Adjunctive Mitomycin C or Amniotic Membrane Transplantation for Ahmed Glaucoma Valve Implantation: A Randomized Clinical Trial. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Yazdani, Shahin; Mahboobipour, Hassan; Pakravan, Mohammad; Doozandeh, Azadeh; Ghahari, Elham
• Is Part Of: Journal of glaucoma. Volume 25:Issue 5(2016:Jun./Jul.)
• Publication Date: 2016-05
• Subjects: Ahmed glaucoma valve -- mitomycin C -- amniotic membrane -- success rate; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000000256
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Purpose: To determine whether adjunctive mitomycin C (MMC) or amniotic membrane transplantation (AMT) improve the outcomes of Ahmed glaucoma valve (AGV) implantation. Methods: This double-blind, stratified, 3-armed randomized clinical trial includes 75 eyes of 75 patients aged 7 to 75 years with refractory glaucoma. Eligible subjects underwent stratified block randomization; eyes were first stratified to surgery in the superior or inferior quadrants based on feasibility; in each subgroup, eyes were randomly assigned to the study arms using random blocks: conventional AGV implantation (group A, 25 eyes), AGV with MMC (group B, 25 eyes), and AGV with AMT (group C, 25 eyes). Results: The 3 study groups were comparable regarding baseline characteristics and mean follow-up ( P =0.288). A total of 68 patients including 23 eyes in group A, 25 eyes in group B, and 20 eyes group C completed the follow-up period and were analyzed. Intraocular pressure was lower in the MMC group only 3 weeks postoperatively ( P =0.04) but comparable at other time intervals. Overall success rate was comparable in the 3 groups at 12 months ( P =0.217). The number of eyes requiring medications ( P =0.30), time to initiation of medications ( P =0.13), and number of medications ( P =0.22) were comparable. Hypertensive phase was slightly but insignificantly more common with standard surgery (82%) as compared with MMC-augmented (60%) and AMT-augmented (70%) procedures ( P =0.23). Complications were comparable over 1 year ( P =0.28). Conclusions: Although adjunctive MMC and AMT were safe during AGV implantation, they did not influence success rates or intraocular pressure outcomes. Complications, including hypertensive phase, were also comparable.