Clinical use of Ahmed glaucoma valve at a tertiary hospital in Spain (2010-2022) with emphasis on the last 5 years

Abstract

Aim: To analyze the trend in Ahmed glaucoma valve (AGV) utilization in recent years and to assess its current clinical profile and surgical indications in glaucoma management.

Methods: A retrospective observational study was conducted at a tertiary hospital within the Spanish National Health System, evaluating AGV surgeries performed from 2010 to 2022. To characterize current AGV use, a subset of 156 eyes that underwent surgery in the past five years was analyzed. Clinical variables, including age, gender, glaucoma type, intraocular pressure (IOP), IOP-lowering medications, and visual field status, were collected from patients aged ≥ 18 years. Temporal trends, surgical indications, and their evolution were examined.

Results: A total of 519 AGV implantations were included. AGV utilization increased from 15.2% of all glaucoma surgeries in 2010 to 27.5% in 2019 but significantly declined thereafter, reaching 6.9% in 2022 (p = 0.001). Among the 156 eyes in the recent subset, 93 had refractory glaucoma, which showed the most pronounced decline in AGV procedures and the poorest surgical outcomes. Eyes with sulcus-placed or aphakic lenses, uveitis, or neovascular glaucoma experienced a less marked reduction in AGV implantation rates. These cases presented with higher baseline IOP but exhibited less glaucomatous damage and a better response to AGV implantation.

Conclusion: AGV implantation has significantly declined over the past five years, particularly in refractory glaucoma. This trend may be attributed to the increased adoption of subconjunctival bleb-forming surgeries and to the impact of the COVID-19 pandemic. Despite this overall decline, AGV continues to be primarily employed in cases of secondary glaucoma.