Effects of Digital Ocular Massage in Patients in a Hypertensive Phase after Ahmed Glaucoma Valve Implantation

Ki Yup Nam; Jong Eun Lee; Chang Sik Kim

doi:10.3341/jkos.2011.52.3.315

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Nam, Lee, and Kim: Effects of Digital Ocular Massage in Patients in a Hypertensive Phase after Ahmed Glaucoma Valve Implantation

Original Article

J Korean Ophthalmol Soc 2011;52(3):315-324.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.3.315

Effects of Digital Ocular Massage in Patients in a Hypertensive Phase after Ahmed Glaucoma Valve Implantation

Ki Yup Nam, MD¹, Jong Eun Lee, MD¹, Chang Sik Kim, MD, PhD^1,²

¹Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea

²Research Institute for Medical Science, Chungnam National University, Daejeon, Korea

Address reprint requests to Chang Sik Kim, MD, PhD Department of Ophthalmology, Chungnam National University Hospital #640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-280-7604, Fax: 82-42-255-3745, E-mail: kcs61@cnu.ac.kr

Received 15 July 201014 September 2010 Accepted 16 December 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 course of the hypertensive phase (HP) after Ahmed glaucoma valve (AGV) implantation and the effects of digital ocular massage.

Methods

A total of 131 eyes of 131 patients, who underwent AGV implantation surgery, were studied retrospectively. HP was defined as an IOP (intraocular pressure) ≥ 22 mm Hg within 6 months after surgery. Various clinical factors related to the occurrence of HP were analyzed. The HP group was compared to the non-HP group. Ocular massage was performed in patients showing acute elevation of IOP at a relatively early postoperative period, and the effects were compared with the non-massage group. The patients who received ocular massage were divided, based on its effects, and compared.

Results

HP developed in 62.6% of the patients after AGV surgery, and the success rate was significantly lower in the HP group. HP occurred more often in males and in patients with high IOP before surgery. HP developed in 82 eyes at 3.3 weeks after surgery in average. Ocular massage was performed in 30 eyes that showed acute IOP increase. The amount of IOP reduction, compared to 1 month after surgery, was greater in massage group than no massage group from 2 months to 3 years after surgery. Successful IOP control by ocular massage was observed in 14 eyes (46.7%), and the success rate was higher in these patients than the patients who showed no significant IOP reduction by ocular massage. But, the difference was not significant (p = 0.072).

Conclusions

HP is related to the final outcome of surgery. Digital ocular massage can be used as an effective method to control HP and prevent further glaucomatous damage.

Keywords: Ahmed glaucoma valve, Hypertensive phase, Ocular massage

References

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Figure 1.

Kaplan-Meier survival curve: Cumulative success after Ahmed glaucoma valve implant surgery. Success: 5 mm Hg < IOP < 22 mmHg (with or without anti-glaucoma medication). Success rates are 96.2% at 6 month, 90.2% at 1 year, 81.3% at 2 years, 78.4% at 3 years after sugery.

Figure 2.

Kaplan-Meier survival curve: Comparison of cumulative success after Ahmed glaucoma valve implant surgery between the group with hypertensive phase and without hypertensive phase. Success: 5 mm Hg < IOP < 22 mmHg (with or without anti-glaucoma medication). Cumulative survival in the group with hypertensive phase: 85.1% at 12 month, 75.0% at 24 month, 69.5% at 36 month postoperatively. Cumulative survival in the group without hypertensive phase was 95.9% at 12 month, 91.4% at 24 month, 88.2% at 36 months. The difference between the 2 groups was statistically significant (p = 0.007, log rank test).

Figure 3.

Changes in intraocular pressure in the groups with and without hypertensive phase. ^∗ Significantly higher IOP between 2 groups (p < 0.05, independent T-test).

Figure 4.

Change in the number of glaucoma medications in the ^∗ Significantly higher groups with and without hypertensive phase. number of medication between 2 groups (p < 0.05, independent T-test).

Figure 5.

Change in intraocular pressure in the groups with and without ocular massage. ^∗ Significantly higher intraocular pressure between 2 groups (p < 0.05, independent T-test).

Figure 6.

Change in the number of glaucoma medication in the groups with and without ocular massage. There is no significant difference between two groups at all the time points.

Figure 7.

The change in intraocular pressure from 1 month after surgery (reference IOP at the beginning of the ocular massage) in the groups with and without ocular massage. ^∗ Significantly greater change in intraocular pressure in massage group (p < 0.05, independent T-test).

Table 1.

Baseline characteristics of subjects

No. of patients (No. of eyes)	131 (131)
Age (mean ± SD, yr)	54.7 ± 12.2
Male (eyes, %)	94 (71.8)
Female (eyes, %)	37 (28.2)
Diabetes mellitus (eyes, %)	53 (40.5)
Systemic hypertension (eyes, %)	32 (24.4)
Duration of glaucoma (mean ± SD, yr)	3.0 ± 5.3
Previous glaucoma surgery (eyes, %)	30 (22.9)
Followup (mean ± SD, mon) (range)	34.0 ± 18.7 (1-60)
Type of glaucoma (%)
Neovascular glaucoma	60 (45.8)
Secondary glaucoma	40 (30.5)
Failed filtering surgery	14 (10.7)
Primary openangle glaucoma	15 (11.5)
Primary angle-closure glaucoma	2 (1.5)
Preoperative intraocular pressure (mean ± SD, mmHg)	35.7 ± 13.9
No. of glaucoma medication (mean ± SD)	3.3 ± 1.1

Table 2.

Comparison of baseline characteristics of the subjects between the groups with and without hypertensive phase

Variables	Hypertensive phase (n = 82)	No hypertensive phase (n = 49)	p-value
Age (mean ± SD, yr)	54.4 ± 13.2	52.3 ± 17.1	0.448^∗
Sex (eyes, %)			0.017^†
Male	65 (79.3)	29 (59.2)
Female	17 (20.7)	20 (40.8)
Systemic disease (eyes, %)
Diabetes mellitus	40 (48.8)	12 (24.5)	0.009^†
Systemic hypertension	25 (30.5)	7 (14.3)	0.057^†
Glaucoma surgery history (eyes, %)	15 (18.3)	15 (30.6)	0.133^†
Duration of glaucoma (mean ± SD, yr)	3.8 ± 5.7	2.5 ± 5.1	0.180^∗
Type of glaucoma
Neovascular glaucoma^‡	47 (78.3)	13 (22.7)	0.001^‡
Secondary glaucoma	21 (52.5)	19 (47.5)
Failed glaucoma surgery	5 (35.7)	9 (64.3)
Primary open angle glaucoma	9 (60.0)	6 (40.0)
Primary angle closure glaucoma	0 (0.0)	2 (100.0)
Preoperative IOP (mean ± SD, mmHg)	38.3 ± 14.4	31.4 ±12.1	0.006^∗
No. of glaucoma medication (mean ± SD)	3.3 ± 1.1	3.4 ± 1.2	0.672^∗

^∗ Independent T-test;

^† Chi-square test;

^‡ Neovascular glaucoma developed hypertensive phase more frequently compared to the other types of glaucomas (Chi-sqaure test, p = 0.001).

Table 3.

Results of logistic analysis on the variables of the development of hypertensive phase

Variables	N	Multivariate
Variables	N	Odds ratio (95% CI)	p-value
Sex
Female	37	1.00
Male	94	3.18 (1.35-7.49)	0.008
Diabetes mellitus
Non-DM	79	1.00
DM patient	52	1.92 (0.65-5.64)	0.235
Glaucoma
Others	71	1.00
Neovascular glaucoma	60	2.05 (0.69-6.11)	0.195
Preoperative IOP		1.03 (1.00-1.06)^∗	0.048

CI = confidence interval.

^∗ Odds ratio when intraocular pressure rise by 1 mmHg.

Table 4.

Comparison of baseline characteristics of the subjects between massage group and no massage group

Variables	Massge group (n = 30)	No massage group (n = 52)	p-value
Age (mean ± SD, yr)	51.3 ± 12.8	56.1 ± 13.1	0.107^∗
Sex (eyes, %)			0.580^†
Male	25 (83.3)	40 (76.9)
Female	5 (16.7)	12 (23.1)
Systemic disease (eyes, %)
DM	19 (63.3)	32 (61.5)	0.066^†
Hypertension	11 (36.7)	14 (26.9)	0.456^†
Glaucoma surgery History (eyes, %)	4 (13.3)	11 (21.2)	0.555^†
Duration of glaucoma (mean ± SD, yr)	2.6 ± 4.1	2.5 ± 5.6	0.953^∗
Preoperative IOP (mean ± SD, mmHg)	37.2 ± 15.1	38.9 ± 14.1	0.607^∗
No. of glaucoma medication (mean ± SD)	3.5 ± 0.9	3.3 ± 1.2	0.310^∗

^∗ Independent T-test;

^† Chi-square test.

Table 5.

Comparison of baseline characteristics and final surgical outcome between successful massage group and massage failure group

Variables	Massage success (n = 14)	Massage failure (n = 16)	p-value
Age (mean±SD, yr)	52.3 ± 14.4	50.4 ± 11.7	0.692^∗
Sex (eyes, %)			0.642^†
Male	11 (78.6)	14 (87.5)
Female	3 (21.4)	2 (12.5)
Systemic disease (eyes, %)
DM	9 (64.3)	10 (62.5)	1.000^†
Hypertension	5 (35.7)	6 (37.5)	0.707^†
Glaucoma surgery history (eyes, %)	0 (0.0%)	2 (100%)	‐
Duration of glaucoma (mean ± SD, yr)	3.6 ± 5.4	1.7 ± 2.3	0.207^∗
Preoperative IOP (mean ± SD, mmHg)	34.1 ± 9.7	39.9 ± 18.5	0.297^∗
No. of glaucoma medication (mean ± SD)	3.4 ± 1.1	3.6 ± 0.7	0.692^∗
Final outcome of operation (eyes,%)			0.072^‡
Success	11 (78.6%)	7 (43.7%)
Failure^§	3 (22.4%)	9 (56.3%)

Failure from complications: 2 hyphema and 1 epithelial defect.

^∗ Independent T-test;

^† Chi-square test;

^‡ Fisher's exact test;

^§ Failure from poor IOP control: 9 cases (30%).

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