The use of Ahmed glaucoma valve in the management of pediatric glaucoma

PURPOSE To assess the intraocular pressure control (TOP), changes in visual acuity, complications, reoperation rates and risk factors for failure following Ahmed glaucoma valve implantation in pediatric eyes with glaucoma. METHODS The medical records of consecutive patients with glaucoma who underwent Ahmed glaucoma valve implantation from January 2000 to December 2009) were retrospectively reviewed. Only one eye of each patient was included. Subgroup analysis was performed in three groups; group 1 included phakic eyes with primary congenital glaucoma, juvenile open-angle, glaucoma, or glaucoma associated with ocular anomalies; group 2 included eyes with glaucoma in aphakia or pseudophakia; group 3 included eyes with other diagnoses. A successful outcome was defined as final IOP between 6 mm Hg and18 mm Hg without loss of light perception or reoperation for glaucoma. RESULTS A total of 71 eyes in 71 patients: 15 (21%) in group 1,47 (66%) in group 2, and 9 (13%) in group 3 were included Successful TOP control was achieved in 44 eyes of 44 patients (62%). Cumulative probabilities of success by Kaplan-Meier analysis at 12 and 24 months was 97% and 80% for the entire group, 100% and 82% for group 1, 95% and 86% for group 2, and 90% and 42% for group 3. Reoperation was necessary for 18 patients (25%), either for tube-related complications or for TOP control. The only significant risk factor for failure was the category of diagnosis (P = 0.029). CONCLUSIONS Ahmed glaucoma valve implantation is an option in the management of pediatric glaucoma; however, reoperations for tube related complications or for persistent elevated TOP is frequently needed.