Intravitreal ranibizumab as an adjunct for Ahmed valve surgery in open-angle glaucoma: a pilot study

Background: To determine the safety and efficacy of intravitreal ranibizumab therapy before and after Ahmed tube insertion for open-angle glaucoma as a means of optimizing postoperative intraocular pressure control. Design: Randomized, controlled trial. Participants: Open-angle glaucoma patients scheduled for Ahmed tube insertion, randomized to ranibizumab or control groups. Methods: Ranibizumab (0.5mg in 0.05mL) was administered intravitreally at three time points: 9days prior to surgery, 1month post-surgery and 2months post-surgery. Control patients underwent the same procedure without ranibizumab. Main Outcome Measure: Success at 6months postoperatively was defined as intraocular pressure <18mmHg with no adjunctive medications or intraocular pressure <15mmHg with one adjunctive medication. Results: The study and control arms included six and five subjects, respectively, with four in each arm undergoing combined cataract surgery. In the ranibizumab arm, the preoperative and postoperative intraocular pressure/medication usage was 21.0 +/- 6.7mmHg on 3.2 +/- 1.5 medications and 14.7 +/- 1.9mmHg on 0.5 +/- 0.8 medications, respectively. In the control arm, preoperative and postoperative intraocular pressure/medication usage was 18.8 +/- 3.8mmHg on 2.8 +/- 1.3 medications and 16.2 +/- 3.6mmHg with 1.8 +/- 1.6 medications, respectively. Success was achieved in 83% of subjects in the ranibizumab group compared with 40% in the control group (two-tailed Fisher's exact test, P=0.24). Conclusion: The findings from this small pilot comparative study suggest that intravitreal ranibizumab use may be a safe and potentially effective adjunctive treatment modality in improving success after Ahmed tube placement.