Long-Term Visual Field Outcomes After Ahmed Glaucoma Valve Implantation

center dot PURPOSE: To measure visual field (VF) rates of change after Ahmed Glaucoma Valve (AGV) implantation and to investigate risk factors for progression. center dot DESIGN: Retrospective, clinical cohort study. center dot METHODS: Patients who underwent AGV implanta-tion with at least 4 eligible postoperative VFs and 2 years of follow-up were included. Baseline, intraoperative, and postoperative data were collected. VF progression was ex-plored with 3 methods: mean deviation (MD) rate; glau-coma rate index (GRI); and pointwise linear regression (PLR). For a subset of eyes with sufficient preoperative and postoperative VFs, rates were compared between the 2 periods. center dot RESULTS: A total of 173 eyes were included. The in-traocular pressure (IOP) and number of glaucoma med-ications were significantly reduced from a median (in-terquartile range [IQR]) of 23.5 (12.1) mm Hg at base-line to 12.8 (4.0) mm Hg at final follow-up, and from (mean +/- SD) 3.3 +/- 1.2 to 2.2 +/- 1.4, respectively. A total of 38 eyes (22%) showed VF progression, and 101 eyes (58%) were stable as assessed by all 3 methods, which accounted for 80% of all eyes. The rate of VF decline by MD and GRI was a median (IQR) of-0.30 (0.8) dB/y and-2.30 (10.6) (of-100), respectively. When com-paring progression before and after surgery, the reduction was not statistically significant with any of the methods. The peak IOP (after 3 postoperative months) was asso-ciated with VF deterioration, with a 7% increase in risk per each additional millimeter of mercury (mm Hg). center dot CONCLUSIONS: To our knowledge, this is the largest published series reporting long-term VF outcomes after glaucoma drainage device implantation. There is a con-tinued, significant rate of VF decline after AGV surgery. (Am J Ophthalmol 2023;251: 173-188. (c) 2023 Elsevier Inc. All rights reserved.)