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Abstract #9219 Published in IGR 5-2
The Ahmed drainage implant in the treatment of pediatric glaucoma
Morad Y; Donaldson CE; Kim YM; Abdolell M; Levin AVAmerican Journal of Ophthalmology 2003; 135: 821-829
PURPOSE: To report the safety and efficacy of Ahmed glaucoma valve (New World Medical, Inc., Rancho Cucamonga, CA) implantation for the management of pediatric glaucoma in the early and intermediate follow-up period. DESIGN: Consecutive interventional case series. METHOD: A retrospective chart review was conducted on 60 eyes (44 patients, age range at surgery 1.5 months to 16 years, average 6 ± 4.9 years), with pediatric glaucoma that underwent Ahmed Glaucoma Valve implantation for medically uncontrolled intraocular pressure (IOP) between the years 1995 and 2000. Outcome measures were control of IOP below 21 mmHg, the need for antiglaucoma medications after surgery, and loss of two or more lines of Snellen acuity. Complications were monitored. RESULTS: The postoperative follow-up period for each eye averaged 24.3 ± 16 months (range, three to 60 months). At last follow-up, IOP was controlled in 44 eyes (73%), 11 of which did not need antiglaucoma therapy. Kaplan-Meier life-table analysis showed probability of success with or without medications of 93% (95% confidence interval (CI), 86-100%), 86% (95% CI, 77-96%), 71% (95% CI, 59-87%), and 45% (95% CI, 28-80%) after 12, 24, 36, and 48 months of follow-up. Average IOP decreased from 32.8 ± 6.2 before surgery to 16.6 ± 8.0 postoperatively (p < 0.0001). The average number of medications used decreased from 4.4 ± 1.97 to 2.0 ± 2.0 (p < 0.0001). Kaplan-Meier survival analysis did not reveal any difference in survival profiles related to specific diagnosis of glaucoma, age (above or below 18 months), or prior surgery. Complications occurred in 30 eyes (50%). Although most resolved or were treated successfully, four patients had severe visual loss during the follow-up. Uveitis was a significant risk factor for tube exposure (Fisher's exact test, p = 0.006). CONCLUSIONS: Ahmed glaucoma valve implantation is an effective treatment for pediatric glaucoma, although patients frequently require antiglaucoma medications. However, a high rate of potentially sight-threatening postoperative complications warrants ongoing close follow-up.
Dr. Y. Morad, Department of Ophthalmology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Classification:
9.1 Developmental glaucomas (Part of: 9 Clinical forms of glaucomas)
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
