Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year

Heon Ju Yoon; Jun Jeong Park

doi:10.3341/jkos.2010.51.2.227

Journal List > J Korean Ophthalmol Soc > v.51(2) > 1008731

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Yoon and Park: Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year

Original Article

J Korean Ophthalmol Soc 2010;51(2):227-233.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.227

Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at One Year

Heon Ju Yoon, MD, Jun Jeong Park, 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

Received 2 July 2009 Accepted 29 October 2009

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.

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Keywords: Ahmed valve implantation, Complication, Neovascular glaucoma, Success rate

References

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Figure 1.

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.

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Figure 2.

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.

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Table 1.

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.

Table 2.

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

Table 3.

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)

Table 4.

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

Table 5.

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%)

Table 6.

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

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