Second Shunt Surgery versus Tenonectomy in the Patients With Failed Ahmed Glaucoma Valve

Azadeh Doozandeh1 *, Farideh Sharifipour1 , Shahin Yazdani1 , Kiana Hassanpour1 , Iman Ansari1 , Parisa Mohammadi1 , Aidin Meshksar1 , Maryam Hajizadeh1

  1. Ophthalmic Research Center, Research Institute for ophthalmology and vision science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract: To investigate the efficacy of tenonectomy in comparison to the second Ahmed Glaucoma Valve (AGV) implantation in patients with a failed surgery.

Methods: In this prospective interventional case-series, consecutive patients with first AGV failure were included between March 2018 to February 2020. The patients randomly underwent tenonectomy and repeated shunt surgery. Tenonectomy procedure consisted of tenotomy around the plate and extensive removal of Tenon’s capsule. The second shunt was placed in the superonasal or inferotemporal quadrant based on the health of the conjunctiva. The primary outcome measure included surgical success. Intraocular pressure (IOP), glaucoma medications, and complications were considered as secondary outcome measures.

Results: A total of 44 patients were enrolled including twenty-five (54.5%) patients in Tenonectomy and 21 (47.7%) in the re-AGV group. Mean age of patients was 31.8 ± 22.3 and 23.7 ± 24.2 years in Tenonectomy and re-AGV groups, respectively. After 6 months, the cumulative probability of success was 53.3 % and 93.8 % in Tenonectomy and re-AGV group, respectively. (logRank=9.7, P=0.002). In the Tenonectomy group, mean IOP significantly decreased from 28.3 ± 5.04 at baseline to 17.2 ± 3.9 and 16.4 ± 2.4 at postoperative month 3 and 6. (Ps= 0.002 and 0.018, respectively) The respective values for the re-AGV group were 30.9 ± 6.2 at baseline, 11.0 ± 1.7 mmHg and 13.6 ± 3.8 mmHg at 3 and 6 postoperative months. Patients in the re-AGV group had significantly lower IOPs compared to the Tenonectomy group in all postoperative visits. At the final follow-up, while the insignificant, mean number of glaucoma medications in the tenonectomy group was higher than the re-AGV group. (3.5 ± 0.2 vs 2 ± 0.6, P= 0.29).

Conclusion: Repeated shunt surgery could perform better than tenonectomy in our mall series of patients with failed AGV. Larger studies with longer follow-up are recommended for a better comparison. Keywords: Glaucoma, filtration surgery, Tenon’s Capsule, Ahmed Glaucoma Valve.





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