Intermediate-Term Outcomes and Complications of Ahmed Glaucoma Valve in Type 1 Keratoprostheses.

IF 2.1 3区医学 Q2 OPHTHALMOLOGY Cornea Pub Date : 2025-01-29 DOI:10.1097/ICO.0000000000003819

Gowri Pratinya Kolipaka, Ramyashri Sastry, Naveen Nukala, Swapna S Shanbhag, Sirisha Senthil

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Abstract

Purpose: To evaluate intermediate-term outcomes and complications associated with Ahmed glaucoma valve (AGV) implantation in eyes with type 1 keratoprosthesis (KPro).

Methods: We retrospectively reviewed records of 43 eyes of 43 Indian patients with type 1 KPro and AGV from 2009 to 2021 with a minimum of 6-months of follow-up. Five eyes that had AGV before KPro were excluded, leaving 38 eyes for analysis. Primary outcome measure was postoperative complications. Secondary outcome measure was stability of glaucoma, assessed by Humphrey visual fields, intraocular pressure, and best-corrected visual acuity (BCVA). Sight-threatening complications, implant removal, or repeat glaucoma surgery was considered failure.

Results: Median age (interquartile range) at AGV implantation was 36.5 (23-49) years, with median post-AGV follow-up of 30.5 (6.5-53) months. Preoperative logarithm of minimal angle of resolution median BCVA was 0.6 (0.4-1). Post-AGV, median intraocular pressure as measured by scleral Schiotz reduced significantly from 30.4 (20.6-30.4) to 13.5(12.2-14.8) mm Hg ( P < 0.0001), and the mean number of antiglaucoma medications significantly decreased from 3.4 to 1.7 ( P < 0.0001). Mean BCVA ( P = 0.24) remained stable. Humphrey visual fields mean deviation progressed from -13.5 dB (-25, -9) to -26 dB (-30, -13) at final follow-up ( P = 0.05) and progression occurred in 10 eyes. Seven eyes (18.4%) had postoperative complications needing surgical intervention, including tube block [5 eyes (13.1%)] and tube exposure [2 eyes (5%)]. One failed AGV needed additional glaucoma surgery after 8 years. None had implant extrusion/explanation or endophthalmitis.

Conclusions: Ahmed glaucoma valve implantation offered promising results in managing glaucoma in eyes with type 1 KPro, particularly in relatively young Indian population. However, close monitoring for tube-related complications and glaucoma progression is warranted.

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Ahmed青光眼瓣膜在1型角膜假体中的中期预后和并发症。

目的：评价1型角膜假体（KPro）患者Ahmed青光眼瓣膜（AGV）植入术的中期预后和并发症。方法：我们回顾性分析了2009年至2021年43例印度1型KPro和AGV患者的43只眼的记录，随访时间至少为6个月。在KPro之前有AGV的5只眼睛被排除在外，剩下38只眼睛用于分析。主要结局指标为术后并发症。次要指标是青光眼的稳定性，通过Humphrey视野、眼内压和最佳矫正视力（BCVA）来评估。威胁视力的并发症、植入物移除或重复青光眼手术被认为是失败的。结果：AGV植入时的中位年龄（四分位数范围）为36.5（23-49）岁，AGV后的中位随访时间为30.5（6.5-53）个月。术前最小分辨角中位BCVA的对数为0.6（0.4-1）。agv后，巩膜Schiotz测量的中位眼压从30.4（20.6-30.4）显著降低到13.5(12.2-14.8)mm Hg (P < 0.0001)，抗青光眼药物的平均用药次数从3.4次显著降低到1.7次（P < 0.0001）。平均BCVA （P = 0.24）保持稳定。最终随访时，汉弗莱视野平均偏差从-13.5 dB（-25, -9）增加到-26 dB (-30, -13) (P = 0.05)， 10只眼有进展。术后并发症7眼（18.4%）需要手术干预，包括管堵5眼（13.1%）、管暴露2眼（5%）。一名AGV失败的患者在8年后需要额外的青光眼手术。无假体挤压/解释或眼内炎。结论：Ahmed青光眼瓣膜植入术在治疗1型KPro患者青光眼方面有很好的效果，特别是在相对年轻的印度人群中。然而，密切监测管相关并发症和青光眼的进展是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cornea 医学-眼科学

CiteScore

5.20

自引率

10.70%

发文量

354

审稿时长

3-6 weeks

期刊介绍： For corneal specialists and for all general ophthalmologists with an interest in this exciting subspecialty, Cornea brings together the latest clinical and basic research on the cornea and the anterior segment of the eye. Each volume is peer-reviewed by Cornea''s board of world-renowned experts and fully indexed in archival format. Your subscription brings you the latest developments in your field and a growing library of valuable professional references. Sponsored by The Cornea Society which was founded as the Castroviejo Cornea Society in 1975.