The Ahmed Versus Baerveldt Study: Five-Year Treatment Outcomes

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• 作者：Panos G. Christakis ; MD¹ ; Jeffrey W. Kalenak ; MD² ; James C. Tsai ; MD³ ; David Zurakowski ; PhD⁴ ; Jeffrey A. Kammer ; MD⁵ ; Paul J. Harasymowycz ; MD⁶ ; Juan J. Mura ; MD⁷ ; Louis B. Cantor ; MD⁸ ; Iqbal I.K. Ahmed ; MD¹ ; ^{ike.ahmed@utoronto.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ABC ; Ahmed Baerveldt Comparison ; AVB ; Ahmed Versus Baerveldt ; IOP ; intraocular pressure ; logMAR ; logarithm of the minimum angle of resolution ; TVT ; Tube Versus Trabeculectomy
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：123
• 期：10
• 页码：2093-2102
• 全文大小：867 K

文摘

To compare 2 frequently used aqueous shunts for the treatment of glaucoma.

id="absSec_2">Design

id="abspara0015">International, multicenter, randomized trial.

id="absSec_3">Participants

id="abspara0020">Patients aged 18 years or older with uncontrolled glaucoma despite maximum tolerated medical therapy, many of whom had failed or were at high risk of failing trabeculectomy.

id="absSec_4">Methods

id="abspara0025">Eligible patients were randomized to receive an Ahmed-FP7 valve implant (New World Medical, Inc, Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc, Santa Ana, CA) using a standardized surgical technique.

id="absSec_5">Main Outcome Measures

id="abspara0030">The primary outcome was failure, defined as intraocular pressure (IOP) outside the target range (5–18 mmHg) or reduced <20% from baseline for 2 consecutive visits after 3 months, severe vision loss, or de novo glaucoma surgery. Secondary outcomes measures included IOP, medication use, visual acuity, complications, and interventions.

id="absSec_6">Results

id="abspara0035">A total of 238 patients were randomized; 124 received the Ahmed-FP7 implant, and 114 received the Baerveldt-350 implant. Baseline characteristics were similar between groups. Mean preoperative IOP was 31.4±10.8 mmHg on 3.1±1.0 glaucoma medications. At 5 years, the cumulative failure rate was 53% in the Ahmed group and 40% in the Baerveldt group (P = 0.04). The main reason for failure in both groups was high IOP, and the cumulative de novo glaucoma reoperation rate was 18% in the Ahmed group and 11% in the Baerveldt group (P = 0.22). Hypotony resulted in failure in 5 patients (4%) in the Baerveldt group compared with none in the Ahmed group (P = 0.02). Mean IOP was 16.6±5.9 mmHg in the Ahmed group (47% reduction) and 13.6±5.0 mmHg in the Baerveldt group (57% reduction, P = 0.001). Mean medication use was 1.8±1.5 mmHg in the Ahmed group (44% reduction) and 1.2±1.3 mmHg in the Baerveldt group (61% reduction, P = 0.03). The 2 groups had similar complication rates (Ahmed 63%, Baerveldt 69%) and intervention rates (Ahmed 41%, Baerveldt 41%). Most complications were transient, and most interventions were slit-lamp procedures.

id="absSec_7">Conclusions

id="abspara0040">Both implants were effective in reducing IOP and the need for glaucoma medications. The Baerveldt group had a lower failure rate and a lower IOP on fewer medications than the Ahmed group, but had a small risk of hypotony that was not seen in the Ahmed group.