Outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma

BACKGROUND: In many types of pediatric glaucoma, there is no clear algorithm for surgical management. In these situations, the procedure of choice can be the implantation of various types of drainage devices.

AIM: To evaluate the outcomes of Ahmed Glaucoma Valve implantation in refractory pediatric glaucoma.

MATERIALS AND METHODS: The treatment results of 52 children (67 eyes) aged 1 month – 17 years (6.6 ± 0.6 years) with unsuccessfully operated primary congenital glaucoma, with glaucoma associated with congenital anomalies of the eyeball, with secondary glaucoma were analyzed. The surgery was considered to be effective when stable intraocular pressure (IOP) was achieved, there were no complications, and no need for repeated interventions.

RESULTS: The effect of surgery was maintained for 6 months in 97% of patients, but after 1, 2 and 3 years it decreased to 91.8%, 82%, and 73.9%, respectively, and to 42.8% after 7 years. Postoperative complications included filtering bleb encapsulation (25.3%), iris retraction to the tube with pupil dislocation (4.5%); ciliochoroidal detachment (4.5%); cataract (3.0%), conjunctival erosion with tube eruption (4.5%), endophthalmitis (1.5%), retinal detachment (6.0%), tube retraction (1.5%), hyphema (3.0%). The risk factors for an unfavorable outcome of the procedure were: an increase in the anteroposterior axis of the eyeball length by 20% or more compared to the age norm, IOP at the time of the surgery higher than 32 mm Hg, as well as previous antiglaucoma filtering procedures.

CONCLUSIONS: The implantation of the drainage device Ahmed Glaucoma Valve is indicated for refractory pediatric glaucoma in case of ineffectiveness of previous surgeries. However, it is necessary to take into account the decrease in the effectiveness of the device over time, which, combined with the possibility of complications, requires long-term follow-up of patients.