Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes

Eun Min Kang; Yun Ha Lee; Sang Jin Seo; Chan Yun Kim; Gong Je Seong; Samin Hong

doi:10.3341/jkos.2014.55.10.1511

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Kang, Lee, Seo, Kim, Seong, and Hong: Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes

Original Article

J Korean Ophthalmol Soc 2014;55(10):1511-1519.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1511

Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes

Eun Min Kang, MD, Yun Ha Lee, MD, Sang Jin Seo, MD, Chan Yun Kim, MD, PhD, Gong Je Seong, MD, PhD, Samin Hong, MD, PhD

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Samin Hong, MD, PhD, Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel: 82-2-2228-3591, Fax: 82-2-312-0541 E-mail: samini@yuhs.ac

Received 5 June 2014 Revised 8 July 2014 Accepted 17 September 2014

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 investigate the clinical outcome of glaucoma surgery performed in patients with painful blind glaucomatous eyes. Methods: A single-center, retrospective, interventional case series was performed by reviewing the medical records of 74 glaucoma patients (74 eyes) who underwent Ahmed glaucoma valve (AGV) implantation or trabeculectomy for painful blind eyes from October 2004 to January 2014. Blindness was defined as visual acuity less than hand motion at the time of surgery. Preoperative and postoperative intraocular pressure (IOP), number of anti-glaucoma medications, and presence of pain were compared in the patients grouped according to the type of glaucoma surgery. The glaucoma type, history of previous glaucoma surgery and postoperative failure/complications were also evaluated.

Results

AGV implantation was performed in 42 eyes (56.8%) of 42 patients, and trabeculectomy was performed in 32 eyes (43.2%) of 32 patients. The average IOP decreased from 41.73 ± 11.77 mm Hg before surgery to 14.29 ± 9.34 mm Hg at five years after the surgery (p < 0.001, paired t-test). The IOP was not significantly different between the groups at any follow-up time point (p = 0.949, linear mixed model). Overall, three patients (4.1%) still experienced eye pain after surgery, IOP greater than 30 mm Hg was observed in eight eyes (10.8%), and additional surgery was required in 11 eyes (14.9%). Evisceration was required in only two eyes (2.7%). Sympathetic ophthalmia was not found in any patient during the follow-up period.

Conclusions

Glaucoma surgery including AGV implantation/trabeculectomy was effective and safe even for painful blind eyes. The procedure may be considered as an alternative to enucleation as an initial surgical option for painful blind glaucomatous eyes.

Keywords: Ahmed glaucoma valve, Glaucoma, Painful blind eye, Sympathetic ophthalmia, Trabeculectomy

References

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Figure 1.

Intraocular pressure (IOP) change after Ahmed glaucom a valve (AGV) implantation and trabeculectomy in painful blind eyes. Each bar represents the 95% confidence interval of each group at each time point. TRAB = trabeculectomy.

Table 1.

Baseline characteristics in Ahmed glaucoma valve implantation group vs. trabeculectomy group in painful blind glaucomatous eyes

	Total	AGV	TRAB	p-value
	(n = 74)	(n = 42)	(n = 32)	p-value
Age (years)	57.19 ± 17.20	57.29 ± 13.91	57.06 ± 20.99	0.959^*
Sex (male)	47 (63.5)	28 (66.7)	19 (59.4)	0.519^†
Diagnosis
POAG	5 (6.8)	1 (2.4)	4 (12.5)	0.159^‡
PACG	9 (12.2)	1 (2.4)	8 (25.0)	0.004^‡
NVG	45 (60.8)	32 (76.2)	13 (40.6)	0.002^†
SG	14 (18.9)	8 (19.0)	6 (18.8)	0.974^‡
CG	1 (1.4)	0 (0.0)	1 (3.1)	0.432^‡
Preoperative vision
HM	32 (43.2)	20 (47.6)	12 (37.5)	0.384^†
LP+	11 (14.9)	5 (11.9)	6 (18.8)	0.515^‡
LP-	31 (41.9)	17 (40.5)	14 (43.8)	0.777^†
Previous glaucoma surgery	11 (14.9)	9 (21.4)	2 (6.3)	0.101^‡
No. of glaucoma medication	3.21 ± 0.75	3.20 ± 0.80	3.22 ± 0.71	0.927^*

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

AGV = Ahmed glaucoma valve; TRAB = trabeculectomy; POAG = primary open-angle glaucoma; PACG = primary angle-closure glaucoma; NVG = neovascular glaucoma; SG = secondary glaucoma; CG = congenital glaucoma; HM = hand-motion; LP+ = light perception; LP- = no light perception.

^* Independent t-test;

^† Pearson's chi-square test;

^‡ Fischer's exact test.

Table 2.

Intraocular pressure changes after Ahmed glaucoma valve implantation and trabeculectomy in painful blind eyes

Time	IOP (mm Hg)
	Total	AGV	TRAB	p-value
	(n = 74)	(n = 42)	(n = 32)	p-value
Preoperative	41.73 ± 11.77 (74)	41.10 ± 11.77 (42)	42.56 ± 11.90 (32)	0.599^*
Postoperative
1 day	15.30 ± 12.03 (74)	15.64 ± 11.96 (42)	14.84 ± 12.29 (32)	0.779^*
1 week	11.04 ± 9.25 (73)	11.71 ± 9.65 (41)	10.19 ± 8.77 (32)	0.490^*
1 month	17.43 ± 10.54 (74)	19.24 ± 10.67 (42)	15.06 ± 10.04 (32)	0.091^*
3 months	17.11 ± 8.83 (71)	18.34 ± 9.31 (41)	15.43 ± 7.98 (30)	0.172^*
6 months	15.24 ± 9.39 (68)	14.75 ± 8.92 (40)	15.93 ± 10.14 (28)	0.614^*
12 months	17.63 ± 11.23 (65)	16.68 ± 10.67 (37)	18.89 ± 12.00 (28)	0.435^*
24 months	15.08 ± 9.73 (49)	14.61 ± 9.92 (28)	15.71 ± 9.69 (21)	0.793^†
36 months	14.73 ± 11.35 (33)	14.12 ± 11.71 (17)	15.38 ± 11.30 (16)	0.613^†
48 months	13.75 ± 8.48 (16)	13.45 ± 9.66 (11)	14.40 ± 5.98 (5)	0.532^†
60 months	14.29 ± 9.34 (17)	16.67 ± 11.18 (9)	11.63 ± 6.41 (8)	0.563^†

Values are presented as mean ± SD (number of follow-up patients).

IOP = intraocular pressure; AGV = Ahmed glaucoma valve; TRAB = trabeculectomy.

^* Independent t-test;

^† Mann-Whitney U-test.

Table 3.

Number of glaucoma medications after Ahmed glaucoma valve implantation and trabeculectomy in painful blind eyes

Time	No. of glaucoma medications
	Total	AGV	TRAB	p-value
	(n = 74)	(n = 42)	(n = 32)	p-value
Preoperative	3.21 ± 0.75 (74)	3.20 ± 0.80 (42)	3.22 ± 0.71 (32)	0.927^*
Postoperative
1 day	0.15 ± 0.66 (73)	0.14 ± 0.66 (42)	0.16 ± 0.68 (31)	0.907^*
1 week	0.17 ± 0.68 (73)	0.18 ± 0.70 (41)	0.16 ± 0.67 (32)	0.869^*
1 month	0.65 ± 1.10 (74)	0.87 ± 1.19 (42)	0.36 ± 0.90 (32)	0.039^*
3 months	0.72 ± 1.11 (71)	1.00 ± 1.21 (41)	0.33 ± 0.84 (30)	0.008^*
6 months	0.82 ± 1.11 (69)	0.99 ± 1.22 (41)	0.57 ± 0.89 (28)	0.105^*
12 months	0.82 ± 1.10 (65)	1.07 ± 1.20 (37)	0.50 ± 0.87 (28)	0.031^*
24 months	0.80 ± 1.11 (49)	1.11 ± 1.20 (28)	0.38 ± 0.84 (21)	0.019^†
36 months	0.80 ± 1.13 (33)	1.03 ± 1.15 (17)	0.53 ± 1.07 (16)	0.129^†
48 months	0.72 ± 0.91 (16)	0.88 ± 0.96 (11)	0.30 ± 0.67 (5)	0.230^†
60 months	0.68 ± 1.01 (17)	0.83 ± 1.09 (9)	0.50 ± 0.96 (8)	0.462^†

Values are presented as mean ± SD (number of follow-up patients).

AGV = Ahmed glaucoma valve; TRAB = trabeculectomy.

^* Independent t-test;

^† Mann-Whitney U-test.

Table 4.

Pre-operation, post-operation 12 months and last visit pain assessment

	Pre-operation		Post-operation 12 months		Last visit
	No.	%	No.	%	No.	%
No pain (grade 0)	0	0.0	52	80.0	62	83.8
Mild pain (grade 1)	0	0.0	10	15.4	9	12.2
Moderate pain (grade 2)	23	31.1	3	4.6	2	2.7
Severe pain (grade 3)	51	68.9	0	0.0	1	1.4

Table 5.

Treatment failure after Ahmed glaucoma valve implantation and trabeculectomy in painful blind eyes

	Total	AGV	TRAB	p-value^*
	(n = 74)	(n = 42)	(n = 32)	p-value^*
Pain failure
Postoperative 12 months	3 (4.6)	2 (5.4)	1 (3.6)	0.999
Last visit	3 (4.1)	3 (7.1)	0 (0.0)	0.254
IOP failure (>30 mm Hg)
Postoperative 12 months	8 (12.3)	3 (8.1)	5 (17.9)	0.275
Last visit	8 (10.8)	4 (9.5)	4 (12.5)	0.720
Additional surgery	11 (14.9)	6 (14.3)	5 (15.6)	0.999
AGV	4 (5.4)	2 (4.8)	2 (6.3)	0.999
TRAB	4 (5.4)	1 (2.4)	3 (9.4)	0.310
Cyclodestruction	1 (1.4)	1 (2.4)	0 (0.0)	0.999
Evisceration	2 (2.7)	2 (4.8)	0 (0.0)	0.502

Values are presented as n (%).

AGV = Ahmed glaucoma valve; TRAB = trabeculectomy; IOP = intraocular pressure.

^* Fischer's exact test.

Table 6.

Complication after Ahmed glaucoma valve implantation and trabeculectomy in painful blind eyes

	Total	AGV	TRAB	p-value^*
	(n = 74)	(n = 42)	(n = 32)	p-value^*
Valve exposure or wound leakage	10 (13.5)	10 (23.8)	0 (0.0)	0.004
Gross hyphema	8 (10.8)	5 (11.9)	3 (9.4)	0.999
Hypotony	3 (4.1)	1 (2.4)	2 (6.3)	0.575
Phthisis	4 (5.4)	1 (2.4)	3 (9.4)	0.310
Sympathetic ophthalmia	0 (0.0)	0 (0.0)	0 (0.0)	−

Values are presented as n (%).

AGV = Ahmed glaucoma valve; TRAB = trabeculectomy.

^* Fischer's exact test.

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