Ahmed Valve Implant Surgery with Adjunctive Mitomycin C and Selective 5-Fluorouracil Injection.

Yun, Il Suk; Lee, Jung Dong; Kim, Yong Hyun; Ahn, Jae Hong

doi:2016.57.3.468

J Korean Ophthalmol Soc > Volume 57(3); 2016 > Article

Original Article

Journal of the Korean Ophthalmological Society 2016;57(3):468-476.
DOI: https://doi.org/10.3341/jkos.2016.57.3.468 Published online March 15, 2016.

Ahmed Valve Implant Surgery with Adjunctive Mitomycin C and Selective 5-Fluorouracil Injection.

Il Suk Yun, Jung Dong Lee, Yong Hyun Kim, Jae Hong Ahn

¹Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea. chrisahn@ajou.ac.kr
²Department of Biostatistics, Ajou University School of Medicine, Suwon, Korea.

마이토마이신과 선택적인 5-Fluorouracil 주사치료를 병용한 아메드밸브 삽입술

윤일석¹⋅이정동²⋅김용현¹⋅안재홍¹

아주대학교 의과대학 안과학교실¹, 아주대학교 의과대학 의학통계실²

Abstract

PURPOSE
To evaluate the surgical results of Ahmed valve implant surgery with adjunctive mitomycin C and selective postoperative 5-fluorouracil (5-FU) subconjunctival injection with a needling procedure. METHODS: In this retrospective study, 40 eyes of 40 patients who had undergone Ahmed valve implant surgery with adjunctive mitomycin C were observed for at least 1 year. The Ahmed valve was implanted after 5-minute application of 0.04% mitomycin C. Selective 5-FU injection with a needling procedure was performed during the follow- up period based on intraocular pressure (IOP). Hypertensive phase was defined as IOP higher than 21 mm Hg within 3 months after operation. IOP higher than 18 mm Hg regardless of IOP-lowering medications at 2 consecutive visits was considered to be a surgical failure. RESULTS: The mean follow-up period was 35.5 ± 12.4 months. Preoperative intraocular pressure was 32.8 ± 7.5 mm Hg, which decreased to 14.0 ± 4.2 mm Hg post-operatively. The number of glaucoma medications decreased significantly from 3.8 ± 0.5 to 2.0 ± 1.0. Eleven of 40 eyes (27.5%) experienced hypertensive phase at 6.0 ± 3.1 weeks after surgery. Kaplan-Meier survival analysis showed cumulative probability of surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years respectively. There were no risk factors that affecting surgical failure except age (hazard ratio = 0.17, p = 0.02). CONCLUSIONS: Ahmed valve implant surgery with adjunctive mitomycin C and selective 5-FU injection with a needling procedure showed good success in refractory glaucoma.

Key Words: Ahmed valve implant;5-Fluorouracil;Mitomycin C;Needling;Refractory glaucoma