Combined phacoemulsification and Ahmed valve glaucoma drainage implant: A retrospective case series

PURPOSE. To report on the efficacy and safety of combined phacoemulsification and an Ahmed valve glaucoma drainage implant with respect to visual acuity improvement, intraocular pressure (IOP) control, and requirement for antiglaucoma medication. METHODS. A retrospective chart review was conducted of 41 eyes (31 patients) with coexisting visually significant cataracts and uncontrolled glaucoma who had combined phacoemulsification and Ahmed valve implantation. The outcome measures were: visual acuity, IOP, antiglaucoma medication requirements, and intra- and post-operative complications. Success was categorized as absolute (IOP<21 mmHg without the need for antiglaucoma medication) and relative (IOP<21 mmHg with one or more antiglaucoma medications). Failure was considered to be an IOP<6 mmHg or IOP>21 mmHg on maximally tolerated medications or any devastating complication. RESULTS. The mean patient age was 67.3±5.9 years old. The mean visual acuity improved from 0.73±0.5 to 0.16±0.16 (p=0.000). The mean IOP decreased from 28.2±3.1 to 16.8±2.1 (p=0.000, 40.4%), while the number of antiglaucoma medication decreased from 2.6±0.66 to 1.2±1.4 (p=0.000). The absolute and relative success rates were 56.1% and 31.7%, respectively; 5 eyes (12.2%) were considered failures. There were no intraoperative complications; postoperative complications occurred in 8 eyes (19.5%). A hypertensive phase was detected in 12 (29.3%) eyes. CONCLUSIONS. Combined phacoemulsification and Ahmed valve glaucoma drainage implantation is a safe and effective alternative to phacotrabeculectomy in patients with coexisting cataract and refractory glaucoma.