Long-term outcomes of pars plana Ahmed valve implant and vitrectomy in eyes with refractory glaucoma

Abstract Background: Pars plana vitrectomy with implantation of an Ahmed glaucoma valve in the vitreous cavity has been reported with a success rate in the management of refractory and neovascular glaucoma. This study aimed to present the outcomes of pars plana Ahmed glaucoma valve (PPAV) surgical implantation in cases with refractory glaucoma. Methods: In this single-center, retrospective, comparative study, ۸۷ consecutive patients diagnosed with refractory glaucoma who underwent PPAV surgical implantation between October ۲۰۱۵ and October ۲۰۱۹ were evaluated. A successful postoperative outcome was defined as intraocular pressure (IOP) less than or equal to ۲۱ mmHg upon examination and a reduction in the number of anti-glaucoma agents used at the last follow-up. Results: Finally, ۸۱ eyes of ۷۸ patients with refractory glaucoma were included; ۵۴ (۶۶.۶۶%) of the eyes had neovascular glaucoma. The mean follow-up was ۲۰.۶۵ ± ۱۲.۱۷ months (range: ۲ to ۵۲ months). The mean preoperative IOP was ۴۰.۰۱ ± ۱.۱۹ mmHg and reduced significantly to ۱۶.۷۳ ± ۰.۸۲ mmHg at the latest follow-up (P < ۰.۰۰۱); thus, a successful IOP outcome was achieved in ۸۸.۸۹% of eyes. The mean number of anti-glaucoma agents decreased significantly from ۲.۸۶ ± ۰.۰۹ preoperatively to ۱.۴۶ ± ۰.۱۱ at the latest follow-up (P < ۰.۰۰۱); while ۶۱ (۷۵.۳۱%) of eyes had a reduction in the number of IOP lowering eye drops, and ۱۴ (۱۷.۲۸%) had no need for IOP lowering eye drops. Conclusions: PPAV surgery is a successful procedure for IOP reduction in patients with refractory glaucoma. Our study demonstrated either reduction or elimination of IOP lowering eye drops postoperatively. Large scale studies with a comparison group, a longer follow-up, and having various subtypes of glaucoma are required as future research to confirm these outcomes.