Long-Term Visual Field Outcomes After Ahmed Glaucoma Valve Implantation

center dot PURPOSE: To measure visual field (VF) rates of change after Ahmed Glaucoma Valve (AGV) implantation and to investigate risk factors for progression. center dot DESIGN: Retrospective, clinical cohort study. center dot METHODS: Patients who underwent AGV implanta-tion with at least 4 eligible postoperative VFs and 2 years of follow-up were included. Baseline, intraoperative, and postoperative data were collected. VF progression was ex-plored with 3 methods: mean deviation (MD) rate; glau-coma rate index (GRI); and pointwise linear regression (PLR). For a subset of eyes with sufficient preoperative and postoperative VFs, rates were compared between the 2 periods. center dot RESULTS: A total of 173 eyes were included. The in-traocular pressure (IOP) and number of glaucoma med-ications were significantly reduced from a median (in-terquartile range [IQR]) of 23.5 (12.1) mm Hg at base-line to 12.8 (4.0) mm Hg at final follow-up, and from (mean +/- SD) 3.3 +/- 1.2 to 2.2 +/- 1.4, respectively. A total of 38 eyes (22%) showed VF progression, and 101 eyes (58%) were stable as assessed by all 3 methods, which accounted for 80% of all eyes. The rate of VF decline by MD and GRI was a median (IQR) of-0.30 (0.8) dB/y and-2.30 (10.6) (of-100), respectively. When com-paring progression before and after surgery, the reduction was not statistically significant with any of the methods. The peak IOP (after 3 postoperative months) was asso-ciated with VF deterioration, with a 7% increase in risk per each additional millimeter of mercury (mm Hg). center dot CONCLUSIONS: To our knowledge, this is the largest published series reporting long-term VF outcomes after glaucoma drainage device implantation. There is a con-tinued, significant rate of VF decline after AGV surgery. (Am J Ophthalmol 2023;251: 173-188. (c) 2023 Elsevier Inc. All rights reserved.)

Automated summary

The purpose of this study was to measure the rates of visual field (VF) changes after Ahmed Glaucoma Valve (AGV) implantation and to investigate the risk factors for progression. The study found that there was a continued, significant rate of VF decline after AGV surgery.