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

Authors Kubaisi B, Maleki A, Ahmed A, Lamba N, Sahawneh H, Stephenson A, Montieth A, Topgi S, Foster CS

Received 19 September 2017

Accepted for publication 25 October 2017

Published 1 May 2018 Volume 2018:12 Pages 799—804

DOI https://doi.org/10.2147/OPTH.S152035

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Buraa Kubaisi,1,2 Arash Maleki,1,2 Aseef Ahmed,1,2 Neel Lamba,1,2 Haitham Sahawneh,1,2 Andrew Stephenson,1,2 Alyssa Montieth,1,2 Shobha Topgi,3 C Stephen Foster1,2,4

1Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; 2Ocular Immunology & Uveitis Foundation, Waltham, MA, USA; 3The State University of New York Downstate, Brooklyn, NY, USA; 4Harvard Medical School, Boston, MA, USA

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

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