Outcomes of Ahmed Glaucoma Valve Implantation with Subsequent Trans-Scleral Diode Cyclophotocoagulation as the Main Intervention if IOP Remained Medically Uncontrolled.

PURPOSE

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation with subsequent trans-scleral diode cyclophotocoagulation (CPC) as the main intervention if IOP remained medically uncontrolled.

PATIENTS AND METHODS

Charts of 108 consecutive eyes (90 patients) that underwent AGV implantation from 2003 to 2018 at a single clinical practice were retrospectively reviewed. The procedure was considered a failure if any of the following occurred: additional incisional glaucoma surgery, IOP >21 mmHg or < 20% reduction from baseline on 2 consecutive study visits after 3 months, IOP ≤ 5 mmHg on 2 consecutive study visits after 3 months, loss of light perception, or AGV removal.

RESULTS

The mean follow-up time was 5.4 ± 3.1 years. Diode CPC was performed in 32%. The mean IOP was 24.8 ± 8.2 mmHg before intervention, and 12.5 ± 5.6 mmHg at last follow-up (p<0.0001). The mean logMAR VA decreased by 0.24 (p=0.002). The success rate was 68%. The reasons for failure were additional incisional glaucoma surgery in 7%, AGV removal in 4%, loss of light perception in 4%, inadequate IOP reduction in 13%, and IOP ≤ 5 mm HG in 6%. The probability of survival by Kaplan Meier analysis was 88%, 76% and 69% at 1, 3, and 5 years after the procedure, respectively. Complications of AGV and CPC were comparable to those previously reported in the literature.

CONCLUSION

The treatment approach of AGV implantation with subsequent trans-scleral diode CPC, as needed, was successful in over 2/3rd of subjects. This study adds to the literature supporting the use of CPC when IOP is medically uncontrolled after AGV.