Conjunctival complications related to Ahmed glaucoma valve insertion

2.50
Hdl Handle:
http://hdl.handle.net/11287/593796
Title:
Conjunctival complications related to Ahmed glaucoma valve insertion
Authors:
Geffen, N.; Buys, Y. M.; Smith, Michael; Anraku, A.; Alasbali, T.; Rachmiel, R.; Trope, G. E.
Abstract:
PURPOSE: Conjunctival complications may occur after glaucoma drainage device surgery. We analyzed the frequency, risk factors, management and outcomes of Ahmed glaucoma valve (AGV)-related conjunctival complications. METHODS: Retrospective review of postoperative conjunctival complications in patients undergoing AGV insertion. Only subjects with >/=1-year follow-up were included. RESULTS: The charts of 158 subjects with a median age of 64+/-16.2 years were reviewed. Median follow-up was 43.5 months (range, 12 to 103 mo). Fifty-three (33.5%) wound dehiscences and 14 (8.9%) device exposures were diagnosed 31.6+/-35.7 and 996+/-735 days after procedure, respectively (P<0.001). Ninety-one subjects (57.6%) had no conjunctival complications. This uncomplicated group used 3.3 (+/-1.1) [95% confidence interval (CI): 3.07, 3.51] hypotensive medications before surgery as compared with 3.8 (+/-1.1) (95% CI: 3.48, 4.10) and 3.9 (+/-0.9) (95% CI: 3.36, 4.36) for dehiscence and exposure groups, respectively (P=0.01). The inferonasal quadrant was associated with the highest rate of dehiscences (4/7, 57.1%) (95% CI: 18.4, 90.1), followed by the inferotemporal quadrant (30/65, 46.2%) (95% CI: 33.1, 58.2), the superotemporal (15/61, 24.6%) (95% CI: 12.9, 33.8), and the superonasal (4/25, 16%) (95% CI: 10.9-52.0; P<0.0073). There were no differences in dehiscence and exposure rates between limbal versus fornix-based approaches (P=0.54; 95% CI: 24.8-44.9, 24.4-45.7, 5.9-19.6, 3-45.1, respectively). Forty-eight (90.6%) dehiscent wounds resolved with conservative management and 5 were resutured, whereas all exposed devices were managed surgically. CONCLUSIONS: Conjunctival dehiscence is usually a benign, common complication after AGV insertion. It does not need repair as long as the tube is well covered. AGV tube or plate exposures are less common, occur later and were promptly repaired as per current practice. Important factors predisposing to these problems include a greater number of preoperative hypotensive medications and the implantation quadrant.
Citation:
J Glaucoma. 2014 Feb;23(2):109-14.
Publisher:
Wolters Kluwer
Journal:
Journal of glaucoma
Issue Date:
1-Feb-2014
URI:
http://hdl.handle.net/11287/593796
DOI:
10.1097/IJG.0b013e31826ab693
PubMed ID:
23059483
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/23059483
Type:
Journal Article
Language:
eng
ISSN:
1536-481X
Appears in Collections:
Ophthalmology (West of England Eye Unit); 2014 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorGeffen, N.en
dc.contributor.authorBuys, Y. M.en
dc.contributor.authorSmith, Michaelen
dc.contributor.authorAnraku, A.en
dc.contributor.authorAlasbali, T.en
dc.contributor.authorRachmiel, R.en
dc.contributor.authorTrope, G. E.en
dc.date.accessioned2016-01-19T12:35:01Zen
dc.date.available2016-01-19T12:35:01Zen
dc.date.issued2014-02-01en
dc.identifier.citationJ Glaucoma. 2014 Feb;23(2):109-14.en
dc.identifier.issn1536-481Xen
dc.identifier.pmid23059483en
dc.identifier.doi10.1097/IJG.0b013e31826ab693en
dc.identifier.urihttp://hdl.handle.net/11287/593796en
dc.description.abstractPURPOSE: Conjunctival complications may occur after glaucoma drainage device surgery. We analyzed the frequency, risk factors, management and outcomes of Ahmed glaucoma valve (AGV)-related conjunctival complications. METHODS: Retrospective review of postoperative conjunctival complications in patients undergoing AGV insertion. Only subjects with >/=1-year follow-up were included. RESULTS: The charts of 158 subjects with a median age of 64+/-16.2 years were reviewed. Median follow-up was 43.5 months (range, 12 to 103 mo). Fifty-three (33.5%) wound dehiscences and 14 (8.9%) device exposures were diagnosed 31.6+/-35.7 and 996+/-735 days after procedure, respectively (P<0.001). Ninety-one subjects (57.6%) had no conjunctival complications. This uncomplicated group used 3.3 (+/-1.1) [95% confidence interval (CI): 3.07, 3.51] hypotensive medications before surgery as compared with 3.8 (+/-1.1) (95% CI: 3.48, 4.10) and 3.9 (+/-0.9) (95% CI: 3.36, 4.36) for dehiscence and exposure groups, respectively (P=0.01). The inferonasal quadrant was associated with the highest rate of dehiscences (4/7, 57.1%) (95% CI: 18.4, 90.1), followed by the inferotemporal quadrant (30/65, 46.2%) (95% CI: 33.1, 58.2), the superotemporal (15/61, 24.6%) (95% CI: 12.9, 33.8), and the superonasal (4/25, 16%) (95% CI: 10.9-52.0; P<0.0073). There were no differences in dehiscence and exposure rates between limbal versus fornix-based approaches (P=0.54; 95% CI: 24.8-44.9, 24.4-45.7, 5.9-19.6, 3-45.1, respectively). Forty-eight (90.6%) dehiscent wounds resolved with conservative management and 5 were resutured, whereas all exposed devices were managed surgically. CONCLUSIONS: Conjunctival dehiscence is usually a benign, common complication after AGV insertion. It does not need repair as long as the tube is well covered. AGV tube or plate exposures are less common, occur later and were promptly repaired as per current practice. Important factors predisposing to these problems include a greater number of preoperative hypotensive medications and the implantation quadrant.en
dc.language.isoengen
dc.publisherWolters Kluweren
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/23059483en
dc.titleConjunctival complications related to Ahmed glaucoma valve insertionen
dc.typeJournal Articleen
dc.identifier.journalJournal of glaucomaen

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