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Moon, Choi, Lee, and Ha: Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(6): 801-806.

Published online: 16 June 2012

DOI: https://doi.org/10.3341/jkos.2012.53.6.801

Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage

Da Ru Chi Moon, MD, Kyung Seek Choi, MD, PhD, Sung Jin Lee, MD, PhD, Seung Joo Ha, MD

Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea.

Address reprint requests to Kyung Seek Choi, MD, PhD. Department of Ophthalmology, Soonchunhyang University Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel: 82-2-709-9357, Fax: 82-2-798-7797, ckseek@schmc.ac.kr

Received 11 July 2011       Accepted 18 April 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To compare the surgical outcomes between sequential -and simultaneous combined vitrectomy and Ahmed valve implantation (AVI) in neovascular glaucoma (NVG) patients with vitreous hemorrhage.

Methods

The medical records of 22 eyes of 22 patients, who had NVG with vitreous hemorrhage treated with vitrectomy and AVI, were retrospectively reviewed. Surgical success was defined as 6 mm Hg ≤ IOP ≤ 21 mm Hg, with or without the use of antiglaucoma medications and failure was defined as cases that had no light perception during the study period and which required additional surgery. The authors of the present study evaluated the surgical success rates and factors affecting surgical success between sequential and simultaneous combined vitrectomy and AVI.

Results

The cumulative surgical success rate by the Kaplan-Meier survival analysis was 45% in sequential combined vitrectomy and AVI (group1), and 18% in combined vitrectomy and AVI (group 2), at 1 year, a significant difference. Preoperative panretinal photocoagulation was related to surgical success rate by Cox's regression model analysis.

Conclusions

Simultaneous combined vitrectomy and AVI is considered as a primary procedure in a patient who has NVG with vitreous hemorrhage. Panretinal photocoagulation in the preoperative periods, is thought to increase the surgical success rate.

Keywords: Ahmed valve implantation, Neovascular glaucoma, Panretinal photocoagulation, Vitrectomy

Figures and Tables

Figure 1
Changes in intraocular pressures in the 2 groups. Intraocular pressure: Significant difference at post-op 3, 6, 9, 12 months between the 2 groups. Group I = vitrectomy combined with AVI, Group II = AVI following vitrectomy. AVI = Ahmed valve implantation.
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Figure 2
Changes in the number of eye drops in the 2 groups. Number of eye drops: No significant difference between the 2 groups. Group I = vitrectomy combined with AVI; Group II = AVI following vitrectomy. AVI = Ahmed valve implantation.
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Figure 3
Changes in surgical success rate in the 2 groups. Surgical success rate: Significant difference at post op 9, 12 months between the 2 groups. Group I = vitrectomy combined with AVI; Group II = AVI following vitrectomy. AVI = Ahmed valve implantation.
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Table 1
Background characteristics in 22 patients NVG with vitreous hemorrhage
jkos-53-801-i001

Values are presented as mean ± SD.

Group I= vitrectomy combined with AVI; Group II= AVI following vitrectomy.

NVG = neovascular glaucoma; AVI = Ahmed valve implantation; DM = diabetes mellitus; HTN = hypertension; NVG = neovascular glaucoma.

*Mann-Whitney test; †Wilcoxon singed ranks test.

Table 2
Visual acuity change before and after surgery of two groups
jkos-53-801-i002

Values are presented as number (%).

Group I = vitrectomy combined with AVI; Group II= AVI following vitrectomy; AVI = Ahmed valve implantation.

Table 3
Outcomes of Cox's regression model*
jkos-53-801-i003

DM = diabetes mellitus; HTN = hypertension.

*Pre-op panretinal photocoagulation is significant risk factor for surgical failure.

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