The role of primary needle revision after Ahmed glaucoma valve (AGV) implantation

Purpose To evaluate the efficacy and safety of primary needle revision after Ahmed Glaucoma Valve (AGV) implantation in comparison with glaucoma medication use. Methods In this interventional case series, 23 eyes of 23 patients who underwent AGV implantation were enrolled. Needle revision was performed when the intraocular pressure was higher than the target pressure before glaucoma medications. Using a 30-gauge needle, the Tenon's capsule over the plate was incised and the bleb was reformed. Patients were examined on a postoperative day one, weekly (for four weeks), and every 1-3 months. Two criteria were used to define cumulative success as a minimum 20% reduction in IOP and 5 < IOP <= 21 mmHg (Criteria A) or 5 < IOP <= 18 mmHg (Criteria B) without (Complete success) or with (Qualified success) glaucoma medication. Results In this pilot study, we enrolled 23 patients with a mean age of 53.8 +/- 12.4 years (25-78 years) who underwent AGV implantation and a one-year follow-up period. The mean number of primary needle revision was 2.2 +/- 1.6 (1-6). One year postoperatively, the cumulative success rate was 91.4% and 86.9% based on Criteria A and B, respectively. The average of preoperative IOP was 28.26 +/- 8.86 mmHg (range 15-46 mmHg), reaching 13.78 +/- 3.54 mmHg (range 8-20) at the end of the one-year follow-up. (P < 0.001) The mean preoperative medication significantly decreased from a median of 4 (range 3-4) at baseline to 2 (range 1-4) after the one-year follow-up (P < 0.001). One patient experienced leakage over the plate, which was successfully treated via conservative management. Conclusion This pilot study showed that primary needle revision is a safe and effective method for controlling IOP after AGV implantation with a lower need for medication.

Automated summary

This pilot study demonstrated that primary needle revision is a safe and effective method for controlling intraocular pressure post-AGV implantation with a decreased need for medication. The cumulative success rate at one year was 91.4% and 86.9% based on Criteria A and B, respectively. Preoperative IOP significantly decreased from 28.26 +/- 8.86 mmHg to 13.78 +/- 3.54 mmHg at the end of the one-year follow-up, along with a significant reduction in the number of medications used.