Retrospective analysis of patients with refractory glaucoma using Ahmed valve implantation

    Abstract

    Retrospective analysis of patients with refractory glaucoma using Ahmed valve implantation

    O.V. Chayka, A.E. Babushkin

    Ufa Eye Research Institute, Ufa

    Purpose. Analysis of clinical results of surgical interventions using the Ahmed valve implantation for refractory glaucoma in 64 patients (76 eyes).

    Material and methods. All patients were on maximum hypotensive therapy before the surgery. Preoperative visual acuity ranged from the correct light projection to 0.1. Tonometry indicators ranged from 25 to 49 mmHg. on average of 35.02±1.8 mmHg. In 47 (61.8%) cases anti-glaucoma fistulizing operations were performed previously. All patients underwent Ahmed valve implantation using the standard methods, and in 37 eyes (48.6%) it was done on the 9th day after anti-VEGF drugs administration.

    Results. Early postoperative complications: hyphema – 42.1%, ciliochoroidal detachment – 12%, mechanical tube blockage with a blood clot – 2.6%, excessive filtration – 3.9%. Within 3 months after the surgery the drainage tube was exposed in 2.6% of cases, which required its removal. After 24 months in 82.1% of cases there were observed the hypotensive effect, and in 46.4% of cases it was reached without medication and in 35.7% of cases IOP was normalized during constant instillation of hypotensive drugs. The treatment completely failed in 17.8% of the cases, and 5 patients had loss of visual functions due to the progression of proliferative diabetic retinopathy.

    Conclusion. Ahmed valve implantation is an effective treatment for refractory glaucoma. Of all the drains used in neovascular glaucoma, according to the authors' experience, Ahmed drainage implantation, especially with the preliminary introduction of anti-VEGF drugs, is the most effective measure when other surgical interventions were not efficient or provided only a short-term effect due to excessive postoperative scarring of the newly formed outflow pathways.

    Key words: refractory glaucoma, Ahmed valve, neovascular glaucoma, anti-VEGF drugs, hypotensive effect, postoperative scarring.