Surgical Technique of Implantation: AGV, Limbal Variant

  • Shibal Bhartiya
  • Monica Gandhi


Ahmed Glaucoma Valve (AGV) is a drainage device used for both primary and refractory glauomas. The surgical technique of AGV implantation is simpler and easier than that for non-valved implants since the implant is limited to one quadrant and does not require manipulation of the recti muscles. Also, since the AGV is valved, manoeuvres like tube ligation and/or tube slits are not required. Because of this the incidence of hypotony in the early postoperative period is less than with non-valved implants, and these patients require relatively less postoperative follow-up and care. Common complications, as with all restrictive valve implants, include longer postoperative hypotensive phase, choroidal effusions and flat anterior chambers (Table 6.1).

Supplementary material

Video 6.1

(MP4 930337 kb)


  1. 1.
    Budenz DL, Barton K, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, Buys YM, Ahmed Baerveldt Comparison Study Group. Treatment outcomes in the Ahmed Baerveldt Comparison Study after 1 year of follow-up. Ophthalmology. 2011;118(3):443–52.CrossRefGoogle Scholar
  2. 2.
    Coleman AL, Hill R, Wilson MR, Choplin N, Kotas-Neumann R, Tam M, Bacharach J, Panek WC. Initial clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol. 1995;120(1):23–31.CrossRefGoogle Scholar
  3. 3.
    Das JC, Chaudhuri Z, Sharma P, Bhomaj S. The Ahmed Glaucoma Valve in refractory glaucoma: experiences in Indian eyes. Eye (Lond). 2005;19(2):183–90.CrossRefGoogle Scholar
  4. 4.
    Souza C, Tran DH, Loman J, Law SK, Coleman AL, Caprioli J. Long-term outcomes of Ahmed glaucoma valve implantation in refractory glaucomas. Am J Ophthalmol. 2007;144(6):893–900.CrossRefGoogle Scholar
  5. 5.
    Papadaki TG, Zacharopoulos IP, Pasquale LR, Christen WB, Netland PA, Foster CS. Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol. 2007;144(1):62–9.CrossRefGoogle Scholar
  6. 6.
    Patel S, Pasquale LR. Glaucoma drainage devices: a review of the past, present, and future. Semin Ophthalmol. 2010;25(5–6):265–70.CrossRefGoogle Scholar
  7. 7.
    Lai JS, Poon AS, Chua JK, Tham CC, Leung AT, Lam DS. Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma. Br J Ophthalmol. 2000;84(7):718–21.CrossRefGoogle Scholar
  8. 8.
    Pakravan M, Yazdani S, Shahabi C, Yaseri M. Superior versus inferior Ahmed glaucoma valve implantation. Ophthalmology. 2009;116(2):208–13.CrossRefGoogle Scholar
  9. 9.
    Nouri-Mahdavi K, Caprioli J. Evaluation of the hypertensive phase after insertion of the Ahmed glaucoma valve. Am J Ophthalmol. 2003;136:1001–8.CrossRefGoogle Scholar
  10. 10.
    Coleman AL, Hill R, Wilson MR, et al. Initial clinical experience with the Ahmed glaucoma valve implant. Am J Ophthalmol. 1995;120:23–31.CrossRefGoogle Scholar
  11. 11.
    Ayyala RS, Zurakowski D, Smith JA, et al. A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma. Ophthalmology. 1998;105:1968–76.CrossRefGoogle Scholar
  12. 12.
    Pakravan M, Rad SS, Yazdani S, Ghahari E, Yaseri M. Effect of early treatment with aqueous suppressants on Ahmed glaucoma valve implantation outcomes. Ophthalmology. 2014;121:1693–8.CrossRefGoogle Scholar
  13. 13.
    Costa VP, Azuara-Blanco A, Netland PA, et al. Efficacy and safety of adjunctive mitomycin C during Ahmed Glaucoma Valve implantation: a prospective randomized clinical trial. Ophthalmology. 2004;111:1071–6.CrossRefGoogle Scholar
  14. 14.
    Kurnaz E, Kubaloglu A, Yilmaz Y, et al. The effect of adjunctive mitomycin C in Ahmed glaucoma valve implantation. Eur J Ophthalmol. 2005;15:27–31.CrossRefGoogle Scholar
  15. 15.
    Alvarado JA, Hollander DA, Juster RP, Lee LC. Ahmed valve implantation with adjunctive mitomycin C and 5-fluorouracil: long-term outcomes. Am J Ophthalmol. 2008;146:276–84.CrossRefGoogle Scholar
  16. 16.
    Al-Mobarak F, Khan AO. Two-year survival of Ahmed valve implantation in the first 2 years of life with and without intraoperative mitomycin-C. Ophthalmology. 2009;116:1862–5.CrossRefGoogle Scholar
  17. 17.
    Zhou M, Wang W, Huang W, Zhang X. Use of Mitomycin C to reduce the incidence of encapsulated cysts following ahmed glaucoma valve implantation in refractory glaucoma patients: a new technique. BMC Ophthalmol. 2014;14:107.CrossRefGoogle Scholar
  18. 18.
    Eid TM, Radwan A, el-Manawy W, el-Hawary I. Intravitreal bevacizumab and aqueous shunting surgery for neovascular glaucoma: safety and efficacy. Can J Ophthalmol. 2009;44(4):451–6.CrossRefGoogle Scholar
  19. 19.
    Zhou MW, Wang W, Huang WB, Chen SD, Li XY, Gao XB, Zhang XL. Adjunctive with versus without intravitreal bevacizumab injection before Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma. Chin Med J. 2013;126(8):1412–7.PubMedGoogle Scholar
  20. 20.
    Zhou M, Xu X, Zhang X, Sun X. Clinical outcomes of Ahmed Glaucoma valve implantation with or without intravitreal Bevacizumab pretreatment for neovascular glaucoma: a systematic review and meta-analysis. J Glaucoma. 2016;25(7):551–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shibal Bhartiya
    • 1
  • Monica Gandhi
    • 2
  1. 1.Department of OphthalmologyFortis Memorial Research InstituteGurgaonIndia
  2. 2.Anterior Segment and Glaucoma Services, Department of OphthalmologyDr. Shroff’s Charity Eye HospitalNew DelhiIndia

Personalised recommendations