Pars Plana Ahmed Valve Implant and Vitrectomy in the Management of Neovascular Glaucoma

Purpose: To evaluate the efficacy and safety of pars plana Ahmed valve implant combined with pars plana vitrectomy and endolaser photocoagulation for the treatment of neovascular glaucoma in patients with vitreous hemorrhage. Methods: Retrospectively, we evaluated the records of 18 eyes of 17 consecutive neovascular glaucoma patients who had undergone pars plana vitrectomy and pars plana Ahmed valve implant. The patients were followed for a mean time of 14.2 months (range 6 to 28 months). Results: Mean preoperative intraocular pressure with oral and two or three topical antiglaucoma medications was 53.3±10 mm Hg, and mean postoperative intraocular pressure without oral antiglaucoma medication was 16.3±7.1 mm Hg (P 0.0001) at the final visit. Overall success rate was 72.2%, defined as an intraocular pressure of higher than 5 mm Hg and less than 21 mm Hg with or without antiglaucoma medication. A postoperative hypertensive phase occurred in 7 patients (38.8%) of which all but one responded to medical therapy. Visual acuity was stabilized or improved in 77.7% of the eyes. There was one case of each of the following adverse events: mild vitreous cavity hemorrhage, hypotony, choroidal effusion, epiretinal membrane, corneal edema, and corneal ulcer. Two cases developed phthisis bulbi and lost light perception. Conclusion: Pars plana vitrectomy and Ahmed valve implantation seems to be a viable surgical modality in the management of neovascular glaucoma and coexistent posterior segment pathology with a relative low rate of serious permanent postoperative complications.