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Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery. The authors have no financial interest in the subject matter of this poster. Leonidas Traipe, M.D. Felipe Valenzuela, M.D. Carlos Nieme, M.D Juan Stoppel, M.D. Allister Gibbons, M.D. Mario Zanolli, M.D.

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combined phacoemulsification and ahmed glaucoma drainage implant surgery

Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery

  • Theauthorshave no financialinterest in thesubjectmatterofthisposter

Leonidas Traipe, M.D.

Felipe Valenzuela, M.D.

Carlos Nieme, M.D

Juan Stoppel, M.D.

Allister Gibbons, M.D.

Mario Zanolli, M.D.

Fundación Oftalmológica Los Andes (FOLA), Santiago, Chile

introduction
Introduction
  • Glaucoma drainage implants are specially indicated when the risks of failure with conventional trabeculectomy are high
          • NVG, uveitic glaucoma, etc.
  • When cataract and glaucoma coexist together in a patient with refractory glaucoma, critical management issues arise
          • Selection of the optimum glaucoma surgical procedure, sequence of surgery, etc
  • This procedure offers theoretical advantages like:
  • Avoid the high risk of failure associated with conventional filtering surgery
  • Improved IOP control in the long term and good visual rehabilitation
  • Less risk of blebitis – endophtalmitis
  • Single surgical procedure
purpose
Purpose
  • To examine theindications, safety, efficacyandcomplicationsofcombinedphacoemulsificationand Ahmed glaucoma drainageimplantsurgery.
methods
Methods
  • Noncomparative, interventional, retrospective, consecutive case series of 24 eyes(21 patients).
  • 1 surgeon (LT)
  • Demographic characteristics  Indications
  • Visual Acuity  Complications
  • IOP and antiglaucoma medications :
    • Complete success IOP < 21mmHg w/o medications
    • Qualified success IOP < 21mmHg with medications
    • Failure IOP > 21mmHg +/- medications
  • Approved by FOLA EthicsComittee
  • StatisticalAnalysiswasperformedusing SPSS 16.0
slide6

* 7 eyes -> 1 previous surgery / 5 eyes -> 2 previous surgeries / 1 eye -> 3 previous surgeries

**Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant . Ophthalmology 2002

**Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

visual acuity
Visual Acuity
  • Improved 79% (19), Maintened 21% (5) p < 0.0001
  • Mean VA Preop 20/400 (HM to 20/30) Postop 20/80 (CF to 20/20)
iop mmhg
IOP (mmHg)

↓ 41%

p < 0.0001

* IOP at last visit

antiglaucoma medications
Antiglaucoma Medications

N° of antiglaucoma medications

↓ 60 %

p < 0.0001

overall outcome
Overall Outcome
  • 1. Complete success IOP < 21mmHg w/o medications
  • 2. Qualified success IOP < 21mmHg with medications
  • 3. Failure IOP > 21mmHg +/- medications
slide11

**Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant . Ophthalmology 2002

**Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

conclusions
Conclusions
  • Combined phacoemulsification and Ahmed glaucoma drainage implant placement seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP, with low incidence of complications.