Ahmed Glaucoma Valve Implantation Through The Ciliary Sulcus In 'Phakic' Eyes Without Lensectomy

Özkan Ö., Arıkan G., Günenç Ü.

10th World Glaucoma Congress, Rome, Italy, 28 June - 01 July 2023, no.838, pp.1140, (Summary Text)

  • Publication Type: Conference Paper / Summary Text
  • City: Rome
  • Country: Italy
  • Page Numbers: pp.1140
  • Dokuz Eylül University Affiliated: Yes

Abstract

INTRODUCTION

 

Glaucoma drainage devices (GDD) have been used widely for many years in the management of refractory or complicated glaucoma cases.1 During GDD surgery silicone tube typically inserted into the anterior chamber (AC). It is well known that tube in the AC may lead to corneal endothelial cell loss and eventually corneal decompensation. 2-4 Ciliary sulcus is another potential space for the tube shunt placement.2,4,5 However, ciliary sulcus insertion of the tube is preferred  in only pseudophakic/aphakic eyes.6 In phakic eyes,  combined surgery (GDD implantation with cataract surgery) is performed. Ciliary sulcus tube shunt placement can also be performed in phakic eyes without lensectomy. 7

 

AIM

 

In this study, we aimed to evaluate the outcomes of ‘phakic’ eyes that underwent Ahmed glaucoma valve (AGV) implantation through the ciliary sulcus   'without lensectomy'.

 

METHOD

 

Medical records of the patients who underwent Ahmed glaucoma valve implantation with the tube placement in the ciliary sulcus between January 2018 and December 2022 were reviewed retrospectively. Only phakic eyes were included in the study (Figure 1,2 and 3).

Aphakic/pseudophakic eyes or eyes in which combined surgery (tube shunt placement and lensectomy) were performed were excluded. Success was defined as postoperative intraocular pressure (IOP) ≥ 6 mmHg and ≤ 21 mmHg with or without antiglaucomatous medications, without further surgery for IOP control, without loss of light perception and without removal of the implant. Glaucoma diagnosis, visual acuity levels, IOP levels and complications were recorded.

 

RESULTS

A total of 15 eyes of 15 patients (9 male, 6 female) were included in the study. Mean age was 53.86 ± 10.85 years (range, 38-76 years). The mean postoperative follow-up period was 13.30 ± 12.40 months (range, 1-36 months). Glaucoma diagnosis are shown in Table 1.

The mean preoperative IOP level was 33.93 ± 6.97 mmHg (range, 24-50 mmHg), and it was found as 12.66 ± 5.52 mmHg (range, 6-20 mmHg) at final visit. Decrease in intraocular pressure level was statistically significant (Wilcoxon signed rank test, p=0.001). Preoperative visual acuity levels were between hand motion (HM) and 0.9. Visual acuity levels at last follow-up visit were also found between HM and 0.9.  At the final visit, visual acuity levels increased in 5 eyes, decreased in 4 eyes, and remained the same in 6 eyes. Postoperative complications are shown in Table 2. Malignant glaucoma was the most common complication and developed in 5 eyes (33.33%). Pars plana vitrectomy, lensectomy, IOL implantation and iridozonulohyaloidectomy were performed in 2 patients who developed malignant glaucoma, while the other 3 patients improved with medical treatment. At final visit, success was achieved in 13 eyes (86.66%). In the other 2 eyes, high IOP was due to bleb encapsulation and it was managed by surgical excision of the encapsulated bleb.

 

CONCLUSION

In phakic eyes, placing the Ahmed glaucoma valve tube  into the ciliary sulcus is a safe and effective procedure.

 

REFERENCES

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  2. Zhang, Q. et al. Te efect of tube location on corneal endothelial cells in patients with Ahmed glaucoma valve. Ophthalmology 2021; 128: 218–226.
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