early treatment with aqueous suppressants after ahmed valve implantation

purpose: to evaluate the effect of early aqueous suppressants initiation on ahmed glaucoma valve success rate. methods: in this randomized clinical trial, a total of 94 eyes of 94 patients with refractory glaucoma were enrolled. the eyes were randomly selected into 2 groups. in group 1 (n=47), patients received early topical combination of timolol-dorzolamide twice daily after ahmed glaucoma valve implantation when the intraocular pressure (iop) reached 10 mmhg. after 3 months the glaucoma medications were adjusted (decreased or increased) based on target pressure. in control group (n=47), patients received stepwise glaucoma medications when iop reached higher than target. main outcome measures included cumulative probabilities of success rate (defined as iop between 6 and 15 mmhg, and 30% reduction in iop), iop, the number of medications, and the rate of hypertensive phase. results: cumulative probabilities of success rate was significantly higher in group 1 compared with control at months 6 (70.5% versus 32.6%, p<0.001) and 12 (63.2% versus 33.2%, p= 0.008). mean iop was statistically lower in group 1 between weeks 1 and 54 (p<0.05). number of medications in group 1 was statistically higher between weeks 1 and 12 (p<0.001) but was not different at weeks 24 and 54 (p= 0.180 and p= 0.197 respectively). the rate of hypertensive phase was significantly less in group 1 compared with control (23.4% versus 66%, p<0.001). conclusion: early initiation of aqueous suppressants after ahmed glaucoma valve implantation can improve success rate.