COMMENTARY

Preventing Hypertensive Phase in Glaucoma Valve Surgery

Shuchi B. Patel, MD

Disclosures

October 28, 2014

In This Article

Effect of Early Treatment With Aqueous Suppressants on Ahmed Glaucoma Valve Implantation Outcomes

Pakravan M, Rad SS, Yazdani S, Ghahari E, Yaseri M
Ophthalmology. 2014;121:1693-1698

Study Summary

This randomized prospective trial sought to evaluate the effect of early aqueous suppressant treatment on outcomes of Ahmed glaucoma valve (AGV) surgery. The aqueous suppressant used was topical fixed-combination timolol/dorzolamide drops, given twice daily when intraocular pressure (IOP) exceeded 10 mm Hg (group 1). The control group (group 2) received conventional stepwise treatment for IOP only when pressure exceeded the target.

The main outcome measures included IOP and success rate, which was defined as IOP > 6 mm Hg but < 15 mm Hg and a reduction in IOP of at least 30% from baseline. The other outcome measures included best corrected visual acuity, complications, and hypertensive phase frequency. The number of medications used at every data point was also recorded.

The total number of patients in the study was 94 (47 in group 1 and 47 in group 2). The baseline characteristics of groups 1 and 2 were similar in terms of type of glaucoma; history of surgery; and mean age (47 ± 18 years and 41 ± 19 years, respectively), preoperative IOP (30.9 ± 9.3 mm Hg and 31.8 ± 9.3 mm Hg, respectively), and mean preoperative glaucoma medications (3.7 ± 0.6 and 3.6 ± 0.6, respectively). All procedures were performed with a similar technique by one of two glaucoma specialists. Patients were scheduled for postoperative visits on day 1 and at weeks 1, 2, 3, 4, 6, 8, 12, 16, 24, and 54, and then every 6 months.

The mixed-model analysis demonstrated a significantly greater reduction in IOP in group 1 at all intervals. At year 1, group 1 also exhibited a higher success rate (63.2% vs 33.3%; P = .008) and a reduced hypertensive phase (23.4% vs 66.0%; P < .001).

Therefore, it seems that the early addition of aqueous suppressant treatment, particularly fixed combination timolol/dorzolamide, improves AGV outcomes by leading to a greater IOP reduction, a higher success rate, and a lower frequency of the hypertensive phase.

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