secondary glaucoma.

Update on Diagnosis and Treatment of Uveitic Glaucoma.

Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.

Long-Term Clinical Outcomes of Ahmed Valve Implantation in Aniridic Glaucoma.

BACKGROUND: This study assessed the efficacy and safety of Ahmed valve implantation in patients with aniridic glaucoma for three consecutive years. METHODS: Six adult patients (seven eyes) with Ahmed valve (AV) implants for aniridic glaucoma were enrolled in the study. The primary outcome measures were intraocular pressure reduction, glaucoma medication use, success rates, and visual acuity after AV implantation. A 30% reduction in IOP from baseline without the need for re-intervention was considered an effective treatment. The cessation of antiglaucoma medications was defined as complete success. Intraoperative and postoperative complications were included as secondary outcome measures. Measurements were performed preoperatively, at the first week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively. RESULTS: A total of seven eyes (6 patients) were evaluated 36 months after AV implantation. The mean ± SD values of IOP preoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively were 30.4 ± 4.0 mmHg, 14.6 ± 4.6 mmHg, 16.1 ± 4.6 mmHg, 20.7 ± 7.0 mmHg, 14.5 ± 2.7 mmHg, 16.5 ± 5.9 mmHg, 16.2 ± 4.0 mmHg, 16.3 ± 4.3 mmHg, 17.2 ± 10.1 mmHg, 17.6 ± 6.9 mmHg, and 18.2 ± 5.5 mmHg, respectively. At the last follow up, the mean IOP was reduced by 40.2%. The qualified success rate was 85.7%. One patient (one eye) at the last follow-up visit did not require antiglaucoma medications, resulting in a complete success rate of 14.3%. Intra- and postoperative mild or moderate subconjunctival bleeding was observed in all the patients. No other major/minor intraoperative or postoperative complications were noted. CONCLUSIONS: In long-term follow up, the AV implantation procedure is well-tolerated and relatively safe for reducing IOP in adult aniridia patients with glaucoma. These results should be validated through studies involving a larger patient cohort.

Efficacy and safety of combined 27-G vitrectomy and Ahmed valve using same sclerotomy site for the tube placement: A case series.

We report a retrospective case series describing the feasibility and outcomes of combined 27-G minimally invasive vitrectomy surgery (MIVS) and Ahmed® Glaucoma Valve (AGV) placement. Four eyes of four patients underwent a combined MIVS using 27-G technology and AGV implantation with the tube placement in the vitreous cavity. Preoperative and postoperative data up to 12 months were collected including the type of glaucoma, intraocular pressure (IOP), glaucoma medications, and complications. All AGVs tubes were placed in the vitreous cavity using the same sclerotomy, although a slight wound enlargement was required. After one year, IOP and glaucoma medications were reduced (41.5 ±â€¯19.1-14.5 ±â€¯3.1 mmHg and from 3(3-3) to 1.5 (1.5-3.5). Three patients developed cystoid macular edema. The first-reported cases of combined MIVS-27-G and AGV showed a reduction of IOP and antiglaucoma medication. Placing the tube using the same sclerotomy location is feasible but a slight enlargement may be required.

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma.

We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy (n =16) or Ahmed valve implantation (n = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, p = 0.987). The mean IOPs were similar as well (p = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; p = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group (p = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.

Pars Plana Ahmed Valve Implantation for Vitrectomized Eyes With Refractory Glaucoma.

This study aimed to analyze the surgical outcomes of pars plana Ahmed valve implantation in vitrectomized eyes with refractory glaucoma. We performed a retrospective case review of consecutive patients with refractory glaucoma after undergoing pars plana vitrectomy who underwent pars plana Ahmed valve implantation between July 2019 and December 2020 at the glaucoma unit of the Affiliated Changshu Hospital of Xuzhou Medical University (Changshu, China). All the patients were followed up for ≥12 months postoperatively. We recorded pre- to postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of anti-glaucoma medication, corneal endothelial count, and surgical complications, if any. There was a significant improvement in the median BCVA from 2.30 (0.87, 2.30) logMAR preoperatively to 1.70 (0.70, 2.30) logMAR at discharge and 1.0 (0.52, 1.85) at final examination (p = 0.011, p = 0.001). Compared with the preoperative IOP level, there was a significant decrease in the postoperative IOP at each postoperative time point (p < 0.001). There was a significant reduction in the median number of anti-glaucoma drugs (including postoperative ocular massage), from 3.00 (2.00, 3.00) preoperatively to 0.00 (0.00, 1.00) at the last follow-up postoperative examination (p < 0.001). A 29-year-old woman with proliferative diabetic retinopathy who underwent surgical treatment at 5 months postoperatively for fibrous wrapping formed around the plate of the Ahmed valve showed an IOP of 14 mmHg at the last follow-up. Our findings indicated that pars plana Ahmed valve implantation can be safely performed for managing vitrectomized eyes with refractory glaucoma.