Trabeculectomy with Mitomycin C versus Ahmed Valve Implantation in Pseudophakic Glaucomatous Eyes

Tae Yoon Lee; Jung Ho Lee; Soon Cheol Cha

doi:10.3341/jkos.2008.49.2.293

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Lee, Lee, and Cha: Trabeculectomy with Mitomycin C versus Ahmed Valve Implantation in Pseudophakic Glaucomatous Eyes

Original Article

J Korean Ophthalmol Soc 2008;49(2):293-302.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.293

Trabeculectomy with Mitomycin C versus Ahmed Valve Implantation in Pseudophakic Glaucomatous Eyes

Tae Yoon Lee, M.D., Jung Ho Lee, M.D., Soon Cheol Cha, M.D.

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Soon Cheol Cha, M.D., Department of Ophthalmology, Yeungnam University Hospital #317-1 Daemyung 5-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3442, Fax: 82-53-626-5936, E-mail: sccha@med.yu.ac.kr

Received 31 May 2007 Accepted 25 October 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 trabeculectomy using mitomycin C (MMC) with Ahmed valve implantation in pseudophakic glaucomatous eyes.

Methods

We retrospectively reviewed the medical records of 68 pseudophakic glaucoma patients (68 eyes) who had undergone trabeculectomy with MMC (group T, 41 eyes) or Ahmed valve implantation (group A, 27 eyes). Intraocular pressure reduction rates, cumulative probabilities of surgical success, and postoperative complications were compared between two groups. Also, risk factors for surgical failures were analyzed.

Results

Intraocular pressure levels at postoperative 12 months were significantly lower in group T (13.8±5.1 mmHg) than in group A (19.6±6.4 mmHg, p=0.001). Cumulative probabilities of surgical success at postoperative 12 months were significantly higher in group T (95.0%) than in group A (66.2%, p=0.000). No significant differences were noted in the occurrences of complications except hyphema in two groups. We found that a younger age (≤50 years) and Ahmed valve implantation were significant risk factors for surgical failures.

Conclusions

Trabeculectomy with MMC can be more effective and preferable as a primary surgical option over Ahmed valve implantation for pseudophakic glaucomatous eyes.

Keywords: Ahmed valve, Pseudophakia, Trabeculectomy

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Figure 1.

Mean intraocular pressure curve for trabeculectomy with mitomycin C (dashed line) and Ahmed valve implantation (solid line). Data are presented as mean±SEM.

Figure 2.

Kaplan-Meier survival curve showing the cumulative probability of surgical success following trabeculectomy with mitomycin C and Ahmed valve implantation. There were greater probabilities of success in MMC trabeculectomy group than in Ahmed valve group (p=0.000, log rank test).

Table 1.

Dermographics and clinical characteristics of patients in two groups

	MMC trabeculectomy (N=41)	Ahmed valve (N=27)	p-value
Age, yr (SD)	58.2 (13.9)	56.2 (12.3)	0.546^*
Sex, n (%)	0.111^†
Male	32 (78.0)	25 (92.6)
Female	9 (22.0)	2 (7.4)
Laterality, n (%)			0.213^‡
Right eye	15 (36.6)	14 (51.9)
Left eye	26 (63.4)	13 (48.1)
Systemic disease, n (%)
Diabetes mellitus	16 (39.0)	7 (25.9)	0.264^‡
Hypertension	9 (22.0)	4 (14.8)	0.464^†
Corneal thickness, µm (SD)	528.5 (48.2)	546.7 (34.9)	0.209^*
Previous cataract surgery, n (%)			0.033^‡
ECCE	26 (63.4)	10 (37.0)
Phacoemulsification	15 (36.6)	17 (63.0)
Prior surgery, n (%)			0.451^‡
Trabeculectomy	9 (21.9)	6 (22.2)
Vitrectomy	5 (12.1)	5 (18.5)

SD = standard deviation; ECCE = extracapsular cataract extraction

^* Student t-test

^† Fisher's exact test

^‡ Chi-square test.

Table 2.

Type of glaucoma in two groups

	MMC trabeculectomy (N=41)	Ahmed valve (N=27)	p-value
Primary open angle glaucoma, n (%)	12 (29.3)	5 (18.5)	0.317^*
Chronic angle closure glaucoma, n (%)	5 (12.2)	4 (14.8)	1.000^†
Neovascular glaucoma, n (%)	11 (26.8)	5 (18.5)	0.429^*
Uveitic glaucoma, n (%)	6 (14.6)	4 (14.8)	1.000^†
Silicone oil induced glaucoma, n (%)	0 (0.0)	5 (18.5)	0.008^†
Exfoliative glaucoma, n (%)	5 (12.2)	4 (14.8)	1.000^†
Ghost cell glaucoma, n (%)	1 (2.4)	0 (0.0)	1.000^†
Rieger syndrome, n (%)	1 (2.4)	0 (0.0)	1.000^†

^* Chi-square test

^† Fisher's exact test.

Table 3.

Mean intraocular pressure (IOP) and glaucoma medication profile in two groups

	MMC trabeculectomy	Ahmed valve	p-value
Preoperative IOP, mmHg (SD)	33.1 (10.7)	34.9 (8.3)	0.447^*
Preoperative medications, n (SD)	3.3 (1.4)	3.9 (0.9)	0.061^†
Postoperative 6 months IOP, mmHg (SD)	13.9 (7.6)	16.8 (7.4)	0.123^*
Postoperative 6 months medications, n (SD)	0.2 (0.6)	0.7 (1.1)	0.046^†
Postoperative 12 months IOP, mmHg (SD)	13.8 (5.1)	19.6 (6.4)	0.001^*
Postoperative 12 months medications, n (SD)	0.2 (0.2)	0.8 (1.1)	0.044^†
Final IOP, mmHg (SD)	14.5 (8.0)	19.1 (8.3)	0.027^*
Final medications, n (SD)	0.5 (1.7)	1.0 (1.4)	0.138^†
Follow-up period, mo (SD)	40.8 (28.9)	15.2 (11.0)	0.000^*

^* Student t-test

^† Mann-Whitney U test.

Table 4.

Postoperative complications in two groups

	MMC trabeculectomy (N=41)	Ahmed valve (N=27)	p-value
Hyphema, n (%)	12 (29.3)	2 (7.4)	0.035^*
Choroidal detachment, n (%)	10 (24.4)	8 (29.6)	0.632^†
Shallow anterior chamber, n (%)	1 (2.4)	3 (11.1)	0.293^*
Hypotony, n (%)	4 (9.8)	6 (22.2)	0.179^*
Endophthalmitis, n (%)	1 (2.4)	1 (3.7)
Bleb leakage, n (%)	2 (4.9)	0
Bullous keratopathy, n (%)	1 (2.4)	0
Papilledema, n (%)	1 (2.4)	0
Tube obstruction, n (%)	0	5 (18.5)
Tube exposure, n (%)	0	3 (11.1)
Maculopathy, n (%)	0	1 (3.7)
Diplopia, n (%)	0	1 (3.7)
Phthisis bulbi, n (%)	0	1 (3.7)

^* Fisher's exact test

^† Chi-square test.

Table 5.

Selective risk factors for surgical failures

Risk factors	Relative risk (95% CI)	p-value^*
MMC trabeculectomy
Age (≤50 yr)	8.928 (1.273 to 20.821)	0.029
Diabetes mellitus	0.329 (0.037 to 2.905)	0.317
Preoperative intraocular pressure (≥30 mmHg)	3.272 (0.962 to 8.768)	0.065
Corneal thickness (<540 µm)	1.106 (0.254 to 4.825)	0.893
Prior surgery	1.266 (0.198 to 8.104)	0.803
Exfoliative glaucoma	0.409 (0.047 to 3.552)	0.417
Neovascular glaucoma	1.497 (0.137 to 6.337)	0.741
Uveitic glaucoma	1.701 (0.158 to 8.274)	0.661
Ahmed valve implantation
Age (≤50 yr)	0.997 (0.084 to 9.859)	0.998
Diabetes mellitus	0.542 (0.062 to 4.738)	0.580
Preoperative intraocular pressure (≥30 mmHg)	2.121 (0.190 to 5.642)	0.541
Corneal thickness (<540 µm)	2.206 (0.214 to 6.778)	0.507
Prior surgery	0.967 (0.027 to 8.866)	0.333
Exfoliative glaucoma	0.777 (0.035 to 7.085)	0.873
Neovascular glaucoma	0.085 (0.002 to 3.129)	0.181
Uveitic glaucoma	1.516 (0.038 to 5.488)	0.728
MMC trabeculectomy and Ahmed valve implantation
Age (≤50 yr)	3.910 (1.211 to 10.621)	0.023
Diabetes mellitus	0.264 (0.069 to 1.015)	0.062
Preoperative intraocular pressure (≥30 mmHg)	2.224 (0.725 to 6.822)	0.162
Corneal thickness (<540 µm)	2.139 (0.664 to 6.892)	0.203
Prior surgery	0.998 (0.098 to 4.316)	0.093
Exfoliative glaucoma	1.066 (0.274 to 4.147)	0.927
Neovascular glaucoma	2.265 (0.247 to 8.802)	0.472
Uveitic glaucoma	0.237 (0.038 to 1.488)	0.203
Ahmed valve implantation	14.062 (7.727 to 33.866)	0.000

CI = confidence interval

^* Cox proportional hazards regression analysis.

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