Comparison of Surgical Outcome After Ahmed Valve Implantation for Patients With and Without Fluocinolone Intravitreal Implant (Retisert)

• Published in: Journal of glaucoma Vol. 25; no. 9; pp. e772 - e776
• Main Authors: Hennein, Lauren, Hou, Jing, Stewart, Jay M, Lowry, Eugene A, Jiang, Zhengxuan, Enanoria, Wayne T.A, Han, Ying
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-09-2016
• Subjects: Adult; Drug Implants; Female; Fluocinolone Acetonide - administration & dosage; Fluocinolone Acetonide - analogs & derivatives; Follow-Up Studies; Glaucoma - surgery; Glaucoma Drainage Implants - adverse effects; Humans; Intraocular Pressure - physiology; Intravitreal Injections; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Time Factors; Treatment Outcome; Uveitis - etiology; Uveitis - prevention & control; Visual Acuity
• ISSN: 1057-0829; 1536-481X
• DOI: 10.1097/IJG.0000000000000497

PURPOSE:To determine whether long-term, slow-release exposure to corticosteroids with Retisert promotes better surgical outcomes after Ahmed valve implantation.
PATIENTS:This comparative retrospective cohort study included 17 study eyes (10 patients) with uncontrolled uveitis requiring Retisert and Ahmed implantation, and 55 control eyes (51 patients) with other types of medically uncontrolled glaucoma that only received Ahmed.
MATERIALS AND METHODS:Main outcome measures were intraocular pressure (IOP), glaucoma eye drops per day, best-corrected visual acuity, early complications, and late complications at 1, 3, 6, and 12 months. Linear mixed effects models were used to model IOP, glaucoma drops per day, and visual acuity at 1 year after surgery.
RESULTS:At 1 year, the study eyes had a mean IOP of 12.24, which was lower than that for control eyes at 15.17 (P=0.04). At 1 year, the average number of glaucoma eye drops used per day for study eyes was 1.4, which was lower than that for control eyes at 2.3 (P=0.03). At 1 year, there were no statistically significant differences in change in visual acuity, early complications, and late complications between study and control eyes.
CONCLUSIONS:Patients who received a Retisert implantation had lower IOP and used fewer glaucoma eye drops compared with control eyes at 1-year post-Ahmed valve surgery. This study suggests that long-term, slow-release corticosteroid medication from Retisert (fluocinolone acetonide) may improve the surgical outcome for patients with an Ahmed valve implantation and/or Retisert helps control uveitis in patients with uveitic glaucoma receiving Ahmed valves.