Purpose: To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase.
Design: Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up.
Methods: Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM).
Results: A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups.
Conclusion: Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term.
Havens SJ, Gulati V. Neovascular glaucoma. Dev Ophthalmol 2016;55:196–204. DOI: 10.1159/000431196
Klonoff DC. The increasing incidence of diabetes in the 21st century. J Diabetes Sci Technol 2009;3(1):1–2. DOI: 10.1177/193229680900300101.
Budenz DL, Barton K, Gedde SJ, et al. Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology 2015;122(2):308–316. DOI: 10.1016/j.ophtha.2014.08.043
Pakravan M, Rad SS, Yazdani S, et al. Effect of early treatment with aqueous suppressants on Ahmed glaucoma valve implantation outcomes. Ophthalmology 2014;121(9):1693–1698. DOI: 10.1016/j.ophtha.2014.03.014
Shalaby WS, Myers JS, Razeghinejad R, et al. Outcomes of valved and nonvalved tube shunts in neovascular glaucoma. Ophthalmol Glaucoma 2021;4(2):182–192. DOI: 10.1016/j.ogla.2020.09.010
Perez CI, Verdaguer S, Khaliliyeh D, et al. Subconjunctival injections of mitomycin c are associated with a lower incidence of hypertensive phase in eyes with Ahmed glaucoma valve. Ophthalmol Glaucoma 2021;4(3):322–329. DOI: 10.1016/j.ogla.2020.10.004
Smith M, Geffen N, Alasbali T, et al. Digital ocular massage for hypertensive phase after Ahmed valve surgery. J Glaucoma 2010;19(1):11–14. DOI: 10.1097/IJG.0b013e31819c485b
Turalba AV, Pasquale LR. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide. Clin Ophthalmol 2014;8: 1311–1316. DOI: 10.2147/OPTH.S64257
Barton K, Gedde SJ, Budenz DL, et al. The Ahmed Baerveldt comparison study methodology, baseline patient characteristics, and intraoperative complications. Ophthalmology 2011;118(3):435–442. DOI: 10.1016/j.ophtha.2010.07.015
Budenz DL, Barton K, Feuer WJ, et al. Treatment outcomes in the Ahmed Baerveldt comparison study after 1 year of follow-up. Ophthalmology 2011;118(3):443–452. DOI: 10.1016/j.ophtha.2010.07.016
Barton K, Feuer WJ, Budenz DL, et al. Three-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology 2014;121(8):1547–57.e1. DOI: 10.1016/j.ophtha.2014.01.036
Budenz DL, Feuer WJ, Barton K, et al. Postoperative complications in the Ahmed Baerveldt comparison study during five years of follow-up. Am J Ophthalmol 2016;163:75–82.e3. DOI: 10.1016/j.ajo.2015.11.023
Christakis PG, Tsai JC, Zurakowski D, et al. The Ahmed Versus Baerveldt study: design, baseline patient characteristics, and intraoperative complications. Ophthalmology 2011;118(11):2172–2179. DOI: 10.1016/j.ophtha.2011.05.003
Nouri-Mahdavi K, Caprioli J. Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma valve. Am J Ophthalmol 2003;136(6):1001–1008. DOI: 10.1016/s0002-9394(03)00630-5
Won HJ, Sung KR. Hypertensive phase following silicone plate Ahmed glaucoma valve implantation. J Glaucoma 2016;25(4):e313–e317. DOI: 10.1097/IJG.0000000000000249
Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez-Roman J, et al. Surgical outcome of Ahmed valve implantation in mexican patients with neovascular glaucoma. J Curr Glaucoma Pract 2014;8(3):86–90. DOI: 10.5005/jp-journals-10008-1168
Xie Z, Liu H, Du M, et al. Efficacy of Ahmed glaucoma valve implantation on neovascular glaucoma. Int J Med Sci 2019;16(10):1371–1376. DOI: 10.7150/ijms.35267
Netland PA. The Ahmed glaucoma valve in neovascular glaucoma (an AOS thesis). Trans Am Ophthalmol Soc 2009;107:325–342.
von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335(7624):806–808. DOI: 10.1136/bmj.39335.541782.AD
Ayyala RS, Zurakowski D, Smith JA, et al. A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma. Ophthalmology 1998;105(10):1968–1976. DOI: 10.1016/S0161-6420(98)91049-1
Hwang JM, Kee C. The effect of surface area expansion with pericardial membrane (preclude) in Ahmed glaucoma valve implant surgery. J Glaucoma 2004;13(4):335–339. DOI: 10.1097/00061198-200408000-00012
Dubey S, Sharma DK, Bhoot M, et al. Hypertensive phase following silicon plate Ahmed glaucoma valve implantation. J Glaucoma 2017;26(3):124. DOI: 10.1097/IJG.0000000000000544
Fargione RA, Tansuebchueasai N, Lee R, et al. Etiology and management of the hypertensive phase in glaucoma drainage-device surgery. Surv Ophthalmol 2019;64(2):217–224. DOI: 10.1016/j.survophthal.2018.10.008
Yuen D, Buys Y, Jin YP, et al. Corticosteroids versus NSAIDs on intraocular pressure and the hypertensive phase after Ahmed glaucoma valve surgery. J Glaucoma 2011;20(7):439–444. DOI: 10.1097/IJG.0b013e3181efbec0
Lee J, Park CK, Jung KI. Initial Glaucoma Medication in the Hypertensive Phase Following Ahmed Valve Implantation: A Comparison of Results Achieved Using Aqueous Suppressants and Prostaglandin Analogs. J Clin Med 2020;9(2). DOI: 10.3390/jcm9020416