¿Es la válvula Ahmed superior al implante Baerveldt como derivación acuosa para el manejo del glaucoma? / Is Ahmed valve superior to Baerveldt implant as an aqueous shunt for the treatment of glaucoma?

Resumen INTRODUCCIÓN: La derivación acuosa ha surgido como una técnica alternativa a la trabeculectomía, considerada la cirugía de elección en pacientes con glaucoma. Actualmente, se considera que la principal indicación de esta técnica es ante el fracaso de la trabeculectomía o en tipos de glaucoma que tienen alto riesgo de fracasar. La válvula Ahmed y el implante Baerveldt son las derivaciones acuosas más utilizadas. Sin embargo, no está claro cuáles son las diferencias entre estas dos alternativas. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales dos son ensayos aleatorizados. Concluimos que la válvula Ahmed probablemente logra una menor disminución de la presión intraocular; podría lograr un menor éxito calificado y probablemente necesita más reintervenciones que el implante Baerveldt. Respecto al perfil de seguridad, la válvula Ahmed no se presenta claramente superior ni inferior al implante Baerveldt.

Abstract INTRODUCTION: Aqueous shunt has emerged as an alternative technique to trabeculectomy, considered the standard for glaucoma surgery. Currently, it is mainly indicated after failure of trabeculectomy or in glaucoma with high risk of failure. The Ahmed valve and the Baerveldt implant are the most commonly used aqueous shunts. However, it is not clear whether there are differences between them. METHODS.: o answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including 10 studies overall, of which two were randomized trials. We concluded the Ahmed valve probably achieves a lower decrease in intraocular pressure, might lead to less qualified success and probably needs more reinterventions than the Baerveldt implant. Regarding safety profile, the Ahmed valve is not clearly superior or inferior to the Baerveldt implant.

The surgical outcome of primary trabeculectomy with mitomycin C and A fornix-based conjunctival flap technique in Thailand.

OBJECTIVE: To determine the surgical outcome of primary trabeculectomy with mitomycin C (MMC) and fornix-based conjunctival flap technique in Thai patients. MATERIAL AND METHOD: This retrospective review was conducted from the clinical records of all Thai glaucoma patients who underwent a primary trabeculectomy with MMC using a fornix-based conjunctival flap technique by or under supervision of one ophthalmologist (NK) between February 2004 and July 2006 at Siriraj Hospital, School of Medicine, Mahidol University, Bangkok, Thailand. RESULTS: There were 69 eyes from 60 patients. Postoperatively, mean intraocular pressure (IOP) was significantly decreased from 26.1 +/- 11.7 mmHg to 11.7 +/- 4.4 mmHg (p < 0.001) and mean number of anti-glaucoma medication was significantly reduced from 3.9 +/- 0.7 to 0.3 +/- 0.9 (p < 0.001) at last visit. Sixty-seven eyes (96.8%) were considered as success. Eight eyes (11.6%) in this group needed topical anti-glaucoma medications. Two eyes (2.9%) were considered as failure. Mean follow-up period was 7.7 +/- 4.0 months. Complications included bleb leaking in 16 eyes, choroidal detachment in four eyes, and blebitis in two eyes. Seven eyes with leaking bleb resolved spontaneously. CONCLUSION: Primary trabeculectomy with MMC using afornix-based conjunctival flap technique is effective as a treatment for Thai glaucoma patients. There is a high rate of success (96.8%) with the low rate of complication.

Traditional versus modified trabeculectomy in primary open angle glaucoma

Two groups of primary open angle glaucoma patients, each of 50 patients, were undergone trabeculectomy. In the first group, [59 eyes], traditional trabeculectomy-where the excised internal corneo-scleral block almost reached the edges of the scleral flap-was performed. The second group [68 eyes], were undergone a modified trabeculectomy. Where internal corneo-sclectomy stopped 1 mm short the edgs of the covering scleral flap i.e., leaving a ledge of 1mm. Cases of either group were followed up for 8-10 months for postoperative complications and intraocular pressure [10P] control. It was found that; modified trabeculectomy was associated with a significantly lower incidence of postoperative shallow or flat chamber and their sequences. Both procedures were effective regarding postoperative intra-ocular pressure control with insignificant difference