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Abstract #9969 Published in IGR 5-3
The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma: a single-surgeon comparison of outcome
Tsai JC; Johnson CC; Dietrich MSOphthalmology 2003; 110: 1814-1821
PURPOSE: To compare the surgical outcome of Baerveldt and Ahmed shunt implants in the treatment of refractory glaucoma. DESIGN: Retrospective, nonrandomized, comparative trial. METHODS AND PARTICIPANTS: The medical records of 118 consecutive patients who underwent glaucoma shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon were reviewed. MAIN OUTCOME MEASURES: The primary outcome measure was surgical success (6 mmHg ≤ intraocular pressure (IOP) ≤ 21 mmHg without additional glaucoma surgery or devastating complication) at 12 months after surgery. Secondary outcome measures included mean IOP and number of medications used at the following postoperative visits: day 1, one week, and one, three and six months, and every six months thereafter. Additional outcome measures evaluated include visual acuities, prevalence and timing of postoperative choroidal detachment, and clinical bleb encapsulation. RESULTS: Survival curve analysis showed success rates of 82.9% of the Ahmed group and 72.9% of the Baerveldt group at 12 months after surgery (p = 0.257). Patients in the Ahmed group exhibited lower IOPs at one day (p < 0.001) and one week (p < 0.001) after surgery and were taking fewer glaucoma medications at one week (p < 0.001) and one month (p < 0.001) after surgery. A higher proportion of Ahmed patients experienced clinical bleb encapsulation than did the Baerveldt patients (60.4 versus 27.1%; p < 0.001). Moreover, the first observation of postoperative bleb encapsulation was sooner after surgery for the Ahmed patients (50.0 ± 43.8 days) than for the Baerveldt patients (69.8 ± 22.6 days; p = 0.001). CONCLUSIONS: The Ahmed shunt implant exhibited better control of IOP in the early postoperative period (one day and one week) with patients requiring fewer glaucoma medications at one week and one month after surgery. There was both a higher prevalence and earlier onset of bleb encapsulation observed with the Ahmed shunt implant.
Dr. J.C. Tsai, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jct2002@columbia.edu
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
