AIM

To analyze the trend in Ahmed glaucoma valve (AGV) utilization in recent years and to assess its current clinical profile and surgical indications in glaucoma management.

METHODS

A retrospective observational study was conducted at a tertiary hospital within the Spanish National Health System, evaluating AGV surgeries performed from 2010 to 2022. To characterize current AGV use, a subset of 156 eyes that underwent surgery in the past five years was analyzed. Clinical variables, including age, gender, glaucoma type, intraocular pressure (IOP), IOP-lowering medications, and visual field status, were collected from patients aged ≥ 18 years. Temporal trends, surgical indications, and their evolution were examined.

RESULTS

A total of 519 AGV implantations were included. AGV utilization increased from 15.2% of all glaucoma surgeries in 2010 to 27.5% in 2019 but significantly declined thereafter, reaching 6.9% in 2022 (p = 0.001). Among the 156 eyes in the recent subset, 93 had refractory glaucoma, which showed the most pronounced decline in AGV procedures and the poorest surgical outcomes. Eyes with sulcus-placed or aphakic lenses, uveitis, or neovascular glaucoma experienced a less marked reduction in AGV implantation rates. These cases presented with higher baseline IOP but exhibited less glaucomatous damage and a better response to AGV implantation.

CONCLUSION

AGV implantation has significantly declined over the past five years, particularly in refractory glaucoma. This trend may be attributed to the increased adoption of subconjunctival bleb-forming surgeries and to the impact of the COVID-19 pandemic. Despite this overall decline, AGV continues to be primarily employed in cases of secondary glaucoma.