The role of primary needle revision after Ahmed glaucoma valve (AGV) implantation
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ORIGINAL PAPER
The role of primary needle revision after Ahmed glaucoma valve (AGV) implantation Maryam Yadgari . Kiana Hassanpour
. Fatemeh Vafaei
Received: 22 May 2020 / Accepted: 16 August 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To evaluate the efficacy and safety of primary needle revision after Ahmed Glaucoma Valve (AGV) implantation in comparison with glaucoma medication use. Methods In this interventional case series, 23 eyes of 23 patients who underwent AGV implantation were enrolled. Needle revision was performed when the intraocular pressure was higher than the target pressure before glaucoma medications. Using a 30-gauge needle, the Tenon’s capsule over the plate was incised and the bleb was reformed. Patients were examined on a postoperative day one, weekly (for four weeks), and every 1–3 months. Two criteria were used to define cumulative success as a minimum 20% reduction in IOP and 5 \ IOP B 21 mmHg (Criteria A) or 5 \ IOP B 18 mmHg (Criteria B) without (Complete success) or with (Qualified success) glaucoma medication. M. Yadgari F. Vafaei Basir Eye Health Research Center, Tehran, Iran M. Yadgari K. Hassanpour (&) Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran e-mail: [email protected]
Results In this pilot study, we enrolled 23 patients with a mean age of 53.8 ± 12.4 years (25–78 years) who underwent AGV implantation and a one-year follow-up period. The mean number of primary needle revision was 2.2 ± 1.6 (1–6). One year postoperatively, the cumulative success rate was 91.4% and 86.9% based on Criteria A and B, respectively. The average of preoperative IOP was 28.26 ± 8.86 mmHg (range 15–46 mmHg), reaching 13.78 ± 3.54 mmHg (range 8–20) at the end of the one-year follow-up. (P \ 0.001) The mean preoperative medication significantly decreased from a median of 4 (range 3–4) at baseline to 2 (range 1–4) after the one-year follow-up (P \ 0.001). One patient experienced leakage over the plate, which was successfully treated via conservative management. Conclusion This pilot study showed that primary needle revision is a safe and effective method for controlling IOP after AGV implantation with a lower need for medication. Keywords Glaucoma Ahmed glaucoma valve Needle revision Intraocular pressure
Introduction K. Hassanpour Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., 16666 Pasdaran, Tehran, Iran
Several studies have shown that AGV is safe and effective in reducing IOP in patients with primary
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[1, 2], secondary [3–5], and refractory glaucoma [6]. One of the main drawbacks of AGV implantation is the higher need for glaucoma medications despite the acceptable IOP control, particularly in comparison with trabeculectomy [1] or Baerveldt Glaucoma implant [7]. Medical management plays an essential part in the treatment of gla
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