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Editors Selection IGR 13-1

Surgical Treatment: Ahmed-Baerveldt Comparison (ABC)

Comment by Ron Gross on:

27663 Treatment Outcomes in the Ahmed Baerveldt Comparison Study after 1 Year of Follow-up, Budenz DL; Barton K; Feuer WJ et al., Ophthalmology, 2011; 118: 443-452

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Budenz, et al. (427) report the one-year results of the multicenter RCT Ahmed (n = 143) Baerveldt (n = 133) Comparison (ABC) of efficacy and complications in eyes with prior incisional surgery or with glaucoma diagnoses known to be poor candidates for trabeculectomy. The study by Barton et al. that describes the study methodology, baseline characteristics, and intraoperative complications, immediately precedes this article. From similar base- lines, at one year, the Baerveldt (BGI) was more effective with a mean IOP of 13.2 mmHg compared to 15.4 mmHg with the Ahmed (AGV), p = .007. Number of medications were slightly lower with the BGI, 1.5 than AGV 1.8, p = .071. Success rates (IOP < 21 mmHg) were similar, although the BGI group had more complete success without medications and more success if 14 or 17 mmHg was used as the cutoff. Early postoperative complications, often related to transiently elevated IOP were more common with the BGI, but frequent in both groups (58% v 43%). Serious complications including reoperation and/or loss of two lines of vision were relatively frequent with 20% in the AGV group and 34% in the BGI group. Reoperation for glaucoma was more common with the AGV. Interestingly, those procedures performed by a surgeon who had done less than twenty of that specific device were at increased risk of failure.

This study demonstrated that tube shunt implantation with either device is an effective means to control IOP in these difficult glaucomas

This study demonstrated that tube shunt implantation with either device is an effective means to control IOP in these difficult glaucomas. However, the potential for complications is substantial with about 30% of eyes experiencing at least a two-line loss of visual acuity in both groups. IOP reduction was greater with the BGI, but this was associated with a higher rate of early and serious complications. Additionally, limited surgeon experience with a specific device was a risk factor for failure.

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