Early Treatment with Aqueous Suppressants after Ahmed Valve Implantation

To evaluate the effect of early aqueous suppressants initiation on Ahmed glaucoma valve success rate. In this randomized clinical trial, a total of 94 eyes of 94 patients with refractory glaucoma were enrolled. The eyes were randomly selected into 2 groups. In group 1 (n=47), patients received early topical combination of Timolol-Dorzolamide twice daily after Ahmed glaucoma valve implantation when the intraocular pressure (IOP) reached 10 mmHg. After 3 months the glaucoma medications were adjusted (decreased or increased) based on target pressure. In control group (n=47), patients received stepwise glaucoma medications when IOP reached higher than target. Main outcome measures included cumulative probabilities of success rate (defined as IOP between 6 and 15 mmHg, and 30% reduction in IOP), IOP, the number of medications, and the rate of hypertensive phase. Cumulative probabilities of success rate was significantly higher in group 1 compared with control at months 6 (70.5% versus 32.6%, P<0.001) and 12 (63.2% versus 33.2%, P= 0.008). Mean IOP was statistically lower in group 1 between weeks 1 and 54 (P<0.05). Number of medications in group 1 was statistically higher between weeks 1 and 12 (P<0.001) but was not different at weeks 24 and 54 (P= 0.180 and P= 0.197 respectively). The rate of hypertensive phase was significantly less in group 1 compared with control 23.4% versus 66%, P<0.001). Early initiation of aqueous suppressants after Ahmed glaucoma valve implantation can improve success rate.