Preventing Hypertensive Phase in Glaucoma Valve Surgery

Shuchi B. Patel, MD


October 28, 2014

In This Article

Hypertensive Phase and Early Complications After Ahmed Glaucoma Valve Implantation With Intraoperative Subtenon Triamcinolone Acetonide

Turalba AV, Pasquale LR
Clin Ophthalmol. 2014;8:1311-1316

Study Summary

This study was a retrospective comparative case series of pseudophakic adult patients with uncontrolled glaucoma who underwent AGV implantation with and without intraoperative subtenon triamcinolone acetonide (TA) injection. Using chart review, 19 consecutive eyes receiving intraoperative subtenon TA between 2009 and 2010 were compared with 23 consecutive eyes that underwent AGV implantation by the same surgeon from 2007 to 2008 but did not receive TA. Data were analyzed for 6 months postoperatively.

Primary outcomes included IOP and number of glaucoma medications before and after AGV implantation. The presence of a hypertensive phase, defined as an IOP measurement > 21 mm Hg (with or without medications) during the 6-month postoperative period, was also recorded. Postoperative complications and visual acuity were analyzed as secondary outcome measures.

The results showed that 5 of 19 (26%) TA cases and 12 of 23 (52%) non-TA cases developed the hypertensive phase (P = .027). The mean IOPs were similar, at 14.2 ± 4.6 in TA cases vs. 14.7 ± 5.0 mm Hg in non-TA cases (P = .78). The number of glaucoma medications needed was similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (one case) and bacterial endophthalmitis (one case) were observed with TA but not in the non-TA group.

In conclusion, subtenon TA injection during AGV implantation may reduce the occurrence of the hypertensive phase, but it does not alter the ultimate IOP outcome while possibly posing an increased risk for serious complications.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.