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Editors Selection IGR 19-4

(Laser) Surgical treatment: Two materials for the Ahmed glaucoma valve

Comment by Robert Feldman & Omar Piovanetti on:

19979 A comparison of the polypropylene plate Ahmed glaucoma valve to the silicone plate Ahmed glaucoma flexible valve, Hinkle DM; Zurakowski D; Ayyala RS, European Journal of Ophthalmology, 2007; 17: 696-701

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Glaucoma drainage devices are used in the treatment of refractory glaucoma. Various materials are used in different models. One of these, the Ahmed glaucoma valve (AGV)(New World Medical, Inc.),has models in different materials; the polypropylene plate AGV (S-2)and the newer silicone plate AGV (FP-7). In rabbits, silicone is lessinflammatory than polypropylene. Hinkle et al. (1488) performed a retrospective, single surgeon, chartreview comparing surgical results of the S-2 AGV in 26 eyes to theFP-7 AGV in 25 eyes. Implant choice was consecutive and dictatedby hospital formulary changes. All patients had a minimum of 12months of follow-up visits. The groups were similar in demographics,preoperative BCVA, IOP, and number of medications.

The IOP was statistically lower in the silicone group (p < 0.05) at day one, six, nine and 12 months. At 12 months, the IOP was 12.1 (SD ± 3.4) in the FP-7 group and 16.1 (SD ± 5.7) in the S-2 group (p < 0.01). The mean number of both pre- and postoperative medications was higher in the FP-7 group. There was no difference in success rates (success was defined as final IOP at least 20% less than the preoperative IOP and > 5 mmHg and < 22 mmHg, without additional glaucoma surgery, loss of vision, or devastating complications, with or without medications). There was < 40% chance of detecting the difference with the study sample size. Shallow chamber and choroidal effusion were more common in the FP-7 group. The incidence of hypertensive phase and need for bleb needling during that period were more common in the S-2 group. The study results confirmed the previous findings of Ishida et al. Overall, the FP-7 resulted in lower final IOP but more early hypotony, and maybe a reasonable alternative to the S-2 shunt.

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