Matarazzo Francesco, Passaro Maria Laura, Rinaldi Michele, Afflitto Gabriele Gallo, Aiello Francesco, Avolio Fabio Claudio, Aurilia Alessandro, Strianese Diego, Nucci Carlo, Costagliola Ciro
Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy.
Department of Physics "Ettore Pancini", University of Naples "Federico II", Naples, Italy.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar 31. doi: 10.1007/s00417-025-06794-w.
BACKGROUND/AIMS: Glaucoma drainage devices (GDDs) are essential in managing complex glaucoma cases. This review focuses on the Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI), the most commonly used GDDs. We aim to evaluate complications associated with AGV and BGI, particularly post-operative hypotony.
We systematically reviewed randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing AGV and BGI. The primary outcome was persistent hypotony (IOP < 5 mmHg). Secondary outcomes included hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, vision loss, cystoid macular edema, diplopia, corneal decompensation, endophthalmitis, hyphema, further surgery for IOP control, tube interventions, exposure, and occlusion.
Thirteen studies (4 RCTs, 9 NRSs) with 2,513 eyes were analyzed. AGV was associated with a lower incidence of persistent hypotony in RCTs (0.6% vs. 4.4%, p = 0.006), choroidal effusion (4.95% vs. 15.8%, p < 0.0001), vision loss (9% vs. 18.9%, p = 0.01), and cystoid macular edema (2.5% vs. 9.6%, p = 0.009). BGI showed a lower need for further surgery to control IOP in RCTs (14.5% vs. 7.5%, p = 0.01). No significant differences were found for other outcomes, including suprachoroidal hemorrhage, corneal decompensation, and tube-related complications.
AGV seems to offers a safer profile with fewer hypotony-related complications compared to BGI. Personalized device selection is crucial for optimizing glaucoma surgery outcomes. Further high-quality, well-designed studies are needed to validate those results.
背景/目的：青光眼引流装置（GDDs）在复杂青光眼病例的管理中至关重要。本综述聚焦于最常用的GDDs，即艾哈迈德青光眼阀（AGV）和贝尔维尔德青光眼植入物（BGI）。我们旨在评估与AGV和BGI相关的并发症，尤其是术后低眼压。
我们系统回顾了比较AGV和BGI的随机对照试验（RCTs）和非随机研究（NRSs）。主要结局是持续性低眼压（眼压<5 mmHg）。次要结局包括低眼压性黄斑病变、脉络膜积液、脉络膜上腔出血、视力丧失、黄斑囊样水肿、复视、角膜失代偿、眼内炎、前房积血、为控制眼压而进行的进一步手术、引流管干预、引流管暴露和阻塞。
分析了13项研究（4项RCTs，9项NRSs），共2513只眼。在RCTs中，AGV与持续性低眼压的发生率较低相关（0.6%对4.4%，p = 0.006）、脉络膜积液（4.95%对15.8%，p < 0.0001）、视力丧失（9%对18.9%，p = 0.01）和黄斑囊样水肿（2.5%对9.6%，p = 0.009）。在RCTs中，BGI显示为控制眼压而进行进一步手术的需求较低（14.5%对7.5%，p = 0.01）。对于其他结局，包括脉络膜上腔出血、角膜失代偿和引流管相关并发症，未发现显著差异。
与BGI相比，AGV似乎具有更安全的特征，与低眼压相关的并发症更少。个性化的装置选择对于优化青光眼手术结局至关重要。需要进一步高质量、精心设计的研究来验证这些结果。
