Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up

Abstract

Purpose

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma.

Methods

This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015.

Results

Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found.

Conclusion

AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years.

Keywords:

• uveitis
• glaucoma
• Ahmed glaucoma valve
• fluocinolone acetonide intravitreal implant
• ocular inflammation

Acknowledgments

Minitab^® and all other trademarks and logos for the Company’s products and services are the exclusive property of Minitab Inc. All other marks referenced remain the property of their respective owners. See minitab.com for more information. The organization had no role in the design or conduct of this research.

Disclosure

C Stephen Foster has the following financial disclosures: consultancies with Aldeyra Therapeutics (Lexington, MA, USA), Bausch & Lomb Surgical, Inc. (Rancho Cucamonga, CA, USA), Eyegate Pharma (Waltham, MA, USA), Novartis (Cambridge, MA, USA), pSivida (Watertown, MA, USA), and Xoma (Berkeley, CA, USA); grants or grants pending with Alcon (Aliso Viejo, CA, USA), Aldeyra Therapeutics (Lexington, MA, USA), Bausch & Lomb (Bridgewater, NJ, USA), Clearside Biomedical (Alpharetta, GA, USA), Dompé pharmaceutical (Milan, Italy), Eyegate Pharma (Waltham, MA, USA), Icon (Dublin, Ireland), Novartis Pharmaceuticals (Cambridge, MA, USA), pSivida (Watertown, MA, USA), Santen (Osaka, Japan), Xoma (Berkeley, CA, USA); payment for lectures including service on speaking bureaus: Alcon (Aliso Viejo, CA, USA), Allergan (Dublin, Ireland); and stock or stock options: Eyegate Pharma (Waltham, MA, USA). The authors report no other conflicts of interest in this work.