ORIGINAL STUDY
Hypertensive Phase Following Silicone Plate Ahmed Glaucoma Valve Implantation Hun Jae Won, MD and Kyung Rim Sung, MD, PhD
Purpose: To estimate the incidence of hypertensive phase (HP) following silicone plate Ahmed glaucoma valve implantation and to explore the risk factors for developing HP. Methods: A total of 325 eyes from 325 patients who underwent Ahmed glaucoma valve implantation for uncontrolled intraocular pressure (IOP) and were followed for at least 1 year were included. The HP was defined as IOP > 21 mm Hg (with or without IOPlowering medication) during the first 3 months after surgery. Eyes were divided into HP and non-HP development groups. Overall success was defined as reaching an IOP > 5 and 30 mm Hg despite use of maximum tolerated medical therapy) at the glaucoma clinic of the Asan Medical Center (Seoul, Korea). Surgical procedure was performed by a single surgeon (K.R.S.) and all participants had to have at least 1-year postoperative follow-up for inclusion in the present study. If both eyes from a single patient met the inclusion criteria, 1 eye was randomly chosen.
Surgical Procedure The surgical procedure was carried out using a fornixbased conjunctival flap constructed at the superotemporal or inferotemporal area. A limbus-based half-thickness scleral flap (5 mm circumference 7 mm radius) was then www.glaucomajournal.com |
Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.
e313
Won and Sung
prepared. AGV patency was tested, and the valve was placed under Tenon’s capsule, 8 to 10 mm posterior from the superotemporal or inferotemporal limbus, and then sutured using 9-0 nylon to ensure fixation. Paracentesis was performed at the temporal sclerocorneal junction, and viscoelastics were injected to prevent a sudden drop in IOP during entry of the proximal tube into the anterior chamber. Chamber entry was initiated under the scleral flap using a 23 G needle, with the procedure conducted 2 mm posterior to the limbus and parallel to the iris plane. The proximal portion of the tube was sized to ensure that the tube length within the anterior chamber, measured from the limbus, was approximately 2 mm. The tube was then inserted in the bevel-up position into the anterior chamber. Finally, the scleral flap was sutured with 9-0 nylon and a watertight conjunctival closure was performed. Patients who underwent combined procedures such as cataract extraction, penetrating keratoplasty, or pars plana vitrectomy were excluded. A topical corticosteroid, cycloplegics, and an antibiotic were prescribed for approximately 1 month of postoperative use, depending on the condition of the eye. Follow-up examinations were performed on postoperative day 1, and at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery, with additional visits scheduled as needed. The eyes that developed HP were treated by starting and/or increasing IOP-lowering medication and topical steroid was prescribed if necessary. Injection of antimetabolite or antivascular endothelial growth factor or digital massage was not performed in any case. The study was approved by the institutional review board of the Asan Medical Center and followed the principles of the Declaration of Helsinki.
Analysis At each visit, IOP was measured by Goldmann applanation tonometry, use of IOP-lowering medication was noted, and any complications were recorded. HP was defined as follows: IOP > 21 mm Hg (with or without IOPlowering medication) within postoperative 3-month period after a successful IOP reduction to 5 and
Hypertensive Phase Following Silicone Plate Ahmed Glaucoma Valve Implantation Hun Jae Won, MD and Kyung Rim Sung, MD, PhD
Purpose: To estimate the incidence of hypertensive phase (HP) following silicone plate Ahmed glaucoma valve implantation and to explore the risk factors for developing HP. Methods: A total of 325 eyes from 325 patients who underwent Ahmed glaucoma valve implantation for uncontrolled intraocular pressure (IOP) and were followed for at least 1 year were included. The HP was defined as IOP > 21 mm Hg (with or without IOPlowering medication) during the first 3 months after surgery. Eyes were divided into HP and non-HP development groups. Overall success was defined as reaching an IOP > 5 and 30 mm Hg despite use of maximum tolerated medical therapy) at the glaucoma clinic of the Asan Medical Center (Seoul, Korea). Surgical procedure was performed by a single surgeon (K.R.S.) and all participants had to have at least 1-year postoperative follow-up for inclusion in the present study. If both eyes from a single patient met the inclusion criteria, 1 eye was randomly chosen.
Surgical Procedure The surgical procedure was carried out using a fornixbased conjunctival flap constructed at the superotemporal or inferotemporal area. A limbus-based half-thickness scleral flap (5 mm circumference 7 mm radius) was then www.glaucomajournal.com |
Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.
e313
Won and Sung
prepared. AGV patency was tested, and the valve was placed under Tenon’s capsule, 8 to 10 mm posterior from the superotemporal or inferotemporal limbus, and then sutured using 9-0 nylon to ensure fixation. Paracentesis was performed at the temporal sclerocorneal junction, and viscoelastics were injected to prevent a sudden drop in IOP during entry of the proximal tube into the anterior chamber. Chamber entry was initiated under the scleral flap using a 23 G needle, with the procedure conducted 2 mm posterior to the limbus and parallel to the iris plane. The proximal portion of the tube was sized to ensure that the tube length within the anterior chamber, measured from the limbus, was approximately 2 mm. The tube was then inserted in the bevel-up position into the anterior chamber. Finally, the scleral flap was sutured with 9-0 nylon and a watertight conjunctival closure was performed. Patients who underwent combined procedures such as cataract extraction, penetrating keratoplasty, or pars plana vitrectomy were excluded. A topical corticosteroid, cycloplegics, and an antibiotic were prescribed for approximately 1 month of postoperative use, depending on the condition of the eye. Follow-up examinations were performed on postoperative day 1, and at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery, with additional visits scheduled as needed. The eyes that developed HP were treated by starting and/or increasing IOP-lowering medication and topical steroid was prescribed if necessary. Injection of antimetabolite or antivascular endothelial growth factor or digital massage was not performed in any case. The study was approved by the institutional review board of the Asan Medical Center and followed the principles of the Declaration of Helsinki.
Analysis At each visit, IOP was measured by Goldmann applanation tonometry, use of IOP-lowering medication was noted, and any complications were recorded. HP was defined as follows: IOP > 21 mm Hg (with or without IOPlowering medication) within postoperative 3-month period after a successful IOP reduction to 5 and
