Surgical outcomes associated with a sutureless drainage valve implantation procedure in patients with refractory glaucoma

Figures & data

Table 1 Clinical characteristics of all study eyes

Variable (N=122)	Mean ± SD
Age (years)	68.3±10.0
Gender (% female)	59/48.4
Glaucoma diagnosis
POAG	86/70.5%
NVG	14/11.5%
CACG	11/9.0%
MMG	4/3.3%
Uveitic glaucoma	3/2.5%
Aphakic glaucoma	2/1.6%
Normal tension glaucoma	1/0.8%
Angle recession glaucoma	1/0.8%
Prior surgeries
Cataract extraction	35/28.7%
Trabeculectomy	10/8.2%
Cyclophotocoagulation	3/2.5%
Penetrating keratoplasty	2/1.6%
Tube shunt implantation	1/0.8%
Tube location
Anterior chamber	98/80.3%
Sulcus	24/19.7%
Baseline IOP (mmHg)
A (n=18)	30.3±11.9
CA (n=46)	23.5±9.4
AE (n=35)	27.3±7.0
ACE (n=23)	27.2±10.8
Total (n=122)	26.3±9.7
Baseline number of medications
A (n=18)	3.5±1.5
CA (n=45)	2.8±1.3
AE (n=35)	3.0±1.6
ACE (n=23)	3.3±1.0
Total (n=121)	3.1±1.4
Mean follow-up (months)	25.8±14.7

Abbreviations: A, Ahmed valve group; ACE, Ahmed valve + cataract extraction + endoscopic cyclophotocoagulation group; AE, Ahmed valve + endoscopic cyclophotocoagulation group; CA, Ahmed valve + cataract extraction group; CACG, chronic angle closure glaucoma; MMG, mixed mechanism glaucoma; NVG, neovascular glaucoma; POAG, primary open angle glaucoma.

Table 2 Mean IOP at each postoperative follow-up visit compared with baseline

	Baseline (n=122)	1 day (n=74)	1 week (n=115)	1 month (n=107)	3 months (n=83)	6 months (n=75)	1 year (n=61)	1.5 years (n=54)	2 years (n=45)	2.5 years (n=41)	3 years (n=35)
Mean ± SDa	26.3±9.7	13.8±11.7	12.7±7.3	16.9±6.1	16.1±4.8	16.0±4.6	15.3±5.3	15.1±4.0	14.4±3.3	14.8±4.3	15.8±5.5
ANOVA between A/CA/AE/ACE groups	P=0.0514	P=0.3402	P=0.4910	P=0.1005	P=0.4168	P=0.2636	P=0.1360	P=0.8464	P=0.5765	P=0.0690	P=0.3817

Notes:

a In mmHg; P-value<0.0001 for each paired t-test comparing mean postoperative IOP and baseline IOP.

Abbreviations: A, Ahmed valve group; ACE, Ahmed valve + cataract extraction + endoscopic cyclophotocoagulation group; AE, Ahmed valve + endoscopic cyclophotocoagulation group; CA, Ahmed valve + cataract extraction group.

Table 3 Number of glaucoma medications at postoperative follow-up visits compared with baseline

	Baseline (n=121)	1 day (n=74)	1 week (n=114)	1 month (n=107)	3 months (n=83)	6 months (n=75)	1 year (n=60)	1.5 years (n=54)	2 years (n=45)	2.5 years (n=41)	3 years (n=35)
Mean ± SD (P-value)a	3.1±1.4	1.8±1.8 (P<0.0001)	0.9±1.5 (P<0.0001)	1.2±1.5 (P<0.0001)	1.5±1.3 (P<0.0001)	1.8±1.3 (P<0.0001)	2.1±1.2 (P<0.0001)	2.0±1.4 (P<0.0001)	2.0±1.2 (P<0.0001)	2.3±1.3 (P=0.0054)	2.2±1.3 (P=0.0021)
ANOVA between A/CA/AE/ACE groups	P=0.1770	P=0.6974	P=0.3230	P=0.0185b	P=0.0180b	P=0.0199b	P=0.6956	P=0.1761	P=0.2946	P=0.0225b	P=0.0098b

Notes:

a Significance level for each paired t-test comparing mean number of postoperative glaucoma medications and baseline number of medications.

b When significance levels <0.05 for ANOVA, post hoc Tukey’s test was performed and showed the following significances for mean number of medications: CA vs ACE subgroups (0.7±1.1 vs 1.7±1.6, P=0.045) at 1 month, CA vs A subgroups (1.3±1.1 vs 2.5±1.2, P=0.019) at 3 months, CA vs AE subgroups (1.4±1.1 vs 2.5±1.8, P=0.029) at 6 months, CA vs AE subgroups (1.5±1.2 vs 2.9±1.3, P=0.023) as well as CA vs ACE subgroups (1.5±1.2 vs 3.3±0.5, P=0.049) at 3 years.

Abbreviations: A, Ahmed valve group; ACE, Ahmed valve + cataract extraction + endoscopic cyclophotocoagulation group; AE, Ahmed valve + endoscopic cyclophotocoagulation group; CA, Ahmed valve + cataract extraction group.

Table 4 Interventions or reoperations following initial surgery for uncontrolled glaucoma

	0–12 months	13–24 months	25–36 months
Wound burping for high IOPa	2	–	–
SLTa	–	2	–
Transscleral cyclophotocoagulation	4	5	2
Cataract extraction with ECP	1	–	–
Revision of AGV for bleb needling and ECP	1	–	–
Trab360 trabeculotomy with other procedureb	1	–	–
Revision of first AGV for bleb needling and insertion of second AGV	1	–	–
Insertion of a second AGV	–	1	–
Insertion of a BVT	–	–	1
Insertion of a Xen gel stent	–	–	1
Total number of reoperations due to uncontrolled glaucoma (%)a	–	–	18 (14.8%)

Notes:

a Office-based interventions except for transscleral cyclophotocoagulation were not included in the overall reoperation rate for uncontrolled glaucoma.

b Intervention was included in the calculation of reoperations for both uncontrolled glaucoma and complications.

Abbreviations: AC, anterior chamber; AGV, Ahmed glaucoma valve; BVT, Baerveldt tube shunt; ECP, endoscopic cyclophotocoagulation; SLT, selective laser trabeculoplasty.

Table 5 Postoperative complications after initial surgery categorized by time of occurrence

	0–12 months	13–24 months	25–36 months
Shallow anterior chamber	10	–	–
Persistent corneal edema	5	–	–
Hyphema	22	–	–
Posterior capsular opacification	9	7	2
Choroidal effusion	3	–	–
Macular edema	3	–	–
Conjunctival erosion	1	–	1
Tube migration	2	–	–
Tube extrusion	1	–	–
Long tube	2	–	–
Tube occlusion	3	–	–
Recurrent iritis	5	–	–
Dyesthesia	1	–	–
Vitreous hemorrhage	–	–	–
Suprachoroidal hemorrhage	–	–	–
Retinal detachment	–	–	–
Endophthalmitis	–	–	–
Malignant glaucoma	–	–	–

Table 6 Interventions or reoperations following initial surgery due to a complication

	0–12 months	13–24 months	25–36 months
Needle sweep for iris obstructiona	1	–	–
AC reformation with Healona	2	–	–
Revision for conjunctival erosion	1	–	1
Tube trimming for anterior migration	2	–	–
Prophylactic tube trimming with other procedureb	2	–	–
Revision for extrusion	1	–	–
Revision for iris obstruction	1	–	–
Revision for heme in tube	1	–	–
Revision for synechiae after uveitis	1	–	–
AC washout for hyphema	1	–	–
AGV removed for dysesthesia	1	–	–
DSEK for corneal decompensation	1	–	–
Total number of reoperations due to complication (%)a	–	–	13 (10.7%)

Notes:

a Office-based interventions were not included in the overall reoperation rate for complications.

b Intervention was included in the calculation of reoperations for both uncontrolled glaucoma and complications.

Abbreviations: AC, anterior chamber; AGV, Ahmed glaucoma valve; DSEK, Descemet’s stripping endothelial keratoplasty.