Clinical experience with the Ahmed Glaucoma Valve implant in eyes with prior or concurrent penetrating keratoplasties.
ABSTRACT To evaluate the Ahmed Glaucoma Valve implant, an aqueous shunting device with a unidirectional valve mechanism, in eyes with concurrent or prior penetrating keratoplasties.
Thirty-one eyes of 31 consecutive patients had placement of an Ahmed Glaucoma Valve implant. Median patient age was 65.1 years (range, 17.2 to 103.4 years). The main outcome measure was time after surgery without failure. Success was defined as no additional glaucoma surgeries or devastating visual complications, no new corneal graft failure, an intraocular pressure greater than or equal to 5 mm Hg on the last two follow-up examinations, and reduction in intraocular pressure. For eyes with preoperative intraocular pressure greater than 22 mm Hg, an average intraocular pressure of less than 22 mm Hg on the last two follow-up examinations was required. For eyes with preoperative intraocular pressure of less than 22 mm Hg, an intraocular pressure lowered by at least 20% from preoperative values was required.
Cumulative probabilities of success at 12 and 20 months (mean +/- SD) were 75.4% +/- 8.2% and 51.5% +/- 11.4%, respectively. Eleven of 31 eyes were failures. The risk of failure in eyes with prior infectious keratitis or keratouveitis was estimated to be 5.8 times greater than that associated with eyes that underwent penetrating keratoplasties for other reasons (P = .009).
Twelve- and 20-month success rates of the implant in eyes with prior or concurrent penetrating keratoplasties were comparable to those of other drainage devices. Eyes with prior infectious keratitis or keratouveitis were at increased risk of failure.
- SourceAvailable from: Sebastião Cronemberger
Article: Ceratoplastia penetrante e glaucomaRevista Brasileira De Oftalmologia - REV BRAS OFTALMOL. 01/2007; 66(4).
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ABSTRACT: To report our experience in the therapeutic management of post-penetrating keratoplasty glaucoma. Post-penetrating keratoplasty (PK) glaucoma is a true threat to visual prognosis. Therapeutic modalities are many, but the absence of a well-defined decision tree and the variable results of the various techniques renders management very difficult. This is a retrospective study including 73 eyes of 71 patients undergoing a penetrating keratoplasty. Patients who developed post-operative ocular hypertension were treated first with eye drops. In the case of failure, surgical procedures were recommended including trabeculectomy or glaucoma drainage devices. The intraocular pressure (IOP) assessed with applanation tonometer, side effects and graft failure were monitored. The first medical treatment used for all patients was a betablocker, which allowed control of intraocular pressure in 80.6 % of eyes. Ahmed glaucoma valve was used in two cases with success and without graft failure. Trabeculectomy was necessary for five patients, three of whom developed immunological graft rejection within 6 to 9 months. We also observed that late ocular hypertension was statistically related to anatomic graft failure, independently of other preoperative factors. Although hypotensive medication is still the first treatment for ocular hypertension after penetrating keratoplasty, a surgical procedure is sometimes required. Glaucoma drainage devices and trabeculectomy are widely practiced, leading to good outcomes, with the risk of rejection lower in cases involving mitomycin C. Cyclodestructive procedures should be reserved for surgical failures with significant visual loss.Journal francais d'ophtalmologie 02/2014; · 0.51 Impact Factor
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ABSTRACT: The aim of this article is to make a review about glaucoma associated with penetrating keratoplasty, describing since its incidence and risk factors until the different options for treatment.Revista brasileira de oftalmologia 08/2007; 66(4):274-286. · 0.16 Impact Factor