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Outcomes of Ahmed glaucoma valve implantation and risk factors for graft failure in eyes with Descemet’s stripping endothelial keratoplasty

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Abstract

Purpose

The aim of this study was to assess the efficacy of Ahmed glaucoma valve (AGV) in eyes with Descemet’s stripping endothelial keratoplasty (DSEK) and glaucoma and evaluate the risk factors for failure.

Methods

Retrospective interventional study included 27 eyes (27 subjects) that underwent AGV implantation following DSEK. The main outcome measure was AGV success, defined as IOP between 6 and 21 mmHg with or without topical antiglaucoma medications (AGMs). Secondary outcome measure was graft survival. Graft failure was defined as corneal edema for ≥ 1 month or irreversible graft opacity requiring intervention.

Results

Eighteen eyes (66.7%) had anterior chamber tube and 9 eyes (33.3%) had sulcus tube placement. Median follow-up was 1.2 years (interquartile range, IQR, 0.5–2.5 years). Following AGV implantation, the median IOP decreased significantly (p < 0.0001), median number of AGMs reduced significantly (p < 0.001) and median visual acuity was maintained (p = 0.76). Cumulative success probability of AGV was 75.8 ± 10.6% at 1 year, and 75.8 ± 10.6% at 2 years. For 24 clear grafts before AGV, estimates of success post-AGV were 100% at 1 year, 77.8 ± 10% at 2 years and 51.9 ± 16.4% at 3 years. Postoperative tube intervention was a borderline significant risk factor for graft failure (p = 0.05) with hazards ratio of 7.2; however, tube location was not associated with failure.

Conclusions

AGV can be considered an effective surgical option for IOP control in eyes with DSEK and glaucoma. However, high risk of long-term graft failure in these eyes needs to be considered specially those eyes needing tube intervention.

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Data availability

Data are submitted as a supplemental table.

Code availability

Not applicable.

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Acknowledgements

Ms. Sreedevi for language editing.

Funding

Hyderabad Eye Research Foundation and Hyderabad Eye Institute, Hyderabad, India.

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Authors and Affiliations

  1. VST Glaucoma Center, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India

    Mayank Rai & Sirisha Senthil

  2. Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India

    Mayank Rai

  3. Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India

    Ashik Mohamed

  4. The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India

    Sunita Chaurasia

Authors
  1. Mayank Rai
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  2. Ashik Mohamed
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  3. Sunita Chaurasia
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  4. Sirisha Senthil
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Contributions

SS, contributed in conception, design, acquisition, analysis, interpretation of data, drafting the manuscript and critically revising it. MR contributed in data collection, and in writing the manuscript. AM, helped with data analysis, interpretation of data and critically revising the manuscript. SC contributed in revising it critically for important intellectual content.

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Correspondence to Sirisha Senthil.

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None of the authors have any conflicting interest.

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Institutional review board approved the study.

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All participants consented for the study and for the study findings to be published.

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Rai, M., Mohamed, A., Chaurasia, S. et al. Outcomes of Ahmed glaucoma valve implantation and risk factors for graft failure in eyes with Descemet’s stripping endothelial keratoplasty. Int Ophthalmol 42, 2335–2345 (2022). https://doi.org/10.1007/s10792-022-02231-7

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  • DOI: https://doi.org/10.1007/s10792-022-02231-7

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