Combined Operation Assosciated with Ahmed Glaucoma Valve Implantation

Hyun A Kim; Ka Hee Park; Tae Kwann Park; Young Hoon Ohn

doi:10.3341/jkos.2014.55.4.578

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Kim, Park, Park, and Ohn: Combined Operation Assosciated with Ahmed Glaucoma Valve Implantation

Original Article

J Korean Ophthalmol Soc 2014;55(4):578-584.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.4.578

Combined Operation Assosciated with Ahmed Glaucoma Valve Implantation

Hyun A Kim, MD, Ka Hee Park, MD, Tae Kwann Park, MD, PhD, Young Hoon Ohn, MD, PhD

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Young Hoon Ohn, MD, PhD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea, Tel: 82-32-621-5425, Fax: 82-32-621-5435 E-mail: yhohn@schmc.ac.kr

Received 25 May 201327 September 2013 Accepted 11 February 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 evaluate surgical results after combined operation associated with Ahmed glaucoma valve (AGV) implantation.

Methods

A retrospective review was performed for 71 eyes of 67 patients who underwent combined operation associated with AGV implantation from June 2003 to August 2012.

Results

Pars plana vitrectomy or phacoemulsification combined with AGV implantation were performed for 16 eyes and AGV implantation alone was performed in 55 eyes. Mean IOP (mm Hg) and the number of antigluacoma agents for both the combined and single groups showed a statistically significant decrease (combined/single; p = 0.008/0.000, 0.002/ 0.000). Visual acuity (log MAR) was improved, but these differences were not statistically significant (combined/single; p = 0.309/0.052).

Conclusions

Combined vitrectomy or phacoemulsification and AGV implantation for intractable glaucoma with vitreoretinal disease or cataract is considered to be the primary procedure because of its equivalent efficacy in lowering IOP, improving visual acuity and decreasing the number of glaucoma agents.

Keywords: Ahmed glaucoma valve implantation, Combined surgery, Phacoemulsification, Vitrectomy

References

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Figure 1.

IOP changes in the 2 groups. There was no significant difference between two groups. Group 1, 2, 3: combined operation (TPPV, AGV, Phaco c PCL); Group 4: AGVI Only.

Table1.

Demographic characteristics of enrolled patients (patients = 60, eyes = 63)

	Group 1^†	Group 2^‡	Group 3^§	Group 1,2,3	Group 4^∏	p-value
N	6	7	3	16	55
Age (years)^*	51.60 ± 5.32	63.50 ± 11.10	73.33 ± 10.12	61.00 ± 11.98	51.17 ± 13.37	0.261^*
Sex ratio (M/F)^*	1	2.5	0.5	1.3	2.4	0.249^*
Diagnosis
NVG	6	5	1	12	43	0.746^#
DR	4/6	5/5	1/1	10/12	36/43
CRVO	1/6	0/5	0/1	1/12	3/43
Others	1/6	0/5	0/1	1/12	4/43
Secondary Glaucoma	0	2	0	2	8	1.000^#
ACG	0	0	2	2	2	0.217^#
POAG	0	0	0	0	2	1.000^#
Lens
Phakic	6	1	3	10	37	0.769^#
Pseudophakic	0	5	0	5	17	1.000^#
Aphakic	0	1	0	1	1	0.402^#

Values are presented as mean ± SD.

TPPV = trans pars planavitrectomy; AGV = Ahmed glaucoma valve; Phaco c PCL = phacoemulsification with posterior chamber lens implantation; DR = diabetic retinopathy; CRVO = central retinal vein occlusion; ACG = angle-closure glaucoma; POAG = primary open-angle glaucoma.

^* Mann-Whitney test

^† TPPV + AGV + Phaco c PCL

^‡ TPPV + AGV

^§ AGV + Phaco c PCL

^∏ AGV only

^# Fisher’s Exact test.

Table 2.

Mean intraocular pressure profile before and after operation (mm Hg)

	Group 1	Group 2	Group 3	Group 1,2,3	Group 4	p-value
Pre op	46.50 ± 18.9	36.43 ± 8.50	40.67 ± 10.97	41.00 ± 13.64	41.73 ± 12.46
Post op 3 m	18.67 ± 7.005	18.20 ± 8.38	15.50 ± 0.71	18.00 ± 6.26	18.20 ± 6.28	0.001^*	0.000^†
Post op 6 m	24.00 ± 6.00	12.60 ± 3.85	14.67 ± 3.51	16.01 ± 6.60	16.20 ± 5.06	0.003^*	0.000^†
Post op 9 m	21.75 ± 5.50	11.5 ± 2.88	15.00 ± 1.14	14.10 ± 4.50	15.80 ± 5.73	0.012^*	0.000^†
Post op 12 m	23.00 ± 6.63	12.25 ± 5.25	13.50 ± 4.95	15.50 ± 7.28	15.78 ± 5.29	0.008	0.000^†

Values are presented as mean ± SD; Difference between Group 1, 2, 3 and Group 4 (time-group interaction); p = 0.277; By Repeated-measures ANOVA.

^* Wilcoxon Signed test Compared between Pre op / Post op 3, 6, 9, 12 months IOP measurements

^† Paired-t test Compared between Pre op / Post op 3, 6, 9, 12 months IOP measurements.

Table 3.

Changes of Visual acuity (log MAR) after operation

	Group 1	Group 2	Group 3	Group 1, 2, 3	Group 4
Pre op	0.95 ± 0.12	1.68 ± 0.85	1.70 ± 1.84	1.37 ± 0.83	1.45 ± 0.89
Post op	0.90 ± 0.24	1.55 ± 0.52	1.50 ± 2.12	1.26 ± 0.76	1.23 ± 0.90
				0.309^*	0.052^†

Values are presented as mean ± SD; Difference between Group 1,2,3 and Group 4 (time-group interaction); p = 0.496; By Repeated-measures ANOVA.

^* Wilcoxon signed test Compared between Pre op / Post op Visual acuity

^† Paired-t test Compared between Pre op / Post op Visual acuity.

Table 4.

Changes of the Median number of Antiglaucoma agent after operation

	Group 1	Group 2	Group 3	Group 1,2,3	Group 4
Pre op
Post op	2.83 ± 0.40	2.17 ± 0.75	2.00 ± 0.00	2.44 ± 0.61	2.85 ± 0.44
p-value	1.00 ± 1.55	0.83 ± 1.33	0.00 ± 0.00	0.68 ± 1.25	0.60 ± 1.00
				0.002^*	0.000^†
					0.000^†

Values are presented as mean ± SD; Difference between Group 1,2,3 and Group 4 (time-group interaction); p = 0.104; By Repeated-measures ANOVA.

^* Wilcoxon signed test Compared between Pre op / Post op median number of Antiglaucoma agent

^† Paired-t test Compared between Pre op / Post op median number of Antiglaucoma agent.

Table 5.

Postoperative complications (%)

Complications	Group 1	Group 3	Group 1,2,3	Group 4	Total
Band keratopathy	1 (1.40)	0 (0)	1 (1.40)	1 (1.40)	2 (2.81)
Corneal erosion	1 (1.40)	0 (0)	1 (1.40)	3 (4.22)	4 (5.63)
Corneal melting	0 (0)	0 (0)	0 (0)	1 (1.40)	1 (1.40)
Tube exposure	0 (0)	1 (1.40)	1 (1.40)	0 (0)	1 (1.40)
Hypotony	0 (0)	0 (0)	0 (0)	4 (5.63)	4 (5.63)
Choroidal detachment	0 (0)	0 (0)	0 (0)	1 (1.40)	1 (1.40)
Endophthalmitis	0 (0)	0 (0)	0 (0)	1 (1.40)	1 (1.40)

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