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Inferior quadrant implantation of glaucoma valve may produce more complications
Ophthalmology. 2009;116(2):208-213.
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The implantation site of an Ahmed glaucoma valve may be an important consideration in long-term outcomes.
The IOP lowering benefit of an Ahmed glaucoma valve (New World Medical) was similar among 58 patients who were implanted in the superior quadrant and 48 patients who were implanted in the inferior quadrant. At 1 year after surgery, IOP was lowered 47% in the superior group and 43% in the inferior group compared with baseline.
However, complications, including implant exposure necessitating removal, cosmetically unappealing appearance and endophthalmitis, were more frequent in the inferior group; 12 eyes in the inferior group had complications compared with three eyes in the superior group (P = .004).
In the study, the location for implantation was left to the operating surgeon's discretion. According to the manufacturer of the device, the preferred surgical site is the superotemporal region. Inferior implantation is less common but necessary in cases of conjunctival scarring, presence of previously implanted shunts, or presence of or anticipated need for intraocular silicone oil, the study noted.
"It may be prudent to avoid [Ahmed glaucoma valve] implantation in the inferior quadrant if the superior quadrants have no contraindications for surgery," according to the study.