Korean J Ophthalmol.  2018 Jun;32(3):211-220. 10.3341/kjo.2017.0105.

Factors Associated with Outcomes of Combined Phacoemulsification and Ahmed Glaucoma Valve Implantation

• Kwon J
• Sung KR

• KMID: 2412800
• DOI: http://doi.org/10.3341/kjo.2017.0105

Abstract

PURPOSE
To evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation.
METHODS
This retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg.
RESULTS
The mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008).
CONCLUSIONS
Combined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.

Keyword

Cataract; Glaucoma; Glaucoma drainage implants; Phacoemulsification

MeSH Terms

Cataract
Diagnosis
Follow-Up Studies
Glaucoma Drainage Implants
Glaucoma*
Glaucoma, Angle-Closure
Glaucoma, Neovascular
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Longitudinal Studies
Phacoemulsification*
Postoperative Complications
Prognosis
Retrospective Studies
Visual Acuity

Figure

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  Fig. 1 Graph showing trends in mean intraocular pressure from preoperative to the last follow-up visit (error bars indicate 95% confidence intervals).

• 

  Fig. 2 Kaplan-Meier survival curve with 95% confidence intervals for the total number of eyes undergoing combined phacoemulsification and Ahmed valve implantation.

• 

  Fig. 3 Kaplan-Meier survival curves for eyes with and without postoperative tube-iris touch.

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