Journal of Current Glaucoma Practice

Register      Login

VOLUME 10 , ISSUE 2 ( May-August, 2016 ) > List of Articles

Original Article

Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy

Robert A Sharpe, Leah L Kammerdiener, Kendall W Wannamaker, Jie Fan, Elizabeth D Sharpe

Keywords : Glaucoma, Resident, Trabeculectomy, Training, Valve

Citation Information : Sharpe RA, Kammerdiener LL, Wannamaker KW, Fan J, Sharpe ED. Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy. J Curr Glaucoma Pract 2016; 10 (2):60-67.

DOI: 10.5005/jp-journals-10008-1203

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2016; The Author(s).


Aims: To compare outcomes of resident-performed Ahmed valve surgery vs trabeculectomy in a Veteran Affairs medical facility. Materials and methods: A retrospective cohort of 103 eyes in 91 patients receiving Ahmed valve (valve) or trabeculectomy (trab) performed at a Veterans Administration Medical Center by residents in their third year of training. The primary outcomes included intraocular pressure (IOP), treatment failure, and complications over 1 year. Results: Of 103 eyes, 44 received valve and 59 received trab. Primary open-angle glaucoma was primary diagnosis more often in trab, while neovascular glaucoma predominated in the valve group (p < 0.001). Preoperative mean IOP was 35.1 ± 11.8 and 24.5 ± 7.1 mm Hg for valve and trabeculectomy respectively (p < 0.001), but at 1 year the IOP difference between groups was not statistically significant (p = 0.064). Overall, 11 (25.0%) and 11 (18.6%) eyes met any criteria for failure for valve and trab respectively. At 1 year, 22.5% of valves had IOP > 21 mm Hg vs only 4.3% of trab (p = 0.02). Complications were infrequent. There were no intraoperative complications for valve, whereas five for trab. Most common immediate complication for valve was hyphema. Both groups had low rates of choroidal effusions and reoperation. Conclusion: Ahmed valve implantation and trabeculectomy produce significant reductions in IOP when performed by residents-in-training. Valves tend to be used more frequently in patients with secondary glaucoma. Although complication profiles differ between procedures, both are safe and well tolerated when performed by resident physicians. Clinical significance: This study provides support for evidence-based patient counseling that supervised, resident-performed Ahmed valve implantation and trabeculectomy are indeed safe and effective.

PDF Share
  1. Congdon N, O'Colmain B, Klaver CC, Klein R, Munoz B, Friedman DS, Kempen J, Taylor HR, Mitchell P, Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004 Apr;122(4):477-485.
  2. Boland MV, Ervin AM, Friedman DS, Jampel HD, Hawkins BS, Vollenweider D, Chelladurai Y, Ward D, Suarez-Cuervo C, Robinson KA. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013 Feb 19;158(4):271-279.
  3. Patel S, Pasquale LR. Glaucoma drainage devices: a review of the past, present, and future. Semin Ophthalmol 2010 Sep-Nov;25(5-6):265-270.
  4. Quigley HA, Cassard SD, Gower EW, Ramulu PY, Jampel HD, Friedman DS. The cost of glaucoma care provided to Medicare beneficiaries from 2002 to 2009. Ophthalmology 2013 Nov; 120(11):2249-2257.
  5. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968 Oct;66(4):673-679.
  6. Joshi AB, Parrish RK II, Feuer WF. 2002 survey of the American Glaucoma Society: practice preferences for glaucoma surgery and antifibrotic use. J Glaucoma 2005 Apr;14(2):172-174.
  7. Topouzis F, Coleman AL, Choplin N, Bethlem MM, Hill R, Yu F, Panek WC, Wilson MR. Follow-up of the original cohort with the Ahmed glaucoma valve implant. Am J Ophthalmol 1999 Aug;128(2):198-204.
  8. Coleman AL, Hill R, Wilson MR, Choplin N, Kotas-Neumann R, Tam M, Bacharach J, Panek WC. Initial clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol 1995 Jul;120(1):23-31.
  9. Wilson MR, Mendis U, Smith SD, Paliwal A. Ahmed glaucoma valve implant vs trabeculectomy in the surgical treatment of glaucoma: a randomized clinical trial. Am J Ophthalmol 2000 Sep;130(3):267-273.
  10. Christakis PG, Kalenak JW, Zurakowski D, Tsai JC, Kammer JA, Harasymowycz PJ, Ahmed II. The Ahmed Versus Baerveldt study: one-year treatment outcomes. Ophthalmology 2011 Nov;118(11):2180-2189.
  11. ACGME. Required minimum number of procedures for graduating residents in ophthalmology [ACGME Website]. 2013. Available from:
  12. Golden RP, Krishna R, DeBry PW. Resident glaucoma surgical training in United States residency programs. J Glaucoma 2005 Jun;14(3):219-223.
  13. Johnstone MA, Shingleton BJ, Crandall AS, Brown RH, Robin AL. Glaucoma surgery treatment patterns of ASCRS members – 2000 survey. J Cataract Refract Surg 2001 Nov;27(11):1864-1871.
  14. Connor MA, Knape RM, Oltmanns MH, Smith MF. Trainee glaucoma surgery: experience with trabeculectomy and glaucoma drainage devices. Ophthalmic Surg Lasers Imaging 2010 Sep-Oct;41(5):523-231.
  15. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment outcomes in the tube versus trabeculectomy study after 1 year of follow-up. Am J Ophthalmol 2007 Jan;143(1):9-22.
  16. Wilson MR, Mendis U, Paliwal A, Haynatzka V. Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy. Am J Ophthalmol 2003 Sep;136(3):464-470.
  17. Tran DH, Souza C, Ang MJ, Loman J, Law SK, Coleman AL, Caprioli J. Comparison of long-term surgical success of Ahmed Valve implant versus trabeculectomy in open-angle glaucoma. Br J Ophthalmol 2009 Nov;93(11):1504-1509.
  18. Budenz DL, Barton K, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, Buys YM, Ahmed Baerveldt Comparison Study Group. Treatment outcomes in the Ahmed Baerveldt Comparison Study after 1 year of follow-up. Ophthalmology 2011 Mar;118(3):443-452.
  19. Barton K, Gedde SJ, Budenz DL, Feuer WJ, Schiffman J, Ahmed Baerveldt Comparison Study Group. The Ahmed Baerveldt Comparison Study methodology, baseline patient characteristics, and intraoperative complications. Ophthalmology 2011 Mar;118(3):435-442.
  20. Wagschal LD, Trope GE, Jinapriya D, Jin YP, Buys YM. Prospective randomized study comparing Ex-PRESS to trabeculectomy: 1-year results. J Glaucoma 2015 Oct-Nov;24(8):624-629.
  21. Pederson JE. Ocular hypotony. Trans Ophthalmol Soc UK 1986;105(Pt 2):220-226.
  22. Chan CK, Lee S, Sangani P, Lin LW, Lin MS, Lin SC. Primary trabeculectomy surgery performed by residents at a county hospital. J Glaucoma 2007 Jan;16(1):52-56.
  23. Kwong A, Law SK, Kule RR, Nouri-Mahdavi K, Coleman AL, Caprioli J, Giaconi JA. Long-term outcomes of residentversus attending-performed primary trabeculectomy with mitomycin C in a United States residency program. Am J Ophthalmol 2014 Jun;157(6):1190-1201.
  24. Seider MI, Rofagha S, Lin SC, Stamper RL. Residentperformed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma 2012 Sep;21(7):469-474.
  25. Lowry EA, Greninger DA, Porco TC, Naseri A, Stamper RL, Han Y. A comparison of Resident-Performed Argon and Selective Laser Trabeculoplasty in patients with open-angle glaucoma. J Glaucoma 2016 Mar;25(3):e157-e161.
  26. Greninger DA, Lowry EA, Porco TC, Naseri A, Stamper RL, Han Y. Resident-performed selective laser trabeculoplasty in patients with open-angle glaucoma. JAMA Ophthalmol 2014 Apr 1;132(4):403-408.
  27. Desai RU, Pekmezci M, Tam D, Song J, Lin SC. Residentperformed Ahmed glaucoma valve surgery. Ophthalmic Surg Lasers Imaging 2010 Mar-Apr;41(2):222-227.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.