Value of fibrin glue use with Ahmed valve implantation in refractory glaucoma

• Main Author: Salah M Al-Mosallamy
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Delta Journal of Ophthalmology
• Subjects: ahmed valve; fibrin glue; refractory glaucoma
• Online Access: http://www.djo.eg.net/article.asp?issn=1110-9173;year=2015;volume=16;issue=1;spage=16;epage=21;aulast=Al-Mosallamy

Purpose This study aimed to evaluate the efficacy and safety of the fibrin glue use with Ahmed glaucoma valve (AGV) implantation in refractory glaucoma. Patients and methods Twenty-two eyes of 22 patients diagnosed with refractory glaucoma were scheduled to receive an AGV and were grouped into two groups: group I included 12 eyes in which fibrin glue was used to secure the scleral flap and conjunctiva over the valve tube. Group II included 10 eyes in which sutures were used as the standard technique for valve implantation. Results The mean age of the patients was 29.5 ± 13.4 and 27.1 ± 10.3 years in groups I and II, respectively, and there was no statistically significant difference between the two groups (P > 0.5). Congenital glaucoma was the most common preoperative diagnosis in each group. The surgical outcome of both groups showed a statistically significant reduction in the mean operation time in group I (37 ± 6 min) than in group II (43 ± 5 min) (P < 0.05). In addition, upper limbal inflammation was less in group I than in group II (17 and 40%, respectively), which was statistically significant (P < 0.05). Complete success was achieved in nine cases (75%) and qualified success was achieved in two cases (17%) in group I; in group II, complete success was achieved in eight cases (80%) and qualified success was achieved in one case (10%). There was no statistically significant difference between both groups in complete success and failure (P > 0.05). There was no statistically significant difference in the mean final intraocular pressure between the two groups (18.1 ± 2.2 and 17.4 ± 3.5 mmHg) in groups I and II, respectively (P > 0.05). The operative complications were hyphema, which occurred in one case in group I (8%) and in two cases in group II (20%). Suprachoroidal hemorrhage occurred in one case in group II. Shallow anterior chamber occurred in two cases (17%) in group I and in two cases (20%) in group II. One case in group I developed choroidal detachment. Tube exposure occurred in three cases, two cases in group I (17%), and one case (10%) in group II. Encysted valve occurred in three cases, two of which belonged to group I (17%) and one case belonged to group II (10%). Conclusion The use of fibrin glue with AGV implantation in refractory glaucoma makes its implantation easier, with a shorter operation time and less postoperative pain and inflammation, but its added cost usually limits its use. However, larger multicenter studies with longer-term follow-up are needed before the widespread use of this surgical technique.