Résumé
Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single?center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ?6 months of follow?up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 � 0.8 vs. 1.9 � 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.
Résumé
Foram revistos os prontuários de 42 pacientes portadores de glaucoma refratário submetidos a trabeculectomia associada ao uso intra-operatório de mitomicina C (0.4 mg/ml) entre outubro de 1991 e maio de 1992 no Serviço de Glaucoma do Wills Eye Hospital (Philadelphia, EUA). Dos 42 olhos, 34 puderam ser seguidos por pelo menos 6 meses. Dentre estes 34, 29 (83,5 por cento) apresentaram controle pressórico adequado ao final de um período de seguimento médio de 7,2 +ou- 1,4 meses. As principais complicaçöes pós-operatórias, entre as quais, descolamento da coróide (16,6 por cento), câmara anterior rasa (9,5 por cento) e maculopatia por hipotonia (4,8 por cento) estäo relacionadas ao excesso de filtraçäo observado no pós-operatório. Este estudo sugere que a mitomicina C é um potente inibidor do processo de cicatrizaçäo, altamente eficaz em prevenir a falência da cirurgia filtrante em olhos com glaucomas refratários. A reduçäo da dosagem e do tempo de exposiçäo à mitomicina C podem resultar em um menor número de complicaçöes secundárias ao excesso de filtraçäo. Estudos prospectivos e randomizados estäo sendo realizados para investigar esta possibilidade