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Conjunctival Complications Related to Ahmed Glaucoma Valve Insertion

Geffen, Noa MD*; Buys, Yvonne M. MD, FRCSC; Smith, Michael MBChB, FRCOphth; Anraku, Ayako MD; Alasbali, Tariq MD§; Rachmiel, Ronny MD; Trope, Graham E. MB, BCh, PhD, FRCSC

doi: 10.1097/IJG.0b013e31826ab693
Original Studies

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.

*Department of Ophthalmology, Meir Medical Center, Kfar Saba

Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

Department of Ophthalmology, Royal Devon & Exeter Hospital, Exeter, UK

§Department of Ophthalmology, King Faisal University, Damman, Saudi Arabia

Disclosure: The authors declare no conflict of interest.

Reprints: Noa Geffen, MD, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 18 C/6 Weitzman st. Ramat- Hasharon, Israel 47211 (e-mail:

Received May 24, 2011

Accepted July 18, 2012

© 2014 by Lippincott Williams & Wilkins.