Flow Pressure Characteristics of the Ahmed Glaucoma Valve and Possible Effect of Entrapped Air in the Tube.

PURPOSE

The purpose of this study was to assess the pressure characteristics of the Ahmed Glaucoma Valve (AGV) and possible effects of air trapped in the tube.

METHOD

Physiologic saline was pumped through 17 AGVs using a syringe infusion pump, and the flow pressure was measured by a set of pressure transducers. During the infusion at a rate of 2 µL/minute, the pressure measurement was repeated twice in each AGV to determine the repriming pressures with/without air (1 µL) in the tube.

RESULTS

After a pressure surge occurred during the initial priming, the pressure decreased suddenly and then became constant. The repriming pressure, determined as the peak pressure before valve opening, was significantly (P < 0.0001, paired t-test) higher with air (26.5 ± 6.8 mm Hg) than without air (12.1 ± 3.8 mm Hg), whereas the constant pressures after repriming was equivalent between with (10.6 ± 3.7 mm Hg) and without (10.4 ± 2.9 mm Hg) air conditions (P = 0.68).

CONCLUSIONS

Air in the AGV tube causes increased repriming pressure of about two-fold compared to repriming without air. This pressure increment caused by air in the capillary-sized tube might occur because of the effects of viscosity pressure and capillary pressure.

TRANSLATIONAL RELEVANCE

To ensure stable surgical results, surgeons are advised to not allow air to remain in the tube. Pars plana tube insertion of the AGV combined with gas tamponade surgery may result in higher-than-expected intraocular pressure. Conversely, injection of air/gas can avoid postoperative hypotony when the AGV is implanted in eyes with a high risk of hypotony.