Long-term Results of Ahmed Valve Implantation With Mitomycin-C in Pediatric Glaucoma

Precis: Mitomycin was used with Ahmed valve implantation in 81 eyes of 63 children. After 5 years, probability of intraocular pressure (IOP) control without glaucoma medication was 35 +/- 6%; 57% achieved IOP control with topical medications after 10 years. Purpose: The purpose of this study was to determine the long-term outcomes of Ahmed glaucoma valve (AGV) implantation with intraoperative application of mitomycin-C (MMC) for the treatment of childhood glaucoma. Methods: Retrospective review of children undergoing AGV implantation with subtenon application of MMC between 2000 and 2019. We defined surgical success as a final IOP of 5 to 21 mm Hg with no glaucoma medication, no subsequent glaucoma surgery, and no severe complication. Qualified success was defined if the above criteria were met with topical antiglaucoma medication. Results: Eighty-one eyes of 63 patients were included. The probability of complete success was 72 +/- 5% (63% to 83%) at 1 year, 58 +/- 6% (48% to 70%) at 2 years, and 35 +/- 6% (25% to 48%) at 5 years. The probability of qualified success was 92 +/- 3% (87% to 98%) at 1 year, 79 +/- 5% (70% to 89%) at 5 years, 57 +/- 7% (44% to 73%) at 10 years, and 39 +/- 9% (24% to 62%) at 14 years. The IOP was reduced by an average of 10.7 +/- 9 mm Hg from preoperative visit to the last follow-up, and the number of medications decreased from 3.0 +/- 1.4 to 1.5 +/- 1.4 after implantation. Conclusions: A significant proportion of patients achieved long-term IOP control without glaucoma medication. The majority achieved IOP control with additional topical antiglaucoma medications. When compared with existing AGV implantation in childhood literature, the use of MMC appears to lengthen the drop-free (complete success) duration, as well as the long-term IOP control with topical medications.