Ahmed valve implantation in glaucoma secondary to chronic uveitis

doi:doi:10.1038/sj.eye.6701841

Eye (2006) 20, 178–183. doi:10.1038/sj.eye.6701841; published online 11 March 2005

Ahmed valve implantation in glaucoma secondary to chronic uveitis

P Ç Özdal¹, R N G Vianna¹ and J Deschênes¹

¹Department of Ophthalmology, Uveitis Service, McGill University, Montréal, Canada

Correspondence: PÇ Özdal, McGill University Health Center, Royal Victoria Hospital, 687, Avenue des Pins West, Suite E4.57, Montréal, Québec, Canada. Tel: +1 514 843 16 25; Fax: +1 514 843 16 18. E-mail: pinarozdal@hotmail.com

Received 1 September 2004; Accepted 1 December 2004; Published online 11 March 2005.

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Abstract

Purpose

To evaluate the efficacy of Ahmed valve (AV) implantation in patients with uveitic glaucoma.

Methods

In total, 18 patients (19 eyes) with glaucoma secondary to chronic uveitis, who underwent AV implantation were retrospectively reviewed. Visual acuity, intraocular pressure (IOP), and glaucoma medications at the most recent examination prior to surgery, were compared with those of last postoperative examination. The surgical success was defined as IOP less than 21 mmHg and greater than 4 mmHg without loss of light perception and visually devastating complications at the last postoperative examination. Decrease in the number of glaucoma medications was also a criterion for surgical success.

Results

The mean follow-up period was 26 plusminus 9.7 months. The mean preoperative and postoperative IOPs were 33.39.7 (range, 20–57) mmHg and 17.310.8 (range, 6–40) mmHg respectively (P<0.0001). The mean number of antiglaucoma medications was 3.50.8 (range, 2–5) preoperatively and 1.41.3 (range, 0–4) postoperatively (P<0.0001). Valve occlusion (five eyes, 26.3%) was the most commonly observed complication. Surgical success was achieved in 13 eyes (68.4%). The cumulative probability of success was 94.4% at 1 year and 60% at 2 years. Five eyes (26.3%) with IOP greater than 21 mmHg and one (5.3%) with corneal decompensation requiring penetrating keratoplasty were considered as failures.

Conclusions

The implantation of AV is an effective surgical procedure for the management of uveitic glaucoma. The inflammatory background might contribute to the occurrence of valve occlusion, which is the most common complication. Prevention of this complication is an essential factor for improving the surgical outcome.