Different surgical modalities for management of uveitic glaucoma: 2 year comparative study

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. 1; pp. e246 - e252
• Main Authors: El‐Saied, Heba Magdy Ahmed, Abdelhakim, Mohamad Amr Salah Eddin
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2022
• Subjects: Adolescent; Adult; Ahmed glaucoma valve (AGV); Disease Management; Eye surgery; Female; Follow-Up Studies; Glaucoma; Glaucoma - etiology; Glaucoma - physiopathology; Glaucoma - surgery; Glaucoma Drainage Implants; Humans; Inflammation; Intraocular Pressure - physiology; Lasers; Male; Middle Aged; Patients; Prospective Studies; Statistical analysis; Success; Surgery; Time Factors; Topical medication; trabeculectomy; Trabeculectomy - methods; trans‐scleral diode laser cyclophotocoagulation (TDLC); Treatment Outcome; uveitic glaucoma (UG); Uveitis - complications; Visual Acuity; Young Adult; trans-scleral diode laser cyclophotocoagulation (TDLC); uveitic glaucoma (UG); trabeculectomy; inflammation; Ahmed glaucoma valve (AGV)
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.14889

Purpose The aim of this study was to compare outcome of 3 different surgical modalities for management of uveitic glaucoma (UG). Methods This is a prospective comparative study, carried out on a cohort of 105 eyes (105 patients) with UG of different aetiologies. Patients were randomly allocated to group A (trabeculectomy), group B (Ahmed glaucoma valve; AGV) or group C (Trans‐scleral diode laser cyclophotocoagulation, TDLC). Postoperatively, all patients were followed up for 2 years. Humphrey SITA standard perimetry was done 6, 12 and 24 months. Complete success was defined as IOP ≤ 21 mmHg and relative decrease of ≥20%, without additional glaucoma surgery or antiglaucoma medication, qualified success as IOP ≤ 21 mmHg and additional reduction of ≥20% in IOP, without additional glaucoma surgery, but with topical medications, while failure was considered when IOP was not controlled with topical medications and the patient needed additional surgery, or hypotony for ≥2 months. Results At first, IOP was significantly lower with AGV and significantly higher with TDLC, with significant drop and percentage drop between the three groups. Starting from the 6th month postoperatively till the end of the 2‐year period, there was no statistically significant difference between the 3 groups. There was no significant difference between the three groups, with complete success achieved in 60% with trabeculectomy, 68.6% with AGV and 62.9% with TDLC. There was significant difference for inflammatory cells grading; 65.7% of eyes with trabeculectomy had 2+ cells, 57% with AGV had 0 cells while 45.7% with TDLC had 1+ cells. Conclusion The three surgical modalities had the same IOP‐lowering effect on the long run, with complete success rate that is close enough between them, with AGV revealing the least inflammation, which might be the cause of more stable VF with Ahmed’s valve proving its superiority to the other 2 techniques for inflammatory glaucoma.