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Lee, Kim, and Cho: Pars Plana Vitrectomy and Ahmed Valve Implantation for Intractable Glaucoma Comorbid With Retinal Disorders
Original Article

J Korean Ophthalmol Soc 2011;52(1):46-52.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.1.46

Pars Plana Vitrectomy and Ahmed Valve Implantation for Intractable Glaucoma Comorbid With Retinal Disorders

Chang Min Lee, MD, Eun Ah Kim, MD, Young Wook Cho, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Eun Ah Kim, MD Department of Ophthalmology, Daegu Fatima Hospital #576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel: 82-53-940-7140, Fax: 82-53-954-7417, E-mail: windypoplar@hanmail.net

Received 19 May 2010       Revised 27 July 2010       Accepted 12 November 2010

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy and long-term prognosis of pars plana vitrectomy and Ahmed valve implantation for intractable glaucoma comorbid with retinal disorders.

Methods

A retrospective review of 34 eyes of 30 patients receiving pars plana vitrectomy and Ahmed valve implantation for intractable glaucoma comorbid with retinal disorders was performed. Preoperative and postoperative intraocular pressure (IOP) and visual acuity, the usage of IOP-lowering medications and postoperative complications, and surgical success rate were evaluated.

Results

IOP and the number of IOP-lowering medications showed a significant decrease after pars plana vitrectomy and Ahmed valve implantation, as compared to before surgery (p < 0.001). The success rate was 88%, 88%, 84% and 85% postoperatively at 1 month, 6 months, 1 year and 3 years respectively. The mean follow up period was 24.21 ± 14.99 months. Complications related to surgery included hyphema in 2 eyes, recurrent corneal epithelial erosion and defect in 2 eyes, corneal ulcer in 2 eyes and vitreous hemorrhage in 4 eyes. Visual acuity improved in 14 eyes (41.1%), no changes in 13 eyes (38.2%) and decreased in 7 eyes (20.6%).

Conclusions

Pars plana vitrectomy and Ahmed valve implantation for intractable glaucoma comorbid with retinal disorders show long-term efficacy in lowering IOP.

Keywords: Ahmed valve implantation, Intractable glaucoma, Pars plana vitrectomy

References

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Table 1.
Demographics of study population (Patients = 30, eyes = 34)
Demographics Group 1 Group 2 p-value
Age (yr) 56.90 ± 13.99 57.00 ± 12.07 0.143*
Gender 0.600†
  Male 5 (62.5%) 11 (32.3%)
  Female 3 (27.5%) 11 (32.3%)
Follow-up period (mon) 15.10 ± 9.84 28.00 ± 15.28 < 0.001*
Diagnosis 0.144†
  Neovascular glaucoma 10 (100%) 22 (91.6%)
   Diabetic retinopathy 8 (80%) 19 (79.1%)
   Central retinal vein occlusion 1 (10%) 3 (12.5%)
   Ocular ischemic syndrome 1 (10%) 0 (0%)
  Secondary glaucoma 0 (0%) 2 (8.3%)
Previous glaucoma operation 1 (10%) 2 (8.3%) 0.776†
Lens status 0.075†
  Phakia 6 (60%) 21 (87.5%)
  Pseudophakia 4 (40%) 3 (12.5%)
  Aphakia 0 (0%) 0 (0%)

Group 1 = vitrectomy combined with Ahmed valve implantation; Group 2 = Ahmed valve implantation following vitrectomy.

* t-test

† Chi-square test.

Table 2.
Combined procedure with pars plana vitrectomy
Combined procedure Total number of eyes (%) Group 1 Group 2
Endolaser photocoagulation 31 (91.1) 10 (100) 21 (87.5)
Membrane peeling 30 (88.2) 9 (90) 21 (87.5)
Cataract extraction 27 (79.4) 6 (60) 21 (87.5)
Intravitreal Gas injection 23 (67.6) 8 (80) 17 (70.8)

Group 1 = vitrectomy combined with Ahmed valve implantation; Group 2 = Ahmed valve implantation following vitrectomy.

Table 3.
Intraocular pressure profile before and after the insertion of the Ahmed glaucoma valve implant
Visit Mean IOP ± SD* (mmHg) Range (mmHg) p value† Number of eyes
Preoparative 38.24 ± 13.60 21∼76 34
1 week 14.88 ± 8.01 5∼44 < 0.001 34
1 month 15.15 ± 5.95 5∼28 < 0.001 34
2 months 15.24 ± 6.00 5∼30 < 0.001 34
3 months 16.68 ± 8.09 4∼41 < 0.001 34
6 months 14.53 ± 6.38 2∼32 < 0.001 34
1 year 14.12 ± 6.80 2∼33 < 0.001 26
2 years 11.50 ± 6.91 2∼25 < 0.001 14
3 years 12.00 ± 5.19 1∼16 0.007 7

* standard deviation

† paired t-test.

Table 4.
Mean intraocular pressure profile for group 1 and group 2 before and after the insertion of the Ahmed glaucoma valve implant
Visit Group 1 Group 2 p value*
Preoparative 45.5 ± 21.38 35.21 ± 7.37 0.043
1 weeks 13.2 ± 3.52 15.58 ± 9.25 0.054
1 month 16 ± 5.62 14.79 ± 6.16 0.215
2 months 15.6 ± 5.78 15.08 ± 6.21 0.135
3 months 16.3 ± 7.54 16.83 ± 8.47 0.172
6 months 11.8 ± 5.59 15.67 ± 6.46 0.224
1 year 11 ± 6.48 14.86 ± 6.82 0.215
2 years 10.33 ± 8.02 11.82 ± 6.98 0.372
3 years 12.0 ± 5.20

Group 1 = vitrectomy combined with Ahmed valve implantation; Group 2 = Ahmed valve implantation following vitrectomy

* paired t-test.

Table 5.
Postoperative complications
Complications Total number of eyes (%) Group 1 Group 2
Hyphema 2 (5.9) 1 (2.9) 1 (2.9)
Anterior chamber collapse 1 (2.9) 1 (2.9) 0 (0)
Corneal ulcer 2 (5.9) 1 (2.9) 1 (2.9)
Recurrent corneal erosion 2 (5.9) 1 (2.9) 1 (2.9)
Vitreous hemorrhage 4 (11.8) 2 (5.9) 2 (5.9)
Phthisis bulbi 2 (5.9) 1 (2.9) 1 (2.9)

Group 1 = vitrectomy combined with Ahmed valve implantation; Group 2 = Ahmed valve implantation following vitrectomy.

Table 6.
Visual acuity change before and after the insertion of the Ahmed glaucoma valve implant
Visual acuity Total number of eyes (%) Group 1 Group 2
Improved 14 (41.1) 2 (20) 12 (50)
Unchanged 13 (38.2) 5 (50) 8 (33.3)
Deteriorated 7 (20.5) 3 (30) 4 (16.7)

Group 1 = vitrectomy combined with Ahmed valve implantation; Group 2 = Ahmed valve implantation following vitrectomy.

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