J Korean Ophthalmol Soc.  2011 Mar;52(3):315-324. 10.3341/jkos.2011.52.3.315.

Effects of Digital Ocular Massage in Patients in a Hypertensive Phase after Ahmed Glaucoma Valve Implantation

• Nam KY
• Lee JE
• Kim CS

• KMID: 2214296
• DOI: http://doi.org/10.3341/jkos.2011.52.3.315

Abstract

PURPOSE
To evaluate the course of the hypertensive phase (HP) after Ahmed glaucoma valve (AGV) implantation and the effects of digital ocular massage.
METHODS
A total of 131 eyes of 131 patients, who underwent AGV implantation surgery, were studied retrospectively. HP was defined as an IOP (intraocular pressure) > or = 22 mm Hg within 6 months after surgery. Various clinical factors related to the occurrence of HP were analyzed. The HP group was compared to the non-HP group. Ocular massage was performed in patients showing acute elevation of IOP at a relatively early postoperative period, and the effects were compared with the non-massage group. The patients who received ocular massage were divided, based on its effects, and compared.
RESULTS
HP developed in 62.6% of the patients after AGV surgery, and the success rate was significantly lower in the HP group. HP occurred more often in males and in patients with high IOP before surgery. HP developed in 82 eyes at 3.3 weeks after surgery in average. Ocular massage was performed in 30 eyes that showed acute IOP increase. The amount of IOP reduction, compared to 1 month after surgery, was greater in massage group than no massage group from 2 months to 3 years after surgery. Successful IOP control by ocular massage was observed in 14 eyes (46.7%), and the success rate was higher in these patients than the patients who showed no significant IOP reduction by ocular massage. But, the difference was not significant (p = 0.072).
CONCLUSIONS
HP is related to the final outcome of surgery. Digital ocular massage can be used as an effective method to control HP and prevent further glaucomatous damage.

Keyword

Ahmed glaucoma valve; Hypertensive phase; Ocular massage

MeSH Terms

Eye
Glaucoma
Humans
Male
Massage
Postoperative Period
Retrospective Studies

Figure

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  Figure 1. Kaplan-Meier survival curve: Cumulative success after Ahmed glaucoma valve implant surgery. Success: 5 mm Hg < IOP < 22 mmHg (with or without anti-glaucoma medication). Success rates are 96.2% at 6 month, 90.2% at 1 year, 81.3% at 2 years, 78.4% at 3 years after sugery.

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  Figure 2. Kaplan-Meier survival curve: Comparison of cumulative success after Ahmed glaucoma valve implant surgery between the group with hypertensive phase and without hypertensive phase. Success: 5 mm Hg < IOP < 22 mmHg (with or without anti-glaucoma medication). Cumulative survival in the group with hypertensive phase: 85.1% at 12 month, 75.0% at 24 month, 69.5% at 36 month postoperatively. Cumulative survival in the group without hypertensive phase was 95.9% at 12 month, 91.4% at 24 month, 88.2% at 36 months. The difference between the 2 groups was statistically significant (p = 0.007, log rank test).

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  Figure 3. Changes in intraocular pressure in the groups with and without hypertensive phase. ∗ Significantly higher IOP between 2 groups (p < 0.05, independent T-test).

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  Figure 4. Change in the number of glaucoma medications in the ∗ Significantly higher groups with and without hypertensive phase. number of medication between 2 groups (p < 0.05, independent T-test).

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  Figure 5. Change in intraocular pressure in the groups with and without ocular massage. ∗ Significantly higher intraocular pressure between 2 groups (p < 0.05, independent T-test).

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  Figure 6. Change in the number of glaucoma medication in the groups with and without ocular massage. There is no significant difference between two groups at all the time points.

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  Figure 7. The change in intraocular pressure from 1 month after surgery (reference IOP at the beginning of the ocular massage) in the groups with and without ocular massage. ∗ Significantly greater change in intraocular pressure in massage group (p < 0.05, independent T-test).

Reference

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