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Vol. 93. Issue 9.
Pages 431-438 (September 2018)
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Vol. 93. Issue 9.
Pages 431-438 (September 2018)
Original article
Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up
Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo
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F. Valenzuelaa, M.J. Oportusa, C.I. Péreza, F. Melladoa, C. Cartesa, F. Villarroela, D. López-Poncea, R. López-Solísb, L. Traipea,
Corresponding author
ltraipe@gmail.com

Corresponding author.
a Fundación Oftalmológica Los Andes, Vitacura, Santiago de Chile, Spain
b Programa de Biología Celular y Molecular, Facultad de Medicina-Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago de Chile, Chile
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Tables (3)
Table 1. Demographic characteristics and ocular history data of study population.
Table 2. Preoperative: BCVA, IOP, MEDS, disk cupping and gonioscopy and postoperative BCVA, IOP and MEDS at last visit.
Table 3. Postoperative complications and other procedures post Ahmed valve of uveitic glaucoma patients treated with Ahmed glaucoma drainage.
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Abstract
Objective

To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma.

Methods

Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004 and 2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP ≥5 and ≤18mmHg without any medication, as qualified success if IOP ≤18mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded.

Results

21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5±31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P<0.001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P<0.001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan–Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months.

Conclusions

Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma.

Keywords:
Uveitis
Uveal diseases
Glaucoma
Intraocular pressure
Ahmed valve
Resumen
Objetivo

Evaluar la eficacia, seguridad y complicaciones a largo plazo del implante de válvula de Ahmed en pacientes con glaucoma uveítico refractario.

Métodos

Revisión retrospectiva de casos consecutivos de pacientes con glaucoma uveítico refractario intervenidos mediante un implante de válvula de Ahmed entre los años 2004-2014. Las características demográficas, la agudeza visual, la presión intraocular (PIO), el número de medicamentos antiglaucomatosos y las complicaciones operatorias y postoperatorias fueron registradas. El éxito completo se definió como una PIO5 y ≤18mmHg sin medicamentos, y el éxito calificado, como una PIO18mmHg con uno o más medicamentos. Aquellos pacientes con un seguimiento inferior a 12 meses fueron excluidos.

Resultados

Veintiún pacientes (26 ojos) fueron incluidos. El seguimiento promedio postoperatorio fue de 53,5±31 meses. Ocho ojos (30%) tuvieron al menos una cirugía de glaucoma fallida previamente. La PIO se redujo de una media de 30 a 14mmHg en la última visita (p<0,001). El número de medicamentos antiglaucomatosos se redujo de una mediana de 2,9 a 1,1 en la última visita (p<0,001). Siete ojos (27%) se calificaron como éxito completo, 13 ojos (50%) como éxito calificado y 6 ojos (23%) cumplieron el criterio de falla. La complicación postoperatoria más frecuente fue la fase hipertensiva en 12 ojos (46%). El análisis de supervivencia de Kaplan-Meier mostró una probabilidad acumulada de éxito del 65% a los 84 meses.

Conclusiones

La cirugía de implante de drenaje de glaucoma de Ahmed se puede considerar una opción quirúrgica eficaz y segura a largo plazo para los pacientes con glaucoma uveítico refractario.

Palabras clave:
Uveítis
Enfermedades de la úvea
Glaucoma
Presión intraocular
Válvula de Ahmed

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