Comparison of long-term surgical success of Ahmed Valve implant versus trabeculectomy in open-angle glaucoma
ABSTRACT To compare the long-term intraocular pressure (IOP) outcomes of Ahmed Glaucoma Valve (AGV) implantation to trabeculectomy with mitomycin C (MMC) in open-angle glaucoma (OAG).
78 OAG patients who underwent AGV implantation were matched with respect to age, preoperative surgery, preoperative IOP and preoperative medicines to 88 OAG patients who underwent trabeculectomy with MMC with a minimum of 3 years' follow-up. The cumulative probability of success between the two groups with different criteria was analysed: (1) an IOP < or =21 mm Hg and a reduction of IOP>/=15% from baseline; and (2) an IOP < or =18 mm Hg and a reduction of IOP > or =20% from baseline. No loss of light perception, no additional glaucoma surgery and no hypotony were also required.
The 5-year cumulative probability of success was not statistically significant between eyes that had an AGV or trabeculectomy with MMC when success was defined as criteria A (p = 0.094). However, when success was defined according to criteria B, eyes undergoing trabeculectomy with MMC had a higher rate of success (p = 0.024).
Trabeculectomy with MMC has a significantly higher 5-year cumulative probability of success compared with AGV implants when greater reduction IOP is necessary.
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ABSTRACT: To compare the efficacy and safety of Ahmed glaucoma valve implantation (AGV) with trabeculectomy in the management of glaucoma patients. A comprehensive literature search (PubMed, Embase, Google, and the Cochrane library) was performed, including a systematic review with meta-analysis of controlled clinical trials comparing AGV versus trabeculectomy. Efficacy estimates were the weighted mean differences (WMDs) for the percentage intraocular pressure reduction (IOPR %) from baseline to end-point, the reduction in glaucoma medications, and the odds ratios (ORs) for complete and qualified success rates. Safety estimates were the relative risks (RRs) for adverse events. All outcomes were reported with a 95% confidence interval (CI). Statistical analysis was performed using the RevMan 5.0 software. Six controlled clinical trials were included in this meta-analysis. There was no significant difference between the AGV and trabeculectomy in the IOPR% (WMD = -3.04, 95% CI: -8.36- 2.26; P = 0.26). The pooled ORs comparing AGV with trabeculectomy were 0.46 (0.22, 0.99) for the complete success rate (P = 0.05) and 0.97 (0.78-1.20) for the quantified success rate (P = 0.76). No significant difference in the reduction in glaucoma medicines was observed (WMD = 0.24; 95% CI: -0.27-0.76; P = 0.35). AGV was found to be associated with a significantly lower frequency of all adverse events (RR = 0.71; 95%CI: 1.14-0.97; p = 0.001) than trabeculectomy, while the most common complications did not differ significantly (all p> 0.05). AGV was equivalent to trabeculectomy in reducing the IOP, the number of glaucoma medications, success rates, and rates of the most common complications. However, AGV was associated with a significantly lower frequency of overall adverse events.PLoS ONE 02/2015; 10(2):e0118142. DOI:10.1371/journal.pone.0118142 · 3.53 Impact Factor
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ABSTRACT: Ziel ist die Untersuchung der Effektivität und der Sicherheit bei der Behandlung von therapierefraktären Glaukomen mithilfe von Ahmed Glaucoma Valve (AGV)-Implantaten über Pars-plana-Zugang nach Vitrektomie.Bei 27 Augen von 22 Patienten mit komplexen therapierefraktären Sekundärglaukomen wurde eine AGV-Implantation über Pars-plana-Zugang durchgeführt. Augeninnendruckwerte, Sehschärfe sowie auftretende Komplikationen wurden erfasst. Die mittlere Nachbeobachtungszeit betrug 23,6 Monate.Es kam zu einer Senkung des Augeninnendrucks von 30,2 mmHg präoperativ auf 13 mmHg nach 36 Monaten. Die Sehschärfe änderte sich nicht. Bei 5 Augen war im Verlauf eine Explantation erforderlich, davon in 3 Fällen aufgrund von Komplikationen in Zusammenhang mit der AGV.Mithilfe der AGV-Implantation über Pars-plana-Zugang kann eine effektive und dauerhafte Drucksenkung auch bei schweren therapierefraktären Sekundärglaukomen erreicht werden. Allerdings muss bei der Behandlung dieser Art von Krankheitsbildern das Risiko von schweren visusbedrohenden Komplikationen in Kauf genommen werden.Der Ophthalmologe 01/2013; 110(6). · 0.72 Impact Factor
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ABSTRACT: Glaucoma is a progressive optic neuropathy that causes characteristic changes of the optic nerve and visual field in relation to intraocular pressure (IOP). It is now known that glaucoma can occur at statistically normal IOPs and prevalence studies have shown that normal tension glaucoma (NTG) is more common than previously thought. While IOP is believed to be the predominant risk factor in primary open angle glaucoma (POAG), IOP-independent risk factors, such as vascular dysregulation, are believed to play an important part in the pathogenesis of NTG. Though certain distinguishing phenotypic features of NTG have been reported, such as an increased frequency of disc hemorrhages, acquired pits of the optic nerve and characteristic patterns of disc cupping and visual field loss, there is much overlap of the clinical findings in NTG with POAG, suggesting that NTG is likely part of a continuum of open angle glaucomas. However, IOP modification is still the mainstay of treatment in NTG. As in traditional POAG, reduction of IOP can be achieved with the use of medications, laser trabeculoplasty or surgery. Studies now show that the choice of medication may also be important in determining the outcomes of these patients. Though it is likely that future treatment of NTG will involve modification of both IOP and IOP-independent risk factors, current efforts to develop IOP-independent neuroprotective treatments have not yet proven to be effective in humans.Indian Journal of Ophthalmology 05/2014; 62(5):529-37. DOI:10.4103/0301-4738.133481 · 0.93 Impact Factor