Impact of same-session trabectome surgery on Ahmed glaucoma valve outcomes
- 73 Downloads
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.
KeywordsAhmed 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.
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.Bettin P, Khaw PT (2012) Glaucoma Surgery. Karger Medical and Scientific PublishersGoogle Scholar
- 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: https://doi.org/10.3928/15428877-20110224-94
- 9.Esfandiari H, Hassanpour K, Knowlton P, et al (2017) Trabectome surgery combined with Baerveldt glaucoma implantation negates tube fenestrationGoogle Scholar
- 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
- 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
- 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. https://doi.org/10.1007/s00417-017-3804-9
- 29.Mosaed - Clin Surg Ophthalmol S, 2014 (2014) The first decade of global trabectome outcomes. touchophthalmology.comGoogle Scholar