Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at 2 Years

Sung Hyup Lim; Won Moon Seo; Jun-Jeong Park; Seong Uk Yun

doi:10.3341/jkos.2011.52.12.1470

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Lim, Seo, Park, and Yun: Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at 2 Years

Original Article

J Korean Ophthalmol Soc 2011;52(12):1470-1477.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.12.1470

Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at 2 Years

Sung Hyup Lim, MD, Won Moon Seo, MD, Jun-Jeong Park, MD, Seong Uk Yun, MD

Department of Ophthalmology, Dongkang General Hospital, Ulsan, Korea

Address reprint requests to Seong Uk Yun, MD Department of Ophthalmology, Dongkang General Hospital #123-3 Taehwa-dong, Jung-gu, Ulsan 681-711, Korea Tel: 82-52-241-1331, Fax: 82-52-241-1146, E-mail: Medi94@naver.com

Received 6 April 20118 August 2011 Accepted 12 October 2011

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 outcomes of Ahmed valve implantation in neovascular glaucoma patients who received intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU) after 24 months of followup.

Methods

A total of 40 eyes from 40 patients with neovascular glaucoma who received antiglaucomatous medication without previous glaucoma surgery were included in the present study. The patients were divided into 2 groups. The control group (20 eyes) underwent Ahmed valve implantation only and the study group (20 eyes) underwent Ahmed valve implantation and received intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of 3 consecutive visits where intraocular pressure (IOP) was over 18 mmHg; 2) 20% IOP reduction from baseline; 3) the final number of topical medications was not reduced by at least two from baseline; 4) the need for additional surgery; or 5) the occurrence of a serious complication.

Results

In the control group, the cumulative success rate was 19.1% at 24 months. The cumulative success rate in the study group was 43.7% at 24 months. 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 resulted in a high success rate and good IOP control and did not cause serious complications during the followup period.

Keywords: Ahmed valve implantation, Neovascular glaucoma, Success rate, MMC, 5-FU

References

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Figure 1.

Intraocular pressure (IOP) following Ahmed valve implantation only (control group) and Ahmed valve implantation with adjunctive intraoperative mitomycin C and postoperative 5-fluorouracil (study group). D = day; W = week; M = month.

Figure 2.

Kaplan-Meier estimates of the cumulative probability of valve success for Ahmed valve implanted eyes. Control group (20 eyes) received Ahmed valve implantation only. Study group (20 eyes) received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence following an initial postoperative period of any of the following events: 1) IOP > 18 mm Hg for three consecutive visits or <20% IOP reduction from baseline and the final number of topical medications needed to be not less than at least 2 from baseline, 2) need for additional surgery to repair a malfunctioning Ahmed valve, or 3) serious postoperative complications.

Table 1.

Baseline characteristics for Ahmed valve-implanted eyes

	Control group (n = 20)	Study group (n = 20)	p-value^∗
Age (yr)	57.80 ± 7.68	51.90 ± 10.40	0.08
Sex			0.821
Male	10 (50.0)	11 (55.0)
Female	10 (50.0)	9 (45.0)
Diagnosis			0.598
NVG with DMR	17 (85)	18 (90)
NVG with CRVO	1 (5)	0 (0)
NVG with OIS	2 (10)	2 (10)
Lens status			0.946
Aphakic	2 (10.0)	2 (10.0)
Phakic	8 (40.0)	9 (45.0)
Pseudophakic	10 (50.0)	9 (45.0)
Preoperative IOP (mm Hg)	38.50 ± 5.31	39.10 ± 5.88	0.731
No. of preoperative-medication	3.05 ± 0.60	2.85 ± 0.81	0.428
MMC time (min)	0	4.72 ± 0.55
No. of 5-FU injections	0	3.27 ± 0.45
Follow up period (mon)	26.8 ± 4.72	28.2 ± 5.22	0.94

Values are presented as mean ± SD or number (%).

NVG = neovascular glaucoma; DMR = diabetic retinopathy; CRVO = central retinal vein occlusion; OIS = ocular ischemic syndrome; MMC = mitomycin C; 5-FU = 5-fluorouracil.

^∗ There was no significant difference between 2 groups in baseline status when compared by Fisher's exact or unpaired t-test.

Table 2.

Postoperative intraocular pressure for Ahmed valve implanted eyes during the followup period

Time	IOP of control group (mm Hg)	IOP of study group (mm Hg)	p-value^∗
Baseline	38.50 ± 5.31	39.10 ± 5.88	0.731
1 day	13.70 ± 2.47	12.85 ± 2.87	0.281
1 wk	13.35 ± 1.39	13.50 ± 3.10	0.821
1 mon	14.65 ± 1.42	13.65 ± 2.01	0.116
3 mon	15.30 ± 1.75	14.35 ± 2.21	0.198
6 mon	16.60 ± 2.58	15.15 ± 3.90	0.200
9 mon	18.55 ± 3.03	15.30 ± 5.11	0.047
12 mon	18.90 ± 3.86	14.20 ± 5.75	0.011
18 mon	19.55 ± 3.90	14.75 ± 5.18	0.005
24 mon	19.95 ± 3.93	14.80 ± 4.76	0.002

Values are presented as mean ± SD.

^∗ Two sample t-test.

Table 3.

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

Postoperative months	Control group	Study group
Postoperative months	Survival proportion (standard error)	Survival proportion (standard error)
6	0.850 (0.0798)	1.0 (0.000)
9	0.637 (0.110)	1.0 (0.000)
12	0.382 (0.119)	0.833 (0.0878)
18	0.382 (0.119)	0.764 (0.104)
24	0.191 (0.148)	0.437 (0.155)

Table 4.

Postoperative characteristics of control and study group

	Control group	Study group	p-value^∗
Hypertensive phase:
Yes	7.00 (35)	4.00 (20)	0.048
Postoperative no. of medications at 24 months	1.40 ± 0.94	0.55 ± 0.69	0.022
Change in no. of medication from baseline	‐1.65 ± 0.81	‐2.30 ± 0.92	0.049
Medications relative to baseline
Lower no. of medications	15 (75)	18 (90)	0.081
Same no. of medications	5 (25)	2 (10)	0.068
Greater no. of medications	0	0

Values are presented as mean ± SD or number (%).

^∗ Chi-square test.

Table 5.

Postoperative complications

	Control group	Study group	p-value^∗
Transient hypotony	2 (10)	5 (25)	0.032
Transient hyphema	3 (15)	2 (10)	0.245
Retration of tube from anterior chamber	2 (10)	1 (5)	0.435

Values are presented as number (%).

^∗ Fisher's exact test.

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