Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Postoperative Use of Prednisolone Acetate versus Difluprednate.

Abstract

PURPOSE:

To evaluate the effect of postoperative topical prednisolone acetate and difluprednate on surgical outcomes of Ahmed glaucoma valve (AGV) implantation.

DESIGN:

Retrospective, comparative case series.

PARTICIPANTS:

The study population consisted of 102 eyes of 90 patients, including 52 eyes that received 1% prednisolone acetate (Pred Forte [PF]; Allergan Inc) and 50 eyes that received 0.05% difluprednate (Durezol [DZ]; Novartis Inc).

METHODS:

The medical records of consecutive patients who underwent AGV implantation at the University of California, San Francisco, were retrospectively reviewed. Patients in the PF group received 1% prednisolone acetate 6 to 8 times per day tapered over 5 to 6 months postoperatively, and patients in the DZ group received 0.05% difluprednate 4 times daily tapered over 4 months postoperatively.

MAIN OUTCOME MEASURES:

Intraocular pressure (IOP), number of glaucoma medications, visual acuity (VA), postoperative complications, and the rate of treatment success.

RESULTS:

At 1 year, the IOPs (mean ± standard deviation) were 12.4 ± 3.7 mmHg in the DZ group and 13.0 ± 4.0 mmHg in the PF group (P = 0.49). The numbers of glaucoma medications were 0.72 ± 0.71 in the DZ group and 1.09 ± 0.91 in the PF group (P = 0.04), with reductions from baseline of 2.5  ±  1.0 glaucoma medications in the DZ group and 1.8  ±  1.6 glaucoma medications in the PF group (P = 0.01). The logarithm of the minimum angle of resolution VAs (mean  ±  standard deviation) were 0.55 ± 0.80 in the DZ group and 0.59 ± 0.65 in the PF group after 1 year of follow-up (P = 0.81). The cumulative probabilities of success were 95.8% in the DZ group and 93.5% in the PF group at 1 year (P = 0.61). Postoperative complications occurred in 4 eyes (7.7%) in the DZ group and 6 eyes (12%) in the PF group (P = 0.52).

CONCLUSIONS:

After 1 year, postoperative treatment with 0.05% difluprednate after AGV implantation resulted in a similar IOP, with the use of fewer glaucoma medications, compared with postoperative treatment with 1% prednisolone acetate. The rates of treatment success and surgical complications were comparable between the 2 groups during the first year of follow-up.

• Authors: Brandon W Kao, Christopher W Fong, Yinxi Yu, Gui-Shuang Ying, Steve J Gedde, Ying Han
• Journal: Ophthalmology. Glaucoma (Ophthalmol Glaucoma) 2022 Sep-Oct Vol. 5 Issue 5 Pg. 468-475 ISSN: 2589-4196 [Electronic] United States
• PMID: 35304317 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• prednisolone acetate
• Fluprednisolone
• Prednisolone
• difluprednate

Topics

• Fluprednisolone (analogs & derivatives)
• Follow-Up Studies
• Glaucoma (drug therapy, surgery)
• Glaucoma Drainage Implants
• Humans
• Postoperative Complications
• Prednisolone (analogs & derivatives)
• Retrospective Studies
• Treatment Outcome