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  • Title: Second Ahmed valve insertion in the same eye.
    Author: Smith M, Buys YM, Trope GE.
    Journal: J Glaucoma; 2009; 18(4):336-40. PubMed ID: 19365202.
    Abstract:
    PURPOSE: To examine the results of same-eye second Ahmed glaucoma drainage device (GDD) insertion in eyes with refractory glaucoma despite previous Ahmed GDD insertion and maximal tolerated medical therapy. METHODS: Noncomparative retrospective case series. RESULTS: Twenty-one patients who had undergone 2 GDD surgeries in the same eye were identified. Following chart review, 19 patients had follow-up of at least 1 year and were included in the analysis. All surgeries involved Ahmed valves. The mean drop in intraocular pressure (IOP) at 12 months and at final follow-up was 8 (43%) and 7.9 mm Hg (42%), respectively. The mean number of glaucoma medications used postoperatively (2.4 at 12 mo and 2.6 at final follow-up) was significantly less than preoperatively (4.1). Although the mean visual acuity was poorer postoperatively, this did not reach statistical significance. Sixteen of the 19 patients (84.2%) were defined as complete or partial success, as they achieved IOP of >/=5 and </=21 mm Hg and >/=20% decrease on preoperative IOP with or without glaucoma drops. Three patients were considered complete failures at 12 months and final follow-up. There were no significant intraoperative complications. One patient (5.3%) required anterior chamber reformation on day 1 postoperatively. One patient (5.3%) suffered a decrease in vision from 20/70 preoperatively to counting fingers postoperatively owing to corneal decompensation. CONCLUSIONS: Second Ahmed GDD surgery seems to be a safe and effective option when IOP remains uncontrolled despite previous GDD implantation.
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