J Korean Ophthalmol Soc.  2016 Mar;57(3):468-476. 10.3341/jkos.2016.57.3.468.

Ahmed Valve Implant Surgery with Adjunctive Mitomycin C and Selective 5-Fluorouracil Injection

• Yun IS
• Lee JD
• Kim YH
• Ahn JH

• KMID: 2213249
• DOI: http://doi.org/10.3341/jkos.2016.57.3.468

Abstract

PURPOSE
To evaluate the surgical results of Ahmed valve implant surgery with adjunctive mitomycin C and selective postoperative 5-fluorouracil (5-FU) subconjunctival injection with a needling procedure.
METHODS
In this retrospective study, 40 eyes of 40 patients who had undergone Ahmed valve implant surgery with adjunctive mitomycin C were observed for at least 1 year. The Ahmed valve was implanted after 5-minute application of 0.04% mitomycin C. Selective 5-FU injection with a needling procedure was performed during the follow- up period based on intraocular pressure (IOP). Hypertensive phase was defined as IOP higher than 21 mm Hg within 3 months after operation. IOP higher than 18 mm Hg regardless of IOP-lowering medications at 2 consecutive visits was considered to be a surgical failure.
RESULTS
The mean follow-up period was 35.5 ± 12.4 months. Preoperative intraocular pressure was 32.8 ± 7.5 mm Hg, which decreased to 14.0 ± 4.2 mm Hg post-operatively. The number of glaucoma medications decreased significantly from 3.8 ± 0.5 to 2.0 ± 1.0. Eleven of 40 eyes (27.5%) experienced hypertensive phase at 6.0 ± 3.1 weeks after surgery. Kaplan-Meier survival analysis showed cumulative probability of surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years respectively. There were no risk factors that affecting surgical failure except age (hazard ratio = 0.17, p = 0.02).
CONCLUSIONS
Ahmed valve implant surgery with adjunctive mitomycin C and selective 5-FU injection with a needling procedure showed good success in refractory glaucoma.

Keyword

Ahmed valve implant; 5-Fluorouracil; Mitomycin C; Needling; Refractory glaucoma

MeSH Terms

Fluorouracil*
Follow-Up Studies
Glaucoma
Humans
Intraocular Pressure
Mitomycin*
Retrospective Studies
Risk Factors
Fluorouracil
Mitomycin

Figure

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  Figure 1. Intraocular pressure following Ahmed valve implantation with adjunctive intraoperative mitomycin C and selective postoperative 5-fluorouracil injection and needling revision.

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  Figure 2. Kaplan-Meier curve of the cumulative probability of valve success for Ahmed valve-implanted eyes. Study group (40 eyes) received Ahmed valve implantation and intraoperative MMC. Failure was defined as the first occurrence of any of the following events during initial postoperative period: 1) IOP >18 mm Hg or <6 mm Hg for two consecutive visits or <20% IOP reduction from baseline, 2) need for additional surgery to repair a malfunctioning Ahmed valve except 5-fluorouracil injection, or 3) serious postoperative complications including visual acuity loss. MMC = mitomycin C; IOP = intraocular pressure.

Reference

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