Impact of same-session trabectome surgery on Ahmed glaucoma valve outcomes

  • Hamed Esfandiari
  • Tarek Shazly
  • Priyal Shah
  • Kiana Hassanpour
  • Pooya Torkian
  • Mehdi Yaseri
  • Nils A. LoewenEmail author



To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A).


A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was success defined as IOP > 5 mmHg, ≤ 21 mmHg and ≥ 20% reduction of IOP from baseline at two consecutive visits after 3 months, and no need for glaucoma reoperation. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA).


The cumulative probability of success at 1 year was 70% in AT, and 65% in A (p = 0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p = 0.001). The corresponding numbers for A were 27.8 ± 10.2 and 16.7 ± 4.9, respectively (p = 0.001). The final IOP was significantly lower in AT (p = 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p = 0.851). Corresponding number at 1 year visit was 1.2 ± 2 in AT and 2.8 ± 1.8 in A (p = 0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p = 0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3 and 28.5%, respectively, p = 0.67).


Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.


Ahmed glaucoma valve Trabectome surgery Hypertensive phase Glaucoma surgery 



We acknowledge support from NIH CORE Grant P30 EY08098 to the Department of Ophthalmology, from the Eye and Ear Foundation of Pittsburgh, and from an unrestricted grant from Research to Prevent Blindness, New York, NY.


NIH CORE Grant P30 EY08098 to the Department of Ophthalmology, from the Eye and Ear Foundation of Pittsburgh, and from an unrestricted grant from Research to Prevent Blindness, New York, NY. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

HE, TS, PS, KH, PT, and MY have no financial disclosure. NAL has received honoraria for trabectome wet labs and lectures from Neomedix Corp.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.


  1. 1.
    Bettin P, Khaw PT (2012) Glaucoma Surgery. Karger Medical and Scientific PublishersGoogle Scholar
  2. 2.
    Tseng VL, Coleman AL, Chang MY, Caprioli J (2017) Aqueous shunts for glaucoma. Cochrane Database Syst Rev 7:CD004918PubMedGoogle Scholar
  3. 3.
    Pakravan M, Esfandiari H, Yazdani S et al (2017) Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial. Br J Ophthalmol 101:1275–1280CrossRefGoogle Scholar
  4. 4.
    Gedde SJ, Panarelli JF, Banitt MR, Lee RK (2013) Evidenced-based comparison of aqueous shunts. Curr Opin Ophthalmol 24:87–95CrossRefGoogle Scholar
  5. 5.
    Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL (2007) Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology 114:2265–2270CrossRefGoogle Scholar
  6. 6.
    Desai MA, Gedde SJ, Feuer WJ, et al (2011) Practice preferences for glaucoma surgery: a survey of the american glaucoma society in 2008. Ophthalmic Surg Lasers Imaging 42:
  7. 7.
    Budenz DL, Barton K, Feuer WJ et al (2011) Treatment outcomes in the Ahmed Baerveldt Comparison Study after 1 year of follow-up. Ophthalmology 118:443–452CrossRefGoogle Scholar
  8. 8.
    Riva I, Roberti G, Katsanos A et al (2017) A review of the Ahmed glaucoma valve implant and comparison with other surgical operations. Adv Ther 34:834–847CrossRefGoogle Scholar
  9. 9.
    Esfandiari H, Hassanpour K, Knowlton P, et al (2017) Trabectome surgery combined with Baerveldt glaucoma implantation negates tube fenestrationGoogle Scholar
  10. 10.
    Nouri-Mahdavi K, Caprioli J (2003) Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma valve. Am J Ophthalmol 136:1001–1008CrossRefGoogle Scholar
  11. 11.
    Ayyala RS, Zurakowski D, Smith JA et al (1998) A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma. Ophthalmology 105:1968–1976CrossRefGoogle Scholar
  12. 12.
    Eibschitz-Tsimhoni M, Schertzer RM, Musch DC, Moroi SE (2005) Incidence and management of encapsulated cysts following Ahmed glaucoma valve insertion. J Glaucoma 14:276–279CrossRefGoogle Scholar
  13. 13.
    Esfandiari H, Loewen NA, Hassanpour K, et al (2017) Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with MMCGoogle Scholar
  14. 14.
    Shelton L, Rada JS (2007) Effects of cyclic mechanical stretch on extracellular matrix synthesis by human scleral fibroblasts. Exp Eye Res 84:314–322CrossRefGoogle Scholar
  15. 15.
    Tripathi RC, Li J, Chan WF, Tripathi BJ (1994) Aqueous humor in glaucomatous eyes contains an increased level of TGF-beta 2. Exp Eye Res 59:723–727CrossRefGoogle Scholar
  16. 16.
    Pakravan M, Rad SS, Yazdani S et al (2014) Effect of early treatment with aqueous suppressants on Ahmed glaucoma valve implantation outcomes. Ophthalmology 121:1693–1698CrossRefGoogle Scholar
  17. 17.
    Yazdani S, Doozandeh A, Pakravan M et al (2017) Adjunctive triamcinolone acetonide for Ahmed glaucoma valve implantation: a randomized clinical trial. Eur J Ophthalmol 27:411–416CrossRefGoogle Scholar
  18. 18.
    Smith M, Geffen N, Alasbali T et al (2010) Digital ocular massage for hypertensive phase after Ahmed valve surgery. J Glaucoma 19:11–14CrossRefGoogle Scholar
  19. 19.
    Francis BA, See RF, Rao NA et al (2006) Ab interno trabeculectomy: development of a novel device (Trabectome™) and surgery for open-angle glaucoma. J Glaucoma 15:68CrossRefGoogle Scholar
  20. 20.
    Kaplowitz K, Bussel II, Honkanen R et al (2016) Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol 100:594–600CrossRefGoogle Scholar
  21. 21.
    Loewen RT, Roy P, Parikh HA et al (2016) Impact of a glaucoma severity index on results of trabectome surgery: larger pressure reduction in more severe glaucoma. PLoS One 11:e0151926CrossRefGoogle Scholar
  22. 22.
    Gedde SJ, Schiffman JC, Feuer WJ et al (2005) The tube versus trabeculectomy study: design and baseline characteristics of study patients. Am J Ophthalmol 140:275–287CrossRefGoogle Scholar
  23. 23.
    Neiweem AE, Bussel II, Schuman JS et al (2016) Glaucoma surgery calculator: limited additive effect of phacoemulsification on intraocular pressure in ab interno trabeculectomy. PLoS One 11:e0153585CrossRefGoogle Scholar
  24. 24.
    Won HJ, Sung KR (2016) Hypertensive phase following silicone plate Ahmed glaucoma valve implantation. J Glaucoma 25:e313–e317CrossRefGoogle Scholar
  25. 25.
    Molteno A, Dempster AG, Mills KB (1988) Methods of controlling bleb fibrosis around draining implants. In: Glaucoma. Proc 4th Int symposium of north eye institute. Manchester, UK. pp 192–211Google Scholar
  26. 26.
    Seah SKL, Gazzard G, Aung T (2003) Intermediate-term outcome of Baerveldt glaucoma implants in Asian eyes. Ophthalmology 110:888–894CrossRefGoogle Scholar
  27. 27.
    Allan EJ, Khaimi MA, Jones JM et al (2015) Long-term efficacy of the Baerveldt 250 mm2 compared with the Baerveldt 350 mm2 implant. Ophthalmology 122:486–493CrossRefGoogle Scholar
  28. 28.
    Kostanyan T, Shazly T, Kaplowitz KB et al (2017) Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching. Graefes Arch Clin Exp Ophthalmol.
  29. 29.
    Mosaed - Clin Surg Ophthalmol S, 2014 (2014) The first decade of global trabectome outcomes. touchophthalmology.comGoogle Scholar
  30. 30.
    Parikh HA, Bussel II, Schuman JS et al (2016) Coarsened exact matching of phaco-trabectome to trabectome in phakic patients: lack of additional pressure reduction from phacoemulsification. PLoS One 11:e0149384CrossRefGoogle Scholar
  31. 31.
    Dang Y, Kaplowitz K, Parikh HA et al (2016) Steroid-induced glaucoma treated with trabecular ablation in a matched comparison with primary open-angle glaucoma. Clin Exp Ophthalmol 44:783–788CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, School of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Ophthalmic Research CenterShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran

Personalised recommendations