Abstract
Purpose
This study was conducted to report the safety and efficacy of pars plana-modified Ahmed Glaucoma Valve PS2 in advanced secondary glaucoma.
Methods
We performed a prospective, interventional case series that included patients with advanced secondary glaucoma and uncontrolled intraocular pressure (IOP). Eleven eyes of nine patients with aphakic, neovascular, traumatic, inflammatory and pseudoexfoliation glaucoma were included. All patients had pars plana vitrectomy before tube insertion.
Results
One year after surgery, IOP was controlled (21 mmHg or less) in ten of 11 eyes (91%), seven (64%) did not need medical antiglaucoma therapy. Average IOP decreased from 32.2±8.3 mmHg before surgery to 15.7±7.7 mmHg postoperatively (P<0.0001). The average number of topically used medications used decreased from 2.9±1.2 to 0.545±0.78 (P<0.0001). Complications included transient hypotony (three eyes—two of them without tube ligature), transient choroidal effusion (three eyes) and an intermediate increase in IOP (seven eyes). Tube exchange was performed in one eye and needling/bleb excision in two patients.
Conclusions
Pars plana-modified Ahmed Valve implantation is effective and safe in advanced glaucoma. Partial ligature of the tube is necessary to prevent early hypotony. Close follow-up of patients is needed to monitor variations of IOP within the first year.
Similar content being viewed by others
References
Ayyala RS, Michelini-Norris B, Flores A, Haller E, Margo CE (2000) Comparison of different biomaterials for glaucoma drainage devices: part 2. Arch Ophthalmol 118:1081–1084
Chalam KV, Gandham S, Gupta S, Tripathi BJ, Tripathi RC (2002) Pars plana modified Baerveldt implant versus Neodymium:YAG cyclophotocoagulation in the management of neovascular glaucoma. Ophthalmic Surg Lasers 33:383–393
Coleman AL, Hill R, Wilson MR, Choplin N, Kotas-Neumann R, Tam M, Bacharach J, Panek WC (1995) Initial clinical experience with the Ahmed glaucoma valve implant. Am J Ophthalmol 120:23–31
Joussen AM, Walter P, Jonescu-Cuypers CP, Koizumi K, Poulaki V, Bartz-Schmidt KU, Krieglstein GK, Kirchhof B (2003) Retinectomy for treatment of intractable glaucoma: long term results. Br J Ophthalmol 87:1094–1103
Kaynak S, Tekin NF, Durak I, Berk AT, Saatci AO, Soylev MF (1998) Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma. Br J Ophthalmol 82:1377–1382
Kee C (2001) Prevention of early postoperative hypotony by partial ligation of silicone tube in Ahmed glaucoma valve implantation. J Glaucoma 10:644–649
Lin S (2002) Endoscopic cyclophotocoagulation. Br J Ophthalmol 86:1434–1438
Lin P, Wollstein G, Schuman JS (2004) Contact transscleral neodymium:yttrium–aluminum–garnet laser cyclophotocoagulation: long-term outcome. Ophthalmology 11:2137–2143
Lloyd MA, Heuer DK, Baerveldt G, Minckler DS, Martone JF, Lean JS, Liggett PE (1991) Combined Molteno implantation and pars plana vitrectomy for neovascular glaucomas. Ophthalmology 98:1401–1405
Luttrull JK, Avery RL (1995) Pars plana implant and vitrectomy for treatment of neovascular glaucoma. Retina 15:379–387
Luttrull JK, Avery RL, Baerveldt G, Easley KA (2000) Initial experience with pneumatically stented Baerveldt implant modified for pars plana insertion for complicated glaucoma. Ophthalmology 107:143–149
Molteno A, Straughan J, Ancker E (1976) Long tube implants in the management of glaucoma. S Afr Med J 50:1062–1066
Rothman RF, Sidoti PA, Gentile RC, Liebmann JM, Ishikawa H, Rosen RB, Ritch R (2001) Glaucoma drainage tube kink after pars plana insertion. Am J Ophthalmol 132:413–414
Schlote T, Derse M, Rassmann K, Nicaeus T, Dietz K, Thiel H-J (2001) Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma. J Glaucoma 10:294–301
Sheppard JD, Shrum KR (1995) Pars plana Molteno implantation in complicated inflammatory glaucoma. Ophthalmic Surg 26:218–222
Sidoti PA, Mosny AY, Ritterband DC, Seedor JA (2001) Pars plana tube insertion of glaucoma drainage implants and penetrating keratoplasty in patients with coexisting glaucoma and corneal disease. Am J Ophthalmol 108:1050–1058
Smiddy WE, Rubsamen PE, Grajewski A (1994) Vitrectomy for pars plana placement of a glaucoma seton. Ophthalmic Surg 25:532–535
Syed HM, Law SK, Nam SH, Li G, Caprioli J, Colemann A (2004) Baerveldt-350 implant versus Ahmed valve for refractory glaucoma. A case-controlled comparison. J Glaucoma 13:38–45
Tsai JC, Johnson CC, Dietrich MS (2003) The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma: a single-surgeon comparison of outcome. Ophthalmology 110:1814–1821
Varma R, Heuer DK, Lundy DC, Baerveldt G, Lee PP, Minckler DS (1995) Pars plana Baerveldt tube insertion with vitrectomy in glaucomas associated with pseudophakia and aphakia. Am J Ophthalmol 119:401–407
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schlote, T., Ziemssen, F. & Bartz-Schmidt, K.U. Pars plana-modified Ahmed Glaucoma Valve for treatment of refractory glaucoma: a pilot study. Graefe's Arch Clin Exp Ophthalmo 244, 336–341 (2006). https://doi.org/10.1007/s00417-005-0008-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-005-0008-5