Initial clinical experience with the Ahmed Glaucoma Valve implant in pediatric patients
A. L. Coleman, R. J. Smyth, M. R. Wilson and M. Tam
Jules Stein Eye Institute, UCLA School of Medicine, USA.
OBJECTIVE: To evaluate the Ahmed Glaucoma Valve implant, an aqueous
shunting device with a unidirectional valve mechanism, in patients younger
than 18 years. DESIGN: Prospective case series. SETTING: Tertiary care
hospital. PATIENTS: Twenty-one consecutive patients younger than 18 years.
The median age of patients was 4.8 years (range, 0.23-17.9 years)
INTERVENTION: Placement of an Ahmed Glaucoma Valve implant between April
1992 and April 1994. MAIN OUTCOME MEASURE: Time after surgery without
failure. Success was defined as an average intraocular pressure less than
22 mm Hg for the last 2 follow-ups in eyes with preoperative intraocular
pressure greater than 22 mm Hg, or an intraocular pressure that was lowered
by at least 20% from preoperative values in eyes with preoperative
intraocular pressure less than 22 mm Hg, and no additional glaucoma
surgeries or visually devastating complications. RESULTS: Cumulative
probabilities of success at 12 and 24 months were 77.9% +/- 8.8% and 60.6%
+/- 13.7%, respectively. One eye had a flat anterior chamber and
suprachoroidal hemorrhage on the first postoperative day. No other eyes had
flat or shallow anterior chambers that required reformation. In 3 eyes the
implant extruded from underneath the conjunctiva and was removed. In 2
other eyes the average intraocular pressure for the last 2 follow-ups was
greater than 22 mm Hg. In 1 eye with an intraocular pressure less than 22
mm Hg preoperatively, the intraocular pressure was not reduced by at least
20%, although the number of antiglaucoma medications was reduced.
CONCLUSION: The 12-and 24-month success rates of the Ahmed Glaucoma Valve
implant are similar to those of other implants when used in a pediatric
population.
