Korean J Ophthalmol.  2012 Dec;26(6):432-437. 10.3341/kjo.2012.26.6.432.

Clinical Outcomes after Combined Ahmed Glaucoma Valve Implantation and Penetrating Keratoplasty or Pars Plana Vitrectomy

Affiliations
  • 1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sungeye@gmail.com
  • 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To evaluate whether a combination of penetrating keratoplasty (PKP) or pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation affords a level of success similar to that of AGV implantation alone.
METHODS
Eighteen eyes underwent simultaneous PPV and AGV, 14 eyes with PKP and AGV and 30 eyes with AGV implantation alone were evaluated. Success was defined as attainment of an intraocular pressure (IOP) >5 and <22 mmHg, with or without use of anti-glaucoma medication. Kaplan-Meier survival analysis was performed to compare cumulative survival between the combined surgery groups and the AGV implantation-alone group. Cox proportional hazard regression analysis was conducted to identify factors predictive of success in each of the three groups.
RESULTS
Mean (+/-standard deviation) preoperative IOP was 30.2 +/- 10.2 mmHg in the PKP + AGV, 35.2 +/- 9.8 mmHg in the PPV + AGV, and 36.2 +/- 10.1 mmHg in the AGV implantation-alone group. The cumulative success rate at 18 months was 66.9%, 73.2%, and 70.8% in the three groups, respectively. Neither combined surgery group differed significantly in terms of cumulative success rate compared with the AGV implantation-alone group (p = 0.556, p = 0.487, respectively). The mean number of preoperative anti-glaucoma medications prescribed was significantly associated with success in the PKP + AGV implantation group (hazard ratio, 2.942; p = 0.024).
CONCLUSIONS
Either PKP or PPV performed in conjunction with AGV implantation afforded similar success rates compared to patients treated with AGV implantation alone. Therefore, in patients with refractory glaucoma who have underlying corneal or retinal pathology requiring treatment with PKP or PPV, AGV implantation can be performed simultaneously.

Keyword

Ahmed valve; Glaucoma; Intraocular pressure; Pars plana vitrectomy; Penetrating keratoplasty

MeSH Terms

Female
Follow-Up Studies
Glaucoma/physiopathology/*surgery
*Glaucoma Drainage Implants
Humans
*Intraocular Pressure
Keratoplasty, Penetrating/*methods
Male
Middle Aged
Prosthesis Implantation/*methods
Retrospective Studies
Tonometry, Ocular
Treatment Outcome
Vitrectomy/*methods

Figure

  • Fig. 1 The cumulative success rates of the three groups determined by Kaplan Meier analysis. AGV = Ahmed glaucoma valve; PKP = penetrating keratoplasty; PPV = pars plana vitrectomy.


Cited by  1 articles

Influence of Vitrectomy-related Factors on the Outcome of Ahmed Glaucoma Valve Implantation
Jaehyuck Jo, Kyung Rim Sung, Yoon Jeon Kim
Korean J Ophthalmol. 2018;32(5):400-408.    doi: 10.3341/kjo.2017.0127.


Reference

1. Kirkness CM, Steele AD, Ficker LA, Rice NS. Coexistent corneal disease and glaucoma managed by either drainage surgery and subsequent keratoplasty or combined drainage surgery and penetrating keratoplasty. Br J Ophthalmol. 1992. 76:146–152.
2. Arroyave CP, Scott IU, Fantes FE, et al. Corneal graft survival and intraocular pressure control after penetrating keratoplasty and glaucoma drainage device implantation. Ophthalmology. 2001. 108:1978–1985.
3. Al-Torbak A. Graft survival and glaucoma outcome after simultaneous penetrating keratoplasty and ahmed glaucoma valve implant. Cornea. 2003. 22:194–197.
4. Rapuano CJ, Schmidt CM, Cohen EJ, et al. Results of alloplastic tube shunt procedures before, during, or after penetrating keratoplasty. Cornea. 1995. 14:26–32.
5. Kwon YH, Taylor JM, Hong S, et al. Long-term results of eyes with penetrating keratoplasty and glaucoma drainage tube implant. Ophthalmology. 2001. 108:272–278.
6. Coleman AL, Mondino BJ, Wilson MR, Casey R. Clinical experience with the Ahmed glaucoma valve implant in eyes with prior or concurrent penetrating keratoplasties. Am J Ophthalmol. 1997. 123:54–61.
7. Faghihi H, Hajizadeh F, Mohammadi SF, et al. Pars plana Ahmed valve implant and vitrectomy in the management of neovascular glaucoma. Ophthalmic Surg Lasers Imaging. 2007. 38:292–300.
8. Lee KS, Sung KR, Na JH, et al. Clinical results of modified anterior chamber tube shunt to an encircling band surgery for uncontrolled intraocular pressure. J Glaucoma. 2011. 06. 22. [Epub]. DOI: 10.1097/IJG.0b013e318225b428.
9. Minckler DS, Heuer DK, Hasty B, et al. Clinical experience with the single-plate Molteno implant in complicated glaucomas. Ophthalmology. 1988. 95:1181–1188.
10. Coleman AL, Hill R, Wilson MR, et al. Initial clinical experience with the Ahmed glaucoma valve implant. Am J Ophthalmol. 1995. 120:23–31.
11. Lloyd MA, Baerveldt G, Fellenbaum PS, et al. Intermediate-term results of a randomized clinical trial of the 350- versus the 500-mm2 Baerveldt implant. Ophthalmology. 1994. 101:1456–1463.
12. Lavin MJ, Wormald RP, Migdal CS, Hitchings RA. The influence of prior therapy on the success of trabeculectomy. Arch Ophthalmol. 1990. 108:1543–1548.
13. Brandt JD, Wittpenn JR, Katz LJ, et al. Conjunctival impression cytology in patients with glaucoma using long-term topical medication. Am J Ophthalmol. 1991. 112:297–301.
14. Baudouin C, Garcher C, Haouat N, et al. Expression of inflammatory membrane markers by conjunctival cells in chronically treated patients with glaucoma. Ophthalmology. 1994. 101:454–460.
15. Broadway DC, Grierson I, O'Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol. 1994. 112:1446–1454.
16. Broadway DC, Grierson I, O'Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol. 1994. 112:1437–1445.
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr