COMMENTARY

Glaucoma Implants at 5 Years: Know the Differences

Shuchi B. Patel, MD

Disclosures

February 26, 2015

Five-Year Treatment Outcomes in the Ahmed Baerveldt Comparison Study

Budenz DL, Barton K, Gedde SJ, et al; Ahmed Baerveldt Comparison Study Group
Ophthalmology. 2015;122:308-316

Study Summary

Two years ago, the 3-year results of the Ahmed Baerveldt Comparison (ABC) were released. For further follow-up, the study group is presenting the 5-year outcomes.

A total of 276 patients initially participated and were randomly assigned to receive either the Ahmed FP7 glaucoma valve (AGV; 143 patients) or the Baerveldt 101-350 glaucoma implant (BGI; 133 patients). All patients had previous intraocular surgery or refractory glaucoma and intraocular pressure (IOP) > 18 mm Hg. The 5-year visit was completed by 174 patients (63%); 87 patients in the AGV group and 87 patients in the BGI group. The main outcome measures were surgical failure, IOP, visual acuity, use of glaucoma medications, and complications (Table).

Table. Main Results

Outcome Measure AGV Group BGI Group
Baseline IOP (mm Hg) 29.6 ± 10.1 28.3 ± 9.3
5-year IOP (mm Hg) 14.7 ± 4.4 12.7 ± 4.5
# of medications at 5 years 2.2 ± 1.4 1.8 ± 1.5
Cumulative probability of failure during 5 years of follow-up 44.7% 39.4%

AGV = Ahmed FP7 glaucoma valve; BGI = Baerveldt 101-350 glaucoma implant; IOP = intraocular pressure

More patients in the AGV group failed because of inadequately controlled IOP or reoperation for glaucoma, but in the BGI group, there was a higher rate of failure owing to persistent hypotony, explantation of implant, or loss of light perception.

In conclusion, surgical success rates for both implants were similar at 5 years. The BGI produced greater IOP reduction and a lower rate of glaucoma reoperation than the AGV, but the BGI was associated with twice as many failures as a result of safety issues.

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