Original article
The Effect of an Ahmed Glaucoma Valve Implant on Corneal Endothelial Cell Density in Children With Glaucoma Secondary to Uveitis

https://doi.org/10.1016/j.ajo.2012.09.001Get rights and content

Purpose

To assess the effect of Ahmed glaucoma valve implants on corneal endothelial cell density (ECD) in children with uveitic glaucoma.

Design

Cross-sectional study.

Methods

setting: Institutional. patient population: Eighty eyes from 42 patients diagnosed with uveitis before the age of 16. Twenty-eight eyes had an Ahmed glaucoma valve implant because of secondary glaucoma. Fifty-two eyes without an implant served as controls. intervention or observation procedure(s): Corneal ECD was examined cross-sectionally using a noncontact specular microscope. Univariate and multivariate generalized estimating equations analyses with correction for paired eyes were performed. main outcome measure(s): Correlation of ECD with the presence of an Ahmed glaucoma valve implant and with the time following implantation.

Results

ECD was significantly lower in the Ahmed glaucoma valve group than in controls (2359 and 3088 cells/mm2, respectively; P < .001) following an average of 3.5 years after Ahmed glaucoma valve implantation. Presence of an Ahmed glaucoma valve implant, previous intraocular surgery, age, duration of uveitis, and history of corneal touch by the implant tube were all significantly associated with decreased ECD. Following a multivariate analysis, presence of an Ahmed glaucoma valve implant (B = −340; adjusted P < .011) and older age (B = −58; adjusted P = .005) remained independently associated with decreased ECD. Within the implant group, the age-adjusted time interval following Ahmed glaucoma valve implantation was highly correlated with decreased ECD (B = −558, P < .001).

Conclusions

Ahmed glaucoma valve implants in children with uveitic glaucoma are independently associated with decreased ECD, and this effect is associated with the time interval following Ahmed glaucoma valve implantation.

Section snippets

Methods

In this cross-sectional observational case study, we included all patients who were diagnosed with uveitis before the age of 16 years and who presented with glaucoma secondary to uveitis and received an Ahmed glaucoma valve implant at the Department of Ophthalmology at the University Medical Center, Utrecht, The Netherlands, from March 10, 2005 through December 5, 2011. Children with uveitis who were diagnosed before the age of 16 and who did not receive an Ahmed glaucoma valve implant served

Results

Eighty eyes from 42 patients were included in this study. The characteristics of the study subjects are summarized in Table 1. The Ahmed glaucoma valve group contained 28 eyes from 21 patients with an S2 implant (n = 26 eyes) or an FP8 implant (n = 2 eyes). Seven and 14 patients had bilateral and unilateral Ahmed glaucoma valve implants, respectively. The control group consisted of 52 eyes without an Ahmed glaucoma valve and included eyes with bilateral uveitis (n = 36), eyes with unilateral

Discussion

The results of this study show that previous Ahmed glaucoma valve implantation is associated with a lower corneal endothelial cell count in children with secondary glaucoma attributable to uveitis. A functioning endothelium is essential for corneal integrity, and transparency and endothelial cell loss during childhood can lead to corneal edema and, ultimately, to visual loss.15, 29 A higher rate of endothelial cell loss at a relatively young age can have negative long-term consequences for

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