Influence of Vitrectomy on Ahmed Glaucoma Valve Success for Glaucoma Secondary to Hereditary Transthyretin Amyloidosis
DOI:
https://doi.org/10.48560/rspo.32914Keywords:
Amyloid Neuropathies, Familial, Glaucoma/surgery, Glaucoma Drainage Implants, Intraocular Pressure, VitrectomyAbstract
INTRODUCTION: Our purpose was to assess the role of previous pars plana vitrectomy (PPV) on the surgical outcomes of patients with hereditary transthyretin amyloidosis (hATTR) who had undergone Ahmed glaucoma valve (AGV) implantation.METHODS: A retrospective cohort study was performed enrolling consecutive patients with a diagnosis of hATTR secondary glaucoma who underwent primary AGV implantation in our department over the last decade. Previous PPV was used to split the patients in two groups (PPV versus non-PPV). The primary outcome was success, defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤21 mmHg with or without medication, with no need for further glaucoma surgery during 60 months of follow-up. Secondary outcomes included postoperative IOP and medication score, early and late surgical complications, as well as the frequency of hypertensive phase and hypotony.
RESULTS: The study included 100 eyes of 79 patients, of which 45 eyes had had PPV. No significant differences were found between groups for age at the time of surgery, hATTR diagnosis or symptoms onset, gender, liver transplant or use of Tafamidis®. Vitrectomized eyes presented worse vision (0.46±0.51 vs 0.22±0.22 logMAR, p=0.002) and had a higher proportion of pseudophakia (40% vs 7%, p<0.001). Preoperative IOP and medication score were not significantly different between groups. The success rate of AGV surgery was 81% at 60 months, with non-PPV presenting a higher success rate at each timepoint. The PPV group presented a higher hazard (HR 2.73 (95%CI 1.07-6.97), p=0.035) for glaucoma surgery failure than the non-PPV group. No differences were found in postoperative IOP and medication at all timepoints nor for postoperative complications or frequency of hypertensive phase or hypotony.
CONCLUSION: The management of glaucoma secondary to hATTR is very complex. In our cohort, patients previously submitted to PPV had lower success after AGV surgery.
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