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Assessing risk factors for postoperative hypotony in Ahmed glaucoma valve implantation surgery

Abstract

Purpose

To assess the risk factors associated with the development of hypotony after Ahmed glaucoma valve (AGV) implantation.

Methods

One hundred and ninety-three eyes of 177 patients with various types of glaucoma that were treated with AGV implantation were retrospectively evaluated. Intraocular pressure lower than 6 mmHg related to the surgery is defined as postoperative hypotony. Patients’ demographic characteristics, type of glaucoma, preoperative and postoperative visual acuity, necessity of antiglaucoma treatments, lens status, previous ocular surgeries, intraocular pressure (IOP) measurements before and after surgeries, the need for additional procedures and postoperative complications were recorded from the patients’ charts.

Results

Hypotony was seen in 68 of 193 eyes (35.2%) postoperatively. In 45 eyes (23.3%), it has occurred in first postoperative day and in 23 eyes (11.9%) after the first day within the first week. There was no difference in intraocular pressures between two groups in the first year follow-up. Pre- and postoperative best-corrected visual acuities, age and gender were not statistically different between hypotony and no hypotony groups (p > 0.05). Also, lens status, history of previous ocular surgery, type of glaucoma and number of preoperative glaucoma medication usage were not found to be different between groups (p > 0.05).

Conclusions

Potential risk factors such as age, sex, lens status, history of previous ocular surgeries, preoperative glaucoma medication usage or glaucoma type are not found to influence upon postoperative hypotony prevalence for AGV surgery. Surgery type and personal ocular factors, which could not be determined beforehand, could be more important than demographic features.

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Data availability

The manuscript has no associated data in a data repository.

References

  1. Budenz DL, Barton K, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, Buys YM, Ahmed Baerveldt Comparison Study G (2011) Treatment outcomes in the Ahmed Baerveldt comparison study after 1 year of follow-up. Ophthalmology 118(3):443–452. https://doi.org/10.1016/j.ophtha.2010.07.016

    Article  PubMed  Google Scholar 

  2. Christakis PG, Kalenak JW, Zurakowski D, Tsai JC, Kammer JA, Harasymowycz PJ, Ahmed II (2011) The Ahmed versus Baerveldt study: one-year treatment outcomes. Ophthalmology 118(11):2180–2189. https://doi.org/10.1016/j.ophtha.2011.05.004

    Article  PubMed  Google Scholar 

  3. Ayyala RS, Michelini-Norris B, Flores A, Haller E, Margo CE (2000) Comparison of different biomaterials for glaucoma drainage devices: part 2. Arch Ophthalmol 118(8):1081–1084. https://doi.org/10.1001/archopht.118.8.1081

    CAS  Article  PubMed  Google Scholar 

  4. Hinkle DM, Zurakowski D, Ayyala RS (2007) A comparison of the polypropylene plate Ahmed glaucoma valve to the silicone plate Ahmed glaucoma flexible valve. Eur J Ophthalmol 17(5):696–701. https://doi.org/10.1177/112067210701700502

    CAS  Article  PubMed  Google Scholar 

  5. Coleman AL, Smyth RJ, Wilson MR, Tam M (1997) Initial clinical experience with the Ahmed Glaucoma Valve implant in pediatric patients. Arch Ophthalmol 115(2):186–191. https://doi.org/10.1001/archopht.1997.01100150188007

    CAS  Article  PubMed  Google Scholar 

  6. Rachmiel R, Trope GE, Buys YM, Flanagan JG, Chipman ML (2008) Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients. Can J Ophthalmol 43(4):462–467. https://doi.org/10.3129/i08-082

    Article  PubMed  Google Scholar 

  7. Jones E, Alaghband P, Cheng J, Beltran-Agullo L, Sheng Lim K (2013) Preimplantation flow testing of Ahmed Glaucoma valve and the early postoperative clinical outcome. J Curr Glaucoma Pract 7(1):1–5. https://doi.org/10.5005/jp-journals-10008-1128

    Article  PubMed  PubMed Central  Google Scholar 

  8. Moss EB, Trope GE (2008) Assessment of closing pressure in silicone Ahmed FP7 glaucoma valves. J Glaucoma 17(6):489–493. https://doi.org/10.1097/IJG.0b013e3181622532

    Article  PubMed  Google Scholar 

  9. Prata JA Jr, Mermoud A, LaBree L, Minckler DS (1995) In vitro and in vivo flow characteristics of glaucoma drainage implants. Ophthalmology 102(6):894–904. https://doi.org/10.1016/s0161-6420(95)30937-2

    Article  PubMed  Google Scholar 

  10. Chiam PJ, Chen X, Haque MS, Sung VC (2018) Outcome of fixed volume intracameral sodium hyaluronate 1.4% injection for early postoperative hypotony after Baerveldt glaucoma implant. Clin Exp Ophthalmol 46(9):1035–1040. https://doi.org/10.1111/ceo.13347

    Article  PubMed  Google Scholar 

  11. Stein JD, McCoy AN, Asrani S, Herndon LW, Lee PP, McKinnon SJ, Allingham RR, Challa P (2009) Surgical management of hypotony owing to overfiltration in eyes receiving glaucoma drainage devices. J Glaucoma 18(8):638–641. https://doi.org/10.1097/IJG.0b013e31819aa4e0

    Article  PubMed  Google Scholar 

  12. Cheng J, Beltran-Agullo L, Buys YM, Moss EB, Gonzalez J, Trope GE (2016) Flow test to predict early hypotony and hypertensive phase after Ahmed Glaucoma Valve (AGV) surgical implantation. J Glaucoma 25(6):493–496. https://doi.org/10.1097/IJG.0000000000000318

    Article  PubMed  Google Scholar 

  13. Gil-Carrasco F, Salinas-VanOrman E, Recillas-Gispert C, Paczka JA, Gilbert ME, Arellanes-Garcia L (1998) Ahmed valve implant for uncontrolled uveitic glaucoma. Ocul Immunol Inflamm 6(1):27–37. https://doi.org/10.1076/ocii.6.1.27.8078

    CAS  Article  PubMed  Google Scholar 

  14. Da Mata A, Burk SE, Netland PA, Baltatzis S, Christen W, Foster CS (1999) Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Ophthalmology 106(11):2168–2172. https://doi.org/10.1016/S0161-6420(99)90500-6

    Article  PubMed  Google Scholar 

  15. Ozdal PC, Vianna RN, Deschenes J (2006) Ahmed valve implantation in glaucoma secondary to chronic uveitis. Eye (Lond) 20(2):178–183. https://doi.org/10.1038/sj.eye.6701841

    CAS  Article  Google Scholar 

  16. Papadaki TG, Zacharopoulos IP, Pasquale LR, Christen WB, Netland PA, Foster CS (2007) Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol 144(1):62–69. https://doi.org/10.1016/j.ajo.2007.03.013

    Article  PubMed  Google Scholar 

  17. Yakin M, Eksioglu U, Sungur G, Satana B, Demirok G, Ornek F (2017) Short-term to long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma secondary to behcet disease. J Glaucoma 26(1):20–26. https://doi.org/10.1097/IJG.0000000000000539

    Article  PubMed  Google Scholar 

  18. Canut MI, Alonso-Agesta M, Botella J, Julio G (2020) Cauterized suture for complete tube occlusion of Ahmed glaucoma valve in hypotony maculopathy. Eur J Ophthalmol 30(1):221–223. https://doi.org/10.1177/1120672119853750

    Article  PubMed  Google Scholar 

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. The study was designed by Ahmet Kaderli and Gülizar Demirok. Data were provided by Ümit Ekşioğlu as the chairmen of the contributing departments. Data collection was performed by Güner Üney, Mehmet Yakın and Berku Günal. The first draft of the manuscript was written by Ahmet Kaderli and Gülizar Demirok, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmet Kaderli.

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Conflict of interest

Author Kaderli declares that he has no conflict of interest. Author Demirok declares that she has no conflict of interest. Author Üney declares that she has no conflict of interest. Author Yakın declares that he has no conflict of interest. Author Günal declares that he has no conflict of interest. Author Ekşioğlu declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Retrospective study design.

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For this type of study (retrospective analysis), formal consent is not required.

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Kaderli, A., Demirok, G., Üney, G. et al. Assessing risk factors for postoperative hypotony in Ahmed glaucoma valve implantation surgery. Int Ophthalmol 41, 3381–3386 (2021). https://doi.org/10.1007/s10792-021-01900-3

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  • DOI: https://doi.org/10.1007/s10792-021-01900-3

Keywords

  • Ahmed glaucoma valve
  • Risk factors
  • Demographic features
  • Shunt surgery
  • Hypotony