Three-Year Treatment Outcomes of Ahmed Glaucoma Valve Implantation with Adjunctive Intraoperative and Postoperative Mitomycin C.

PURPOSE: To describe 3-year outcomes of Ahmed glaucoma valve (AGV) implantation with adjunctive use of intraoperative and postoperative mitomycin C (MMC).

DESIGN

Retrospective observational consecutive case series.

PARTICIPANTS

One hundred and twenty-one eyes of 95 patients with medically uncontrolled glaucoma who underwent AGV implantation combined with intraoperative and postoperative subconjunctival MMC injections between 2011 and 2017 at University of California, San Francisco Medical Center.

METHODS

Clinical data were extracted from patients' medical records, including intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and surgical complications.

MAIN OUTCOME MEASURES: Intraocular pressure, treatment failure (defined as IOP > 21 mmHg or reduced <20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma, and loss of light perception vision), number of glaucoma medications, BCVA, and surgical complications.

RESULTS

Intraocular pressure (mean ± SD) decreased from 23.7 ± 9.5 mmHg preoperatively to 12.7 ± 3.9 mmHg at 3 years (P < 0.001), and the number of glaucoma medications (mean ± SD) decreased from 2.9 ± 1.0 to 1.3 ± 0.9 (P < 0.001). The cumulative probability of failure at 3-year was 26% (95% confidence interval, 19%-34%). Best-corrected visual acuity (logarithm of the minimum angle of resolution [logMAR] mean ± SD) remained stable from preoperative vision (logMAR 0.45 ± 0.68 preoperatively, 0.56 ± 0.77 at 3 years, P = 0.16). The complication rate was 17% and the most common early postoperative complications were diplopia and hypotony maculopathy.

CONCLUSIONS

Ahmed glaucoma valve implantation combined with intraoperative and postoperative MMC resulted in a significant reduction in IOP and number of glaucoma medications with a low rate of surgical complications and stable BCVA during 3 years of follow-up.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.