Comparison of Safety and Efficacy Between Silicone and Polypropylene Ahmed Glaucoma Valves

Joon Sung Bae; Nam Ho Lee; Hwang Ki Kim; Yong Ho Sohn

doi:10.3341/jkos.2008.49.5.791

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Bae, Lee, Kim, and Sohn: Comparison of Safety and Efficacy Between Silicone and Polypropylene Ahmed Glaucoma Valves

Original Article

J Korean Ophthalmol Soc 2008;49(5):791-797.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.5.791

Comparison of Safety and Efficacy Between Silicone and Polypropylene Ahmed Glaucoma Valves

Joon Sung Bae, M.D., Nam Ho Lee, M.D., Hwang Ki Kim, M.D., Yong Ho Sohn, M.D., Ph.D.

Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea

Address reprint requests to Yong Ho Sohn, M.D., Ph.D. Department of Ophthalmology, Konyang University, Kim's Eye Hospital #156 4ga, Youngdeungpo-dong, Youngdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7777, Fax: 82-2-2633-3976, E-mail: yhsohn@konyang.ac.kr

Received 26 December 2006 Accepted 12 December 2007

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 compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs).

Methods

The medical records of 62 consecutive refractory glaucoma patients who had undergone AGV implantion from March 2003 to December 2005 were reviewed retrospectively. Among the 62 patients, 32 patients underwent polypropylene AGV implantation (group P) and the other 30 patients underwent silicone AGV implantation (group S). Postoperative IOP, the complication rate, and the success rate were compared between the two groups.

Results

The life-table success rates for the group P were 81.3% at 6 months and 71.2% at 12 months, and the success rates for the group S were 89.9% at 6 months and 78.6% at 12 months, showing no significant difference between the two groups. Complications, including non-tube-related complications, were observed more frequently in the group S, but there was no significant difference between the two groups.

Conclusions

The silicone AGV can reduce IOP effectively but may be associated with non-tube-related complications.

Keywords: Refractory glaucoma, Silicone and polypropylene, Ahmed glaucoma valve

References

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Figure 1.

Comparison of the mean intraocular pressure between polypropylene and silicone AGV during one-year followup. There were no statistically significant differences between groups (P>0.05). Preop = before surgery.

Figure 2.

Comparison of the mean number of glaucoma medications between polypropylene and silicone AGV during one-year followup. There were no statistically significant differences between groups (P>0.05). Preop = before surgery.

Figure 3.

Graph demonstrating the Kaplan-Meier survival curves according to surgical success definition after implantation of the polypropylene and the silicone AGVs. There were no statistically significant differences between groups.

Figure 4.

Comparison of rates of success (12 months), NLP (loss of light perception), hypotony, and complication between polypropylene and silicone AGVs.

Table 1.

Patient demographics

	Polypropylene group (N=32)	Silicone group (N=30)	P-value
Age (years) (mean±SD)	53.6±13.5	53.7±13.7	0.96∗
Sex (M/F)	17/15	17/13	0.21^†
Followup (months) (mean±SD)	9.3±4.3	10.9±3.1	0.11∗
Glaucoma subtype			0.69^†
POAG	2 (6.3%)	1 (3.3%)
SOAG	7 (21.9%)	9 (30.0%)
NVG	23 (71.9%)	20 (66.7%)

^∗ Student t-test;

^† Chi-square test; SD = standard deviation; POAG = primary open angle glaucoma; SOAG = secondary openangle glaucoma; NVG = neovascular glaucoma.

Table 2.

Preoperative data of polypropylene and silicone Ahmed glaucoma valve groups

	Polypropylene group	Silicone group	P-value
No. of prior operations (mean±SD)	1.2±1.1	1.5±1.3	0.28^∗
No. of preoperative medications (mean±SD)	2.5±0.8	2.3±0.6	0.09^∗
Preoperative IOP (mean±SD)	46.9±10.1	42.5±8.7	0.07^†

^∗ Mann-Whitney test;

^† Student t-test; IOP = intraocular pressure (mmHg).

Table 3.

IOP comparison of polypropylene and silicone Ahmed glaucoma valve (AGV) implantation

Interval	Polypropylene group (N=32) IOP (mean±SD)	Silicone group (N=30) IOP (mean±SD)	P-value∗
Preoperative IOP	46.9±10.1	42.5±8.7	0.71
1 day	15.1±11.5	11.4±5.1	0.11
1 week	14.3±9.2	12.3±5.5	0.32
1 month	20.2±9.9	16.9±8.1	0.18
3 months	19.3±8.9	16.9±7.2	0.29
6 months	16.7±7.9	18.7±13.7	0.51
12 months	18.4±8.1	17.1±8.9	0.61

^∗ P-value = Student t-test.

Table 4.

Postoperative complications after polypropylene and silicone AGV implantation

	Polypropylene group (N=32) N (%)	N (%) Silicone group (N=30)	P-value∗
Complications	4 (12.5%)	8 (26.7%)	0.115
Tube-related	3 (9.4%)	3 (10.0%)	0.329
Blocked tube	0	1
Tube migration	1	0
Exposed tube	2	2
Non-tube related	1 (3.1%)	5 (16.7%)	0.085
Flat anterior chamber (required reformation)	1	2
Large choroidal effusion	0	1
Hypotony maculopathy	0	1
Total hyphema	0	1

^∗ P-value = Fisher's exact test.

Table 5.

Other complications after polypropylene and silicone AGV implantation

	Polypropylene group (N=32) N (%)	N (%) Silicone group (N=30)	P-value∗
NLP^†	5 (15.6%)	3 (10.0%)	0.226
BCVA^‡ decrease	3 (9.4%)	2 (6.7%)	0.323
Hypotony	4 (12.5%)	4 (13.3%)	0.294
Phthisis bulbi	5 (15.6%)	2 (6.7%)	0.161

^∗ P-value = Fisher's exact test;

^† NLP=loss of light perception;

^‡ BCVA=best corrected visual acuity.

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