A Pilot Study Assessing Treatment Outcomes in Neovascular Glaucoma Using Ahmed Glaucoma Valve with and without Cyclophotocoagulation

Richard L Ford; O'Rese J Knight; Meredith R Klifto; Alice Yang Zhang; Christopher A Wiesen; David Fleischman

doi:10.5005/jp-journals-10078-1358

A Pilot Study Assessing Treatment Outcomes in Neovascular Glaucoma Using Ahmed Glaucoma Valve with and without Cyclophotocoagulation

J Curr Glaucoma Pract. 2022 Jan-Apr;16(1):4-10. doi: 10.5005/jp-journals-10078-1358.

Authors

Richard L Ford¹, O'Rese J Knight¹, Meredith R Klifto¹, Alice Yang Zhang¹, Christopher A Wiesen², David Fleischman¹

Affiliations

¹ Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
² Odom Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.

Abstract

Purpose: The purpose of this retrospective pilot study was to examine the short-term effect of simultaneous Ahmed Glaucoma Valve implantation and cyclophotocoagulation on postoperative outcomes in patients with neovascular glaucoma.

Methods and materials: Patient charts were selected for inclusion in this study if they carried a diagnosis of neovascular glaucoma and underwent Ahmed glaucoma valve implantation only, Ahmed glaucoma valve implantation with cyclophotocoagulation, or cyclophotocoagulation only. A total of 55 eyes of 54 patients were selected for data collection and analysis. Main outcome measures included 1-, 3-, and 6-month intraocular pressure and occurrence of the hypertensive phase. Other outcomes included visual acuity, surgical complication rate, and a number of 6-month postoperative ophthalmic medications.

Results: A significantly lower intraocular pressure was seen in the group that received Ahmed glaucoma valve implantation + cyclophotocoagulation compared to the Ahmed glaucoma valve-only group at 3 and 6 months (p = 0.03 and <0.001, respectively). The difference in the occurrence of the hypertensive phase between the Ahmed glaucoma valve-only group and the Ahmed glaucoma valve + cyclophotocoagulation group approached but did not reach significance (p = 0.052). A significantly lower intraocular pressure was also seen in the cyclophotocoagulation-only group compared to the Ahmed glaucoma valve-only group at 3 months (p = 0.006).

Conclusion: Simultaneous Ahmed glaucoma valve implantation and cyclophotocoagulation significantly lowered intraocular pressure at 3 and 6 months compared to Ahmed glaucoma valve implantation alone in patients with neovascular glaucoma.

Clinical significance: Neovascular glaucoma is difficult to manage medically and surgically. When surgery is performed, intraocular pressure often remains elevated postoperatively despite aggressive medical management. This study examines a novel method to lower intraocular pressure after Ahmed glaucoma valve implantation in patients with neovascular glaucoma.

How to cite this article: Ford RL, Knight ORJ, Klifto MR, et al. A Pilot Study Assessing Treatment Outcomes in Neovascular Glaucoma Using Ahmed Glaucoma Valve with and without Cyclophotocoagulation. J Curr Glaucoma Pract 2022;16(1):4-10.

Keywords: Ahmed glaucoma valve; Cyclophotocoagulation; Hypertensive phase; Intraocular pressure; Neovascular glaucoma; Retrospective pilot cohort study.