Manipulating an existing Ahmed glaucoma valve (AGV) can decrease postsurgical drops and achieve additional intraocular pressure (IOP) lowering without targeting additional tissues of the eye to lower IOP. Topical anesthesia followed by infraduction of the globe exposes the silicone tube coursing from the limbus to the AGV plate. An incision down to the silicone tube and adjacent sclera is made between the patch graft at the limbus and the AGV plate. Blunt ± sharp dissection of the tissues is continued toward the limbus, thereby extending the potential space that fluid can flow into (creating a future bleb space). The capsule at the anterior edge of the AGV plate is incised at the sclera. A fluid rush indicates the tube is working. A cruciate incision is made in the anterior wall of the silicone tube; beading of aqueous should happen spontaneously. Paracentesis and anterior chamber (AC) fill with viscoelastic are performed to maintain the AC. Two-layer running, locking 8-0 or 9-0 Vicryl on a BV needle is used to close. Mitomycin C 0.2 mg/mL x 0.1 cc is injected into Tenon over the AGV plate. At 1-year follow-up of 40 eyes of 40 patients, complete surgical success was achieved in 70% and qualified surgical success in 80%. Hypotony occurred in 6 eyes (15%), all of which resolved. Mean baseline IOP was 28.9 ± 8.1 mm Hg on 2.3 ± 0.7 glaucoma drops. One-year mean IOP was 13.8 ± 4.6 mm Hg (P < .001), with an average of 0.7 ± 1.2 (P < .001) drops.

Financial Disclosures: Dr. Delan Jinapriya discloses financial relationships with Abbvie (Consultant/Advisor); Bausch + Lomb (Consultant/Advisor); D Jinapriya Medicine Professional Corporation (Equity Stock Holder - Private); Euclid Telehealth (Stock Options - Public or Private, Equity Stock Holder - Private); and Santen, Inc. (Consultant/Advisor).

Dr. Mohamed Afify Khodeiry, Laura Reyna Soberanis, Timothy David Ratzlaff, and Mohab M A Eldeeb discloses no financial relationships.