JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2010.51.2.227 jkos-51-227 Original Article Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year YoonHeon Ju MD ParkJun Jeong MD Department of Ophthalmology, Dongkang General Hospital, Ulsan, Korea Address reprint requests to Park Jun Jeong, MD Department of Ophthalmology, Dongkang General Hospital #123-3 Taehwa-dong, Jung-gu, Ulsan 681-711, Korea Tel: 82-52-241-1331, Fax: 82-52-241-1741, E-mail: jjparkmd@nate.com 09 2010 07 09 2010 51 2 227 233 02072009 29102009 Copyright © 2010 Korean Ophthalmological Society 2010 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 outcome after Ahmed valve implantation in patients with neovascular glaucoma when using intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU).

 Methods

A total of 40 eyes of 40 patients with neovascular glaucoma who received antiglacomatous medication without previous glaucoma surgery were included in the present study. The patients received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of three consecutive visits where intraocular pressure (IOP) was ＞18 mmHg or 20% IOP reduction from baseline and the final number of topical medication did not reduce by at least two from baseline, 2) the need for additional surgery, or 3) the occurrence of a serious complication.

 Results

The cumulative success rate was 77.5% at 12 months. The final number of topical medication after Ahmed valve implantation was 0.73±0.78, and the change in the number of medication from baseline was −2.18±0.84. Serious complications such as endophthalmitis, valve exposure or prolonged hypotony were not observed.

 Conclusions

The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation results in a high success rate and good IOP control and did not show serious complications within the postoperative period.

 Ahmed valve implantation Complication Neovascular glaucoma Success rate References Coleman AL Hill R Wilson MR Initial clinical experience with Ahmed glaucoma valve implant Am J Ophthalmol 1995 1202331 Allen RC Bellow AR Hutchinson BT Filtration surgery in the treatment of neovascular glaucoma Ophthalmology 19828911817 Sutton GE Popp JC Records RE Krupin Denver valve and aberrations glaucoma Trans Ophthalmol Soc U K 198210211921 Lee SH Ma KT Hong YJ Outcome of Ahmed Valve aberrations in Refractory Glaucoma J Korean Ophthalmol Soc 200748 8390 Topouzis F Coleman AL Choplin N Follow-up of the original cohort with the Ahmed glaucoma valve implant Am J Ophthalmol 1999128198204 Nouri-Mahdavi K Caprioli J Evaluation of the hypertensive phase after insertion of the Ahmed glaucoma valve Am J Ophthalmol 200313610018 Susanna R Nicolela MT, Takahashi WY Mitomycin C as adjunctive therapy with glaucoma implant surgery Ophthalmic Surg 19942545862 Kook MS Yoon J Kim J Lee MS Clinical results of Ahmed glaucoma valve implantation in refractory glaucoma with adjunctive mitomycin C Ophthalmic Surg Lasers 2000311006 Kurnaz E Kubaloglu A Yilmaz Y The effect of adjunctive mitomycin C in Ahmed glaucoma valve implantation Eur J Ophthalmol 2005152731 Schwartz AL Anderson RD Trabecular surgery Arch aberrations 1974921348 Allen RC Bellow AR Hutchinson BT Filtration surgery in the treatment of neovascular glaucoma Ophthalmology 19828911817 Skuta GL Parrish RK Wound healing in glaucoma filtering surgery Surv Ophthalmol 19873214970 Lee JH Kim SS Hong YJ A clinical study of the Ahmed glaucoma valve implant in refractory glaucoma J Korean Ophthalmol Soc 200142100310 Ayyala RS Zurakowski D Smith JA A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma aberrationsogy 1998105196876 Guo W Song Y Sun X Ahmed valve Implantation for refractory glaucoma Zhonghua Yan Ke Za Zhi 19973341720 Yalvac IS Eksioglu U Santana B Duman S Long term results of Ahmed glaucoma valve and Molteno implant in neovascular glaucoma Eye 2007216570 Im YW Lym HS Park CK Moon JI Comparison of mitomycin trabeculectomy and Ahmed valve implant surgery for aberrations glaucoma J Korean Ophthalmol Soc 200445151521 Lee JJ Park KH Kim DM Kim TW Clinical outcomes of aberrations glaucoma valve implantation using tube ligation and removable external stents Korean J Ophthalmol 2009238692 Alvarado JA Hollander DA Juster RP Lee LC Ahmed valve implantation with adjunctive mitomycin C and 5-fluorouracil: long-term outcomes Am J Ophthalmol 200814627684 Wilson MR Mendis U Paliwal A Haynatzka V Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy Am J Ophthalmol 2003 13646470 Souza C Tran DH Loman J Long-term outcomes of Ahmed glaucoma valve implantation in refractory glaucoma Am J Ophthalmol 2007144893900 Trigler L Proia AD Freedman SF Fibrovascular ingrowths as a cause of Ahmed glaucoma valve failure in children Am J aberrations 20061413889 Hill RA Pilouzian A Liaw L Pathophysiology of and aberrations against late Ahmed glaucoma valve occlusion Am J aberrations 200012960812 Figures and Tables

Intraocular pressure (IOP) following Ahmed valve implantation with adjunctive intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU). *D=day †W=week; ‡M=month.

Kaplan-Meier estimates of the cumulative probability of valve success for Ahmed valve implanted eyes. Failure was defined as the first occurrence following an initial postoperative period of any of the following events: 1) IOP >18 mmHg for three consecutive visits or <20% IOP reduction from baseline and the final number of topical medications was not reduced by at least two from baseline, 2) need for additional surgery to repair a malfunctioning Ahmed valve, or 3) serious postoperative complication.

Baseline characteristics for Ahmed valve-implanted eyes

Ahmed valve implanted eyes (n=40)
Age (Mean± SD) 54.80±9.51
Sex, n (%)
   Male 21 (53.0%)
   Female 19 (47.7%)
Diagnosis, n (%)
   NVG 40 (100.0%)
Lens status, n (%)
   Aphakic 3 (7.5%)
   Phakic 19 (47.5%)
   Pseudophakic 18 (45.0%)
Previous glaucoma surgery
   No 40 (100%)
Preoperative IOP (Mean± SD) mmHg 38.80±5.53
No. of preoperative medication (Mean± SD) 2.95±0.71
MMC time (minute) 5.75±0.95
No. of 5-FU injections (Mean± SD) 4.07±0.65
Follow up period (Mean± SD, months) 16.8±3.73

NVG=neovascular glaucoma

MMC=mitomycin C

5-FU=5-fluorouracil.

Postoperative intraocular pressure for Ahmed valve implanted eyes during the follow-up period

Time IOP (Mean± SD) (mmHg)
Baseline 38.80±5.53
1 day 13.27±2.68
1 week 13.42±2.37
1 month 14.15±1.79
3 months 14.65±2.05
6 months 15.13±3.40
9 months 15.03±5.11
12 months 14.65±5.28

Kaplan-Meier estimates of probability of success in Ahmed valve implanted eyes

Month Ahmed valve implanted eyes (n=40)
postoperative Survival proportion (Standard error)
1 0.975 (0.024)
2 0.900 (0.047)
3 0.825 (0.060)
6 0.800 (0.063)
9 0.775 (0.066)
12 0.775 (0.066)

Postoperative characteristics of Ahmed valve implanted eyes

Ahmed valve implanted eyes (n=40)
Hypertensive phase
 Yes 9.00 (22.5%)
Postoperative no. of medications
 Mean (SD) 0.78 (0.73)
Change in no. of medication from baseline
 Mean (SD) −2.18 (0.84)
Medications relative to baseline
 Lower no. of medications 38 (95%)
 Same no. of medications 2 (5%)
 Greater no. of medications 0

Postoperative complication for Ahmed valve implanted eyes

Ahmed valve implanted eyes (n=40)
Transient hypotony 2 (5.0%)
Transient hyphema 3 (7.5%)
Retration of tube from anterior chamber 2 (5.5%)

Previous published estimated probability of valve success from studies of Ahmed valve implantation alone for neovascular glaucoma

Postoperative Year
1 st year
Sang Hyup Lee and associates4 0.51
Guo W and associates15 0.40
I.S. Yalvac and associates16 0.63
Yong Woo Im and associates17 0.42
Jong Joo Lee and associates18 0.30