Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma THEKLA G. PAPADAKI, IOANNIS P. ZACHAROPOULOS, LOUIS R. PASQUALE, WILLIAM B. CHRISTEN, PETER A. NETLAND, AND C. STEPHEN FOSTER ● PURPOSE: To present long-term outcomes of Ahmed glaucoma valve implantation for uveitic glaucoma. ● DESIGN: Interventional case series. ● METHODS: Retrospective chart review of 60 patients (60 eyes) with uveitic glaucoma who underwent Ahmed valve implantation over a four-year period at a tertiary uveitis referral center. Success definition 1 included patients with an intraocular pressure (IOP) between 5 and 21 mm Hg, reduced by 25% from that before implantation. Success definition 2 (qualified success) excluded those patients in whom serious complications occurred. ● RESULTS: Mean follow-up time was 30 months (range, six to 87 months; four-year results relate to a cohort of 15 patients). Success rates were 77% and 50% and qualified success rates were 57% and 39% at one and four years, respectively. At four years, 74% of the patients required glaucoma medication to maintain IOP control. The overall complication rate was 12%/person- years. The rate of visual acuity loss was 4%/person- years; that was most commonly attributed to corneal complications that were more likely to occur in patients with preoperative corneal disease (P  .01, Fisher exact test). ● CONCLUSIONS: Ahmed glaucoma valve implantation is a safe yet moderately successful procedure for uveitic glaucoma. Long-term success rates are enhanced with the use of glaucoma medications, and corneal complications are the most common of all potential serious complica- tions. (Am J Ophthalmol 2007;144:62– 69. © 2007 by Elsevier Inc. All rights reserved.) G LAUCOMATOUS OPTIC NERVE DAMAGE AND VI- sual field defects occur in 20% to 40% of all patients with uveitis. 1,2 Management of uveitic glaucoma commonly is very challenging because of the young age of many of the patients and the numerous mechanisms involved in its pathogenesis, including steroid-induced intraocular pressure (IOP) elevation. 3 Medical therapy may not be as well tolerated in uveitic glaucoma as in other types of glaucoma. Prostaglandin analogs, for example, have been reported to induce recur- rent uveitis, to provoke macular edema, to activate her- petic eye disease, or to induce a paradoxical increase in IOP in eyes with uveitic glaucoma. 3,4 Cholinergic drugs disrupt the blood-aqueous barrier and may promote the development of posterior synechiae. 5 Not surprisingly, many patients with uveitic glaucoma eventually need glaucoma surgery. Trabeculectomy is subject to a high rate of eventual failure in patients with uveitic glaucoma. 3,5 Filtration surgery for uveitic glaucoma achieves IOP control in up to 90% of patients in the first two years after surgery, 4–6 but this number may drop to 30% after five years. 7 The adjunctive use of mitomycin C (MMC) has been shown to increase the success rate of filtering procedures to 62.5% at five years after surgery. 8 Glaucoma drainage devices have been proposed as a surgical strategy in patients with uncontrolled secondary glaucoma in which the risk of filter failure is high. We reported a 94% success rate at one year after Ahmed glaucoma valve implantation in patients with glaucoma secondary to uveitis. 9 Studies in which the Ahmed glau- coma valve implant was used for management of other forms of glaucoma have shown that the success rate of the procedure may decline considerably after the first year. 10 –14 Herein, we present the results of long-term follow-up (up to four years) of patients with uveitic glaucoma who were managed with Ahmed glaucoma valve implantation. METHODS THIS WAS A RETROSPECTIVE, INTERVENTIONAL CASE SE- ries conducted by a university-based tertiary care uveitis practice. We reviewed the records of all patients with uveitic glaucoma at the Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary who underwent Ahmed glaucoma valve implantation from September 1994, when the first Ahmed glaucoma valve was implanted in a patient with uveitis at our institution, through September 2002. Accepted for publication Mar 7, 2007. From the Massachusetts Eye Research and Surgery Institute, Ocular Immunology and Uveitis Foundation, and the Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, Massachusetts (T.G.P., I.P.Z., C.S.F.); the Glaucoma Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, Massachusetts (T.G.P., L.R.P.); the Department of Medicine, Division of Preventive Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts (W.B.C.); and the Glaucoma Service, University of Memphis, Memphis, Tennessee (P.A.N.). Inquiries to Thekla G. Papadaki, Department of Ophthalmology, University of Crete, Greece, 40 Anopoleos Street, 71 201 Heraklion Crete, Greece; e-mail: theklapap@med.uoc.gr © 2007 BY ELSEVIER INC.ALL RIGHTS RESERVED. 62 0002-9394/07/$32.00 doi:10.1016/j.ajo.2007.03.013