J Korean Ophthalmol Soc.  2011 Dec;52(12):1470-1477. 10.3341/jkos.2011.52.12.1470.

Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at 2 Years

• Lim SH
• Seo WM
• Park JJ
• Yun SU

• KMID: 2215151
• DOI: http://doi.org/10.3341/jkos.2011.52.12.1470

Abstract

PURPOSE
To evaluate the outcomes of Ahmed valve implantation in neovascular glaucoma patients who received intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU) after 24 months of follow-up.
METHODS
A total of 40 eyes from 40 patients with neovascular glaucoma who received antiglaucomatous medication without previous glaucoma surgery were included in the present study. The patients were divided into 2 groups. The control group (20 eyes) underwent Ahmed valve implantation only and the study group (20 eyes) underwent Ahmed valve implantation and received intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of 3 consecutive visits where intraocular pressure (IOP) was over 18 mmHg; 2) 20% IOP reduction from baseline; 3) the final number of topical medications was not reduced by at least two from baseline; 4) the need for additional surgery; or 5) the occurrence of a serious complication.
RESULTS
In the control group, the cumulative success rate was 19.1% at 24 months. The cumulative success rate in the study group was 43.7% at 24 months. Serious complications such as endophthalmitis, valve exposure, or prolonged hypotony were not observed.
CONCLUSIONS
The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation resulted in a high success rate and good IOP control and did not cause serious complications during the follow-up period.

Keyword

Ahmed valve implantation; Neovascular glaucoma; Success rate; MMC; 5-FU

MeSH Terms

Endophthalmitis
Eye
Fluorouracil
Follow-Up Studies
Glaucoma
Glaucoma, Neovascular
Humans
Intraocular Pressure
Mitomycin
Fluorouracil
Mitomycin

Figure

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  Figure 1. Intraocular pressure (IOP) following Ahmed valve implantation only (control group) and Ahmed valve implantation with adjunctive intraoperative mitomycin C and postoperative 5-fluorouracil (study group). D = day; W = week; M = month.

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  Figure 2. Kaplan-Meier estimates of the cumulative probability of valve success for Ahmed valve implanted eyes. Control group (20 eyes) received Ahmed valve implantation only. Study group (20 eyes) received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence following an initial postoperative period of any of the following events: 1) IOP > 18 mm Hg for three consecutive visits or <20% IOP reduction from baseline and the final number of topical medications needed to be not less than at least 2 from baseline, 2) need for additional surgery to repair a malfunctioning Ahmed valve, or 3) serious postoperative complications.

Reference

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