Skip to main content

  • Silicone Ahmed valve performs well in children with refractory glaucoma

    Glaucoma, Pediatric Ophth/Strabismus

    Add to My Bookmarks

    This study reports the outcomes of silicone Ahmed glaucoma valve (AGV) implantation in the management of refractory pediatric glaucoma.

    Study design

    The authors retrospectively reviewed the charts of 53 children (65 eyes) with refractory glaucoma who were followed for at least 6 months. All eyes were implanted with the AGV (flexi plate silicone FP7 or FP8) by a single surgeon.

    The study primarily measured the success of the AGV in patients with refractory pediatric glaucoma. As a secondary outcome measure, the authors compared the outcomes of patients with primary congenital glaucoma versus those with secondary pediatric glaucoma. Success was measured as IOP between 5 and 21 mm Hg, with or without topical medications.

    Outcomes

    Implantation of the AGV was an effective option for patients with refractory pediatric glaucoma, with nearly 90% success at 4 years. There were no significant differences in success rates between the primary congenital glaucoma and secondary glaucoma groups (P=0.49). The number of prior surgeries was a significant risk factor for failure (HR 2.2; P=0.01).

    Limitations

    The study did not compare this approach with the Baerveldt glaucoma shunt. Loss to follow-up was also a limiting factor. In any pediatric glaucoma practice, poor understanding of the disease likely leads to the loss of patients to follow-up.

    Clinical Significance

    Management of childhood glaucoma is a diagnostic and therapeutic challenge. Children are often non-compliant with their medications and subsequently require surgical intervention. The first-line approach often includes trabeculotomy or trabeculectomy, or a glaucoma drainage device. But the next steps are unclear, given the high failure rate of the initial surgery. This review suggests AGV implantation has a good success rate in patients with primary or secondary refractory pediatric glaucoma. Eyes were more likely to fail if they had undergone previous surgeries. Therefore, meticulous counseling of parents and children is required, as well as close follow up.