Outcomes of Ahmed glaucoma valve implantation in eyes with pediatric keratoplasty.

Abstract

PURPOSE\nThis study aimed to assess the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in eyes with pediatric keratoplasty and glaucoma.\n\n\nDESIGN\nRetrospective, non-comparative, interventional case series.\n\n\nPARTICIPANTS\nTwenty-eight eyes of 25 children that underwent AGV following penetrating keratoplasty (PK) in 22 eyes and Descemet s stripping endothelial keratoplasty (DSEK) in 6 eyes were included.\n\n\nMETHODS\nChildren (age ≤16 years) treated with AGV implant following keratoplasty from 2008-2019 with documented 6 months follow-up operated by a single surgeon were included.\n\n\nMAIN OUTCOME MEASURES\nThe primary outcome measure was AGV survival (intraocular pressure (IOP) between 6 and 21 mmHg with or without topical anti-glaucoma medications (AGM)), and the secondary outcome measure was corneal graft survival.\n\n\nRESULTS\nThe Mean age (±standard deviation) at AGV surgery was 4.8 ± 0.7 years. Mean follow-up after AGV was 3.4±0.5 years. Mean IOP (mmHg) decreased significantly from 31.5±2.0 to 21.1±2.3 at 6 months post-surgery (p<0.001). The mean number of AGM reduced significantly (p<0.001) and there was no change in the mean visual acuity (p>0.04 with Bonferroni correction). The cumulative survival probability of AGV was 92.9±4.9% at 1 year and 81.3±11.7% at 5 years. The AGV success was comparable between PK and DSEK eyes (p=0.73). The cumulative probability of graft survival was 96.2±3.8% at 1 year and 77.8±9.1% at 5-years. The graft survival was also comparable between PK and DSEK eyes (p=0.18). One eye needed tube trimming; none had tube or implant exposure. The major complication noted was corneal graft infection in eight eyes (28.5%).\n\n\nCONCLUSIONS\nIn this cohort, the long-term AGV success and graft survival outcomes are satisfactory considering that AGV was performed in complex eyes with keratoplasty.