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@#AIM:To assess the efficacy of Ahmed glaucoma valve implantation combined with lens extraction for neovascular glaucoma(NVG)with cataract.<p>METHODS: A retrospective comparative study was designed. 93 patients with NVG were enrolled. All patients received preoperative anti-vascular endothelial growth factor(VEGF)injections, 41 eyes underwent Ahmed glaucoma valve(AGV)implantation only, and 52 eyes underwent AGV implantation and lens extraction by phacoemusification. The best corrected visual acuities(BCVA), intraocular pressure(IOP), and surgical complications were evaluated.<p>RESULTS: Postoperative visual acuity was improved in 16 eyes(39%), decreased in 14 eyes(34%), unchanged in 11 eyes(27%)in group 2, and 15 eyes(29%)improved,24 eyes(46%)decreased, 13 eyes(25%)unchanged in group 1 respectively(<i>P</i>>0.05). The group 2 demonstrated an 51% complete and 22% qualified success rate and 27% failure rate, and the 44% complete and 25% qualified success rate and 31% failure rate in group 1(<i>P</i>>0.05). Among the complications, fibrous exudation(56%)was the first, hyphema(46%)came second in group 2, while shallow anterior chamber(35%)was the most, fibrous exudations(31%)and anterior chamber hyphema(25%)followed in the group 1. And no tube extrusion serious complication had occurred in both groups(<i>P</i><0.05). No significant differences in postoperative complications were observed between the groups(<i>P</i>>0.05).<p>CONCLUSION: For NVG with cataract, AGV implantation with lens extraction is a priority for reduction of IOP and improvement of visual acuity.
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@#AIM: To compare the clinical efficacy of two methods for treating refractory glaucoma.<p>METHODS: A total of 30 patients with refractory glaucoma(32 eyes)selected from our hospital from January 2014 to September 2018 were retrospectively analyzed. According to the treatment methods, they were divided into experimental group(16 eyes treated by modified Ahmed glaucoma valve implantation)and control group(16 eyes treated by traditional Ahmed glaucoma valve implantation). The visual acuity, intraocular pressure, number of anti-glaucoma drugs, the success rate, complications and average length of hospitalization were compared between the two groups, during follow-up at post operative 1d, 1wk, 1mo, 3mo and 6mo.<p>RESULTS:There was no significant difference in intraocular pressure between the two groups at post-operative 1d, 1wk, 1mo, 3mo, 6mo(all <i>P</i>>0.05). The total success rate was 87%(14/16)in experimental group while 75%(12/16)in control group(<i>P</i>=0.654). BCVA did not improve significantly at post operative 6 mo compared with baseline in both groups(<i>P</i>>0.05). The average length of hospital stay in the experimental group(4.50±1.37d)was significantly lower than that in the control group(7.63±3.69d)(<i>P</i>=0.003). The incidece of shallow anterior chamber was 31% in control group, while in experimental group, it was 0, which showed significant difference.<p>CONCLUSION: Modified Ahmed drainage valve implantation is an effective method for treating refractory glaucoma, with more simple operations, shorter hospitalizing time and lower incidence of shallow anterior chamber.
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@#AIM: To observe the clinical efficacy of intravitreal injection of conbercept combined with trabeculectomy and conbercept combined with Ahmed glaucoma valve implantation in treatment of neovascular glaucoma(NVG).<p>METHODS: Totally 40 cases(40 eyes)of NVG patients selected from our hospital from February 2016 to June 2017 were retrospectively analyzed. According to the treatment methods, they were divided into group A(conbercept with trabeculectomy+ panretinal photocoagulation)and group B(conbercept combined with Ahmed glaucoma valve implantation+ panretinal photocoagulation), 20 cases(20 eyes)in each group. The visual acuity, intraocular pressure, intraocular pressure control rate, neovascularization were observed after 6mo follow-up.<p>RESULTS: Before treatment, there was no significant difference in intraocular pressure between the two groups(<i>P</i>>0.05). The intraocular pressure in group B was lower than that in group A(<i>P</i><0.05)at 6mo after treatment, but there was no significant difference in visual acuity, intraocular pressure control rate and the regression of neovascularization between the two groups(All <i>P</i>>0.05).<p>CONCLUSION: Intravitreal injection of conbercept combined with Ahmed glaucoma valve implantation and conbercept combined with trabeculectomy for NVG are safe and effective, but the former is more effective in reducing intraocular pressure.
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·AIM: To study the influence of Ahmed glaucoma valve implantation on eyesight, intraocular pressure and corneal endothelial cell density of patients with traumatic angle recession glaucoma. ·METHODS: Totally 33 cases (35 eyes) of patients with traumatic angle recession glaucoma admitted to our hospital since June 2014 to June 2016 were selected and treated with Ahmed glaucoma valve implantation. The clinical data of all patients were retrospectively analyzed, so as to evaluated to success rate of surgery. Non-contact tonometer was applied to surveying intraocular pressure before treatment and at 1wk, 1,3,6mo and 1a post treatment. Specular microscope was adopted to examine and calculate the corneal endothelial cell density before treatment and at 1wk, 1, 3, 6mo and 1a post treatment. All affected eyes were compared for visual acuity before surgery and in 1a after surgery, moreover, patients were followed - up, received the further consultations and the complications were recorded. ·RESULTS: As for 35 affected eyes, the absolute success rate of surgery was 54% , while the relative success rate was 40% , and the total successful rate and failure rate were 94% and 6% respectively. In terms of the number of people who had no light sensation before surgery, or who had light sensation, ≤0. 01, 0. 01-0. 10 or >0. 10-0. 20, there was no significant difference (Z=-0. 132, P=0. 362). The intraocular pressure before treatment was 43. 43 ± 3. 65mmHg, at 1wk after surgery was 13. 50 ± 2. 54mmHg, at 1mo was 15. 93 ± 2. 61mmHg, at 6mo was 16. 00 ± 2. 18mmHg and at 1a was 16. 45 ± 2. 21mmHg, and the difference among different time points had statistical significance (F= 887. 82, P<0. 01). After treatment the intraocular press decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other ( P> 0. 05 ). Before treatment, the corneal endothelial cell density was 2443. 35 ± 343. 12 pieces/mm2, in 1wk after the surgery was 2231.67±334.45 pieces /mm2, in 1mo after the surgery was 2065. 47 ± 336. 45 pieces /mm2, in 3mo after surgery was 2031. 47 ± 345. 76 pieces/mm2, in 6mo was 2001. 72±337. 18 pieces /mm2and in 1a after the surgery was 1979. 65 ± 301. 32 pieces /mm2, and the difference among different time points had statistical significance ( F = 13. 49, P<0. 01 ). After treatment the corneal endothelial cell density decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other (P>0. 05). After surgery, there were 4 cases (4 eyes) of ocular hypotension, 3 cases (3 eyes) of hyphema, 2 cases ( 2 eyes) of drainage tube plugging and 2 cases ( 2 eyes ) of intraocular hypertension, which were all quickly relieved after basic intervention treatment. · CONCLUSION: Treating traumatic angle recession glaucoma with Ahmed glaucoma valve implantation can dramatically optimize the state of intraocular hypertension and protect the retaining visual acuity, and visual acuity can be optimized in some cases. It causes little complication that can be relieved with basic prognosis, but postoperative corneal endothelial cell loss exists in some cases.
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Neovascular glaucoma (NVG) is a kind of devastating secondary glaucoma characterized by neovascularization in iris and anterior chamber angle,which often results in loss of vision.The current standard of treatment includes retinal ablation and control of enhanced intraocular pressure with drugs and surgical therapy.There are a lot of surgical therapies of NVG,while the prognosis of these therapies are not satisfactory as most of them would be effected by different kinds of complications.Ahmed glaucoma valve implantation (AGVI) is one of the main treatments means being widely used with less postoperative complications,such as shallow anterior chamber,low intraocular pressure.Failure of AGVI mainly caused by fiber hyperplasia and neovascularization.AGVI combined with anti-fibrosis therapy and anti-vascular endothelial growth factor (VEGF) therapy might be a promising method to promote surgical outcomes.It has been shown that AGVI combined with anti-VEGF drugs can improve the success rate of surgery.Besides,some researchers found that AGVI with intraoperative application of anti-fibrosis drugs,such as mitomycin C,sustained-release anti-fibrosis drugs can improve the prognosis of surgery in neovascular glaucoma patients.The progress of research on anti-fibrosis and anti-VEGF treatment combined with Ahmed glaucoma valve implantation was discussed in this review.
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Background The aqueous flare is obvious in uveitic glaucomatous eye due to the damage of blood-aqueous barrier,especially following intraocular surgery.How to quantitatively determine the aqueous flare is important for us to understand the severity of inflammatory response.Objective This study was to assess inflammatory response following Ahmed glaucoma valve implantation in uveitic glaucomatous eye.Methods A nonrandomized controlled study was carried out under the approval of Ethic Committee of Zhongshan Ophthalmic Center of Sun Yat-sen University.Twenty-nine eyes of 29 subjects with refractory glaucoma were enrolled this hospital from October 2011 through July 2012.The patients were divided into the uveitic glaucoma group (10 eyes) and the other refractory glaucoma group (19 eyes) with the matched demography,and Ahmed glaucoma valve implantation was performed on all the eyes under the informed consent of each patient.The aqueous flare value was determined with FC-2000 flare-cell photometry and intraocular pressure (IOP) was measured with Goldmann tonometer before surgery and 1 day,3 days,1 week,2 weeks,1 month and 3 months after surgery.The outcomes were compared between the two groups,and the correlation of aqueous flare value with IOP was analyzed.Results In the uveitic glaucoma group,the aqueous flare values were 21.10 (10.50,38.58) photoparticles/ms,88.00 (23.55,168.63) photoparticles/ms and 29.90 (8.90,65.18)photoparticles/ms 1 day,3 days and 1 week after surgery,which were significantly higher than 13.53 (7.60,24.00) photoparticles/ms before surgery (all at P＜0.01).The same trend was found in the other refractory glaucoma group.In addition,the aqueous flare value was higher in the uveitic glaucoma group than that in the other refractory glaucoma group in 3 months after surgery (q=-3.445,P＜0.01).No significant differences were seen in IOP between the two groups at various time points (all at P＞0.05).Also,no significant correlations were seen between IOP and aqueous flare value in all patients at various time points (preoperation:rs =0.136,P =0.481; postoperative 1 day:rs =0.019,P =0.922 ; postoperative 3 days:rs =-0.035,P =0.858 ; postoperative 1 week:rs =0.317,P=0.094; postoperative 2 weeks:rs =0.034,P =0.861 ; postoperative 1 month:rs =-0.094,P =0.628 ; postoperative 3 months:rs =0.065,P =0.738).Conclusions FC-2000 flare-cell photometry can reflect the inflammatory reaction of the anterior chamber following Ahmed glaucoma valve implantation in various types of refractory glaucomatous eyes.The postoperative inflammatory response is more serious and lasting in uveitic glaucomatous eye.
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?AlM: To investigate the outcome and safety of Ahmed glaucoma valve implantation treatment in uncontrolled primary congenital glaucoma ( PCG) . ? METHODS: Twenty - two eyes in 22 children with uncontrolled PCG were reviewed retrospectively and underwent Ahmed glaucoma valve implantation treatment from January 2011 to December 2014. Main checking index included intraocular pressure ( lOP ) before and after operation, corneal diameter and complications. ?RESULTS: Preoperative mean age was 3. 74±2. 24y, and 2. 59 ± 1. 78y apart from the last operation. Postoperative average lOP was 35. 22 ± 6. 36mmHg. Average corneal diameter was 12. 79 ± 0. 75mm. Mitomycin C ( 0. 3 - 0. 5mg/mL ) was used in all operations for 3-5min. Glaucoma valves were implanted in the temporal or nose above the equator sclera. Postoperative lOP was 11. 4±4. 45mmHg at 1wk, and 16. 73± 7. 23mmHg after 12mo. As lOP ?CONCLUSlON:Ahmed glaucoma valve implantation in uncontrolled PCG is a safe and viable treatment.
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?AlM: To compare clinical efficacy between Ahmed glaucoma valve implantation and trabeculectomy in patients with primary open angle glaucoma ( POAG) . ?METHODS: This retrospective study included 58 eyes from 45 patients with primary open angle glaucoma. And 32 eyes underwent penetrating trabeculectomy ( group A), while 26 eyes were performed Ahmed glaucoma valve implantation ( group B) . lntraocular pressure ( lOP) , best-corrected visual acuity ( BCVA ) , visual field and post-operative complications were observed between these two groups. ?RESULTS:(1) lOP:the lOP of post-operation in group A were (13. 56±4. 91), (14. 47±4. 03), (17. 56±5. 74), (18. 25±5. 49), (18. 13±4. 24), (19. 68±4. 55) mm Hg at 2d, 1, and 2wk, 1, 3 and 6mo respectively; and that were (13.58±4. 16), (16. 00±4. 83), (18. 00±5. 05), (19. 42±5. 41), (18. 42±3. 37), (20. 00±5. 37) mm Hg in group B. There was no statistically significant difference in lOP between the two groups ( P> 0. 05 ). ( 2 ) BCVA: the number of visual acuity decreased eyes, with 6mo follow-up, was 7 (22%) in group A; and that was 5 in group B (19%). There was no statistically significant difference in vision loss postoperatively between the two groups (χ2=0. 061, P>0. 05). (3) Visual field: with 6mo follow-up, there were 13 eyes ( 41%) which had constricted visual field in group A, while those were 10 eyes (38%) in group B; the difference of visual field loss between the two groups was not statistically significant (χ2 = 0. 028, P>0. 05 ) . ( 4 ) Complications: six-month follow-up after operation, there were 4 eyes with shallow anterior chamber, 4 eyes with complicated cataract and 1 eyes with Descemet’s membrane detachment in group A, while that was 1 eyes with shallow anterior chamber and 1 eyes with complicated cataract in group B; there was statistically significant difference in the rate of complications between the two groups (χ2 = 4. 144, P0. 05). ? CONCLUSlON: Both Ahmed glaucoma valve implantation and trabeculectomy are effective methods for the treatment of POAG. The clinical efficacy was no difference between the two methods. However, compared with trabeculectomy, Ahmed glaucoma valve implantation was safer and had fewer complications.
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PURPOSE: To evaluate surgical results after combined operation associated with Ahmed glaucoma valve (AGV) implantation. METHODS: A retrospective review was performed for 71 eyes of 67 patients who underwent combined operation associated with AGV implantation from June 2003 to August 2012. RESULTS: Pars plana vitrectomy or phacoemulsification combined with AGV implantation were performed for 16 eyes and AGV implantation alone was performed in 55 eyes. Mean IOP (mm Hg) and the number of antigluacoma agents for both the combined and single groups showed a statistically significant decrease (combined/single; p = 0.008/0.000, 0.002/ 0.000). Visual acuity (log MAR) was improved, but these differences were not statistically significant (combined/single; p = 0.309/0.052). CONCLUSIONS: Combined vitrectomy or phacoemulsification and AGV implantation for intractable glaucoma with vitreoretinal disease or cataract is considered to be the primary procedure because of its equivalent efficacy in lowering IOP, improving visual acuity and decreasing the number of glaucoma agents.
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Humans , Cataract , Retrospective Studies , Glaucoma , Phacoemulsification , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To evaluate the long-term surgical results of Ahmed glaucoma valve implantation (AGVI) and the effects of intracameral bevacizumab injection in neovascular glaucoma (NVG) after diabetic vitrectomy. METHODS: We reviewed the medical records of 57 patients with NVG after diabetic vitrectomy who underwent AGVI with or without intracameral bevacizumab injection. In each group, preoperative and postoperative intraocular pressure, the number of glaucoma medications, and best corrected visual acuity (BCVA) were compared. We analyzed the rates of surgical success, postoperative complications, and risk factors. RESULTS: The cumulative probability of success was 87.7% at 1 year, 78.8% at 2 years, 70.5% at 3 years, and 61.6% at 5 years. Intraocular pressure and the number of glaucoma medications were significantly reduced and BCVA was significantly better at all postoperative follow-up time points in both groups. There were no differences in mean intraocular pressure, the number of glaucoma medications, BCVA, or the rates of surgical success between the two groups. The incidence of hypertensive phase was significantly reduced in the intracameral bevacizumab group, but neither the surgical success rate nor intraocular pressures were different compared with the control group. CONCLUSIONS: Ahmed glaucoma valve was a good therapeutic modality for long-term treatment of NVG occuring after diabetic vitrectomy. Intracameral bevacizumab injection had no effects on the surgical results of Ahmed glaucoma valve surgery.