Outcomes of Ahmed Glaucoma Valve Implantation in the Ciliary Sulcus Versus the Anterior Chamber.

Precis: AGV implantation through the ciliary sulcus offers similar IOP control to anterior chamber insertion with reduced corneal endothelial cell loss, despite technical difficulties during the insertion process.

Purpose

To report the surgical outcomes of Ahmed glaucoma valve (AGV) implantation through the ciliary sulcus (CS).

Patients and methods: We performed a retrospective analysis of 204 eyes of 204 patients with AGV implantation through the CS and 85 eyes of 85 patients with AGV implantation through the anterior chamber (AC). The cumulative probability of success was defined as an IOP between 5 and 18 mmHg and reduction of IOP≧20% from the preoperative IOP. Kaplan-Meier analysis evaluated success up to five years.

Results

AGV-CS/AC eyes included POAG (74/12 eyes), PACG (8/0), XFG (62/50), NVG (4/1) and secondary glaucoma (56/22), respectively. There was no significant difference in qualified success rates of AGV-CS (89.7%) and AGV-AC (87.1%). Intraoperative tube insertion difficulties occurred in 47 eyes (23.0%) in the CS group and none in the AC group. Layered hyphema was more frequently observed in CS group (25 eyes, 12.3%) than in AC group (5 eyes, 5.9%). The monthly loss of corneal endothelial cell density (per mm2) was significantly lower in CS group (14.5±20.4) than in AC group (24.5±34.3).

Conclusions

Although the higher rates of intraoperative troubles for insertion and postoperative hyphema were observed, the IOP control of AGV-CS insertion is comparable to that of AC insertion with less detrimental effects on the corneal endothelium. With appropriate techniques, CS is a reasonable insertion site for refractory glaucoma.