Indications and outcomes of Ahmed glaucoma valve implants in Kenya
Abstract
Title:
Indications and outcomes of Ahmed glaucoma valve implants in Kenya.
Objective:
To establish
the indications, efficacy in
control
of intraocular pressure
, complications
and need for additional anti
-
glaucoma medication and surgery after
Ahmed glaucoma valve
implantation.
Design:
Retrospective case series
Setting:
The study was conducted in various institutions
in Kenya
where Ahmed valve
implants
are
used as surgical therapy for
control
of intraocular pressure. These were:
KNH
,
K
ikuyu
Eye
U
nit and Tenwek Mission Hospital
.
Subjects:
All adults and children who had undergone Ahmed glaucoma valve implantation
between 2006 and 2012.
Outcome measures:
This comprised of the mean
intraocular
pressure
, use of additional anti
-
glaucoma drugs post
-
ope
ratively, surgical complications and the need for additional surgery.
Results
:
A
total of 50 records were reviewed. The male to female ratio was 3:2.M
ajority of the
patients
were
in the 0 to 10 year age group.
The age range was 2 to 83 years. The mean pre
-
operation IOP was 42.50
mm/
H
g with
a range of
21 to 63
mm/H
g
.Failed trabeculectomy was the
most common i
ndication of AGV implantation (20%).Four percent of
all
the patients
had Ahmed
valve surgery as the primary surgery. Paediatric glaucoma was the indicati
on for surgery in 16%
of the
patients.
There
was a statistically significant reduction in the mean IOP after surgery
throughout the follow
-
up period. On the firs
t day after surgery the mean intraocular pressure
reduced to
17.5
mm/H
g
from a mean IOP of
42.50
mm/H
g before
surgery.
Sixty four percent of
the patients were not on any glaucoma medication on the first post
-
operative day.
The
most
common complication noted was
hypotony, seen
in four patients in the
first day after surgery
and in one
patient
in the fi
rst year of follow
-
up.
Conclusion
:
The most common indication for AGV use in Kenya was failed trabeculectomy.
Other common indications were primary congenital glaucoma and neovascular glaucoma.Good
IOP control was achieved with the AGV in patients who ha
d uncontrolled glaucoma with the use
of conventional medical therapy.There was a statistically significant reduction in the number of 10
anti
-
glaucoma medication used after surgery
. Hypotony was the most common complication
noted, whereas endophthalmitis was
the most serious complication.
Publisher
University of Nairobi