Abstract

FR.10.09

Ahmed Glaucoma Valve with MMC after other antiglaucomatous surgery and in ‘predisposed’ eyes

Stefanie Pape, Anne Brüggemann, Maya Müller

Klinik für Augenheilkunde, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck

Purpose
The implantation of drainage systems for IOP lowering in eyes that has undergone antiglaucomatous surgery or after unsuccessful surgery, e.g. ‘predisposed’ fellow eyes gains rising interest.
Patients and Methods
Retrospective consecutive series of 55 eyes (e) of 47 patients who underwent Ahmed Glaucoma Valve (AGV) implantation in between 2004 and 2009 (53 in anterior chamber, 2 in pars plana). Analyzed data: type of glaucoma, lens status, best corrected visual acuity (BCVA), IOP, glaucoma medication preop. and at the end of follow-up, surgical procedures prior to AGV and complications. Mean follow-up: 12 months (2 – 44), mean age at the time of implantation: 67,4 years (25 - 86).
Results
Open angle glaucoma (POAG): 26 e, pseudoexfoliation glaucoma (PEX): 11 e, secondary glaucoma (SG): 11 e, angle-closure glaucoma (ACG): 7 e. 48 e were pseudophakic, 4 e phakic and 3 e aphakic. Prior  AGV interventions: trabeculectomy (TE) n=21, to Re-TE (n=4), LTP (n=10) and CPC (n=15). 19 fellow eyes have been treated primarily with filtration surgery, 14 of those with insufficient IOP reduction or postop. complications. All types of glaucoma revealed a signif. reduction of IOP: in total preop: 27,4mmHg (SD 8,4) to in total postop: 13,9mmHg (SD 3,6) [p<0,0001]; POAG: 25,0mmHg (SD 8,6) to 13,3mmHg (SD 3,3) [p<0,0001]; PEX: 27,8mmHg (SD 9,3) to 14,4mmHg (SD 3,4) [p<0,0001]; SG: 32,0mmHg (SD 7,3) to 14,0mmHg (SD 3,6) [p<0,0001]; ACG: 28,8mmHg (SD 4,3) to 15,2mmHg (SD 4,9) [p<0,05]. Mean IOP reduction with 18mmHg was most effective in the group of SG. BCVA showed no difference in any group preop. (logMar 0,72; SD 0,72) and after AGV implantation (logMar 0,81; SD 0,85). Regarding IOP and BCVA there was no difference between pat. treated with prior filtering surgery and without surgical intervention. The number of medication decreased from 2,8 at baseline to few individual cases (10 eyes, 21,8%) with 2,1 medication. A total of 16 e showed the following postop. events: transient increased IOP (n=5), hypotony requiring tube ligature (n=1), hyphaema with anterior chamber lavage (n=4), dislocation and repositioning of the tube (n=4), late IOP increase due to encapsulation of the AGV (n=4), 3 of the latter received a secondary AGV.
Conclusions 
In eyes with prior surgical intervention the implantation of AGV is an effective method independent of the type of glaucoma.

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