Ahmed Valve Implantation Versus Sub-Scleral Trabeculectomy with Mitomycin in Neovascular Glaucoma Pretreated with Intra-Vitreal Ranibizumab and Panretinal Photocoagulation

This work aimed to compare the effectiveness of Ahmed valve implant versus sub-scleral trabeculectomy with mitomycin C in patients with neovascular glaucoma pretreated with intra-vitreal ranibizumab and panretinal photocoagulation. Methods: prospective comparative non-randomized controlled study including patients with NVG pretreated with intra-vitreal ranibizumab and PRP then evenly distributed into two groups. Patients enrolled in group 1 underwent Ahmed valve implantation; whereas those enrolled in group 2 underwent sub-scleral trabeculectomy combined with MMC. Results: the study recruited 50 patients. Mean age was 62 years. Mean pre-operative IOP was 46.5 mmHg in group 1 and 46.2 mmHg in group 2. Mean post-operative IOP in group 1 was 12.7 and 18.9 mmHg at months 1 and 24, respectively. Mean post-operative IOP in group 2 was 12.15 and 19.7 mmHg at months 1 and 24, respectively. The difference between both groups in terms of IOP values was not statistically significant at any time point throughout the study. Post-operative complications occurred in 30% and 45% of patients in groups 1 and 2 respectively and were controlled medically within one week. Conclusion pretreating NVG with intra-vitreal ranibizumab and PRP improves glaucoma surgery success rate. Ahmed valve implant and trabeculectomy with MMC appear to be equally effective in controlling IOP.