Ahmed Glaucoma Valve Implantation Versus Trabeculotomy as Initial Intervention for Primary Congenital Glaucoma—Long-Term Follow-Up

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PRÉCIS: Ahmed glaucoma valve (AGV) emerges as a more effective primary procedure compared with trabeculotomy for pediatric glaucoma patients, especially within the first 2 years. PURPOSE: To compare the outcomes between initial AGV implantation and trabeculotomy in children with primary congenital glaucoma (PCG). PATIENTS AND METHODS: This retrospective cohort study was conducted on patients with PCG who underwent either trabeculotomy or AGV implantation between 1998 and 2022 at Soroka University Medical Center. Outcome measures included intraocular pressure (IOP) change, cup-to-disc ratio, corneal clarity, additional surgeries, ocular hypotensive medication use, and the occurrence of adverse events over 36 months of follow-up. Primary success was defined as a postoperative IOP of 5-21 mmHg without additional surgeries or serious sight-threatening complications. RESULTS: A total of 83 eyes from 55 patients were included: 34 in the AGV group and 49 in the trabeculotomy group. The primary success rate was significantly higher at all time points of the follow-up period in the AGV group compared with the trabeculotomy group ( P =0.014). Trabeculotomy was associated with a significantly higher risk of surgical failure compared with AGV implantation (HR: 3.23; 95% CI: 1.35-7.71; P =0.008). Notably, only 2 eyes in the AGV group underwent additional surgeries, compared with 25 in the trabeculotomy group ( P <0.001). CONCLUSIONS: AGV as an initial procedure seems to be safe and more effective than trabeculotomy for the treatment of PCG in this select population, with fewer additional surgeries.

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