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Intraocular Pressure Control and Corneal Graft Survival After Implantation of Ahmed Valve Device in High-Risk Penetrating Keratoplasty

Almousa, Radwan MD, MRCSEd, FRCOphth; Nanavaty, Mayank A. DO, MRCSEd, FRCOphth; Daya, Sheraz M. MD, FACP, FACS, FRCSEd; Lake, Damian B. MBChB, FRCOphth

doi: 10.1097/ICO.0b013e31828d2a17
Clinical Science

Purpose: To analyze the control of intraocular pressure (IOP) and corneal graft survival after implantation of Ahmed glaucoma device (AGD) in eyes that had high-risk penetrating keratoplasty (PK).

Methods: This is a retrospective noncomparative case series of 59 eyes that had high-risk PK and underwent AGD insertion. The primary outcome measures are the control of IOP between 6 and 21 mm Hg and corneal graft survival. The secondary outcome measures are risk factors associated with IOP control and corneal graft survival.

Results: The mean IOP reduced significantly after the AGD procedure (26.45 ± 6.8 mm Hg preoperatively vs. 16.85 ± 7.4 mm Hg, 16.95 ± 4.6 mm Hg, 17.97 ± 5.7 mm Hg, 15.78 ± 5.2 mm Hg, and 15.59 ± 5.5 mm Hg, at 1 month, 6 months, 1 year, 2 years, and at the last follow-up postoperatively; P < 0.0001). Over a median follow-up of 78 months (range, 9–175 months) after AGD insertion, IOP control was successful in 44 eyes (75.8%). IOP control was successful in 96% of the eyes at 1 year, 87% at 2 years, 83% at 3 years, and 83% at 5 years. The percentage of clear corneal grafts after 1, 2, 3, and 5 years following the AGD insertion were 87%, 77%, 65%, and 47%, respectively. Further surgery after AGD insertion was associated with 1.79 times greater risk of failure of IOP control.

Conclusions: AGD was effective in controlling the IOP associated with high-risk PK over a 5-year period. Postvalve surgery doubles the risk of failure of IOP control.

Supplemental Digital Content is Available in the Text.

*The Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, West Sussex, United Kingdom; and

Ophthalmology Department, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.

Reprints: Radwan Almousa, Ophthalmology Department, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, United Kingdom (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

The authors have no funding or conflicts of interest to disclose.

Received October 17, 2012

Accepted February 13, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.