1. Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery Leonidas Traipe, M.D. Felipe Valenzuela, M.D. Carlos Nieme, M.D Juan Stoppel, M.D. Allister Gibbons, M.D. Mario Zanolli, M.D. Fundación Oftalmológica Los Andes (FOLA), Santiago, Chile The authors have no financial interest in the subject matter of this poster

2. Introduction Glaucoma drainage implants are specially indicated when the risks of failure with conventional trabeculectomy are high NVG, uveitic glaucoma, etc. When cataract and glaucoma coexist together in a patient with refractory glaucoma, critical management issues arise Selection of the optimum glaucoma surgical procedure, sequence of surgery, etc This procedure offers theoretical advantages like: Avoid the high risk of failure associated with conventional filtering surgery Improved IOP control in the long term and good visual rehabilitation Less risk of blebitis – endophtalmitis Single surgical procedure

3. Purpose To examine the indications, safety, efficacy and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery.

4. Methods Noncomparative, interventional, retrospective, consecutive case series of 24 eyes (21 patients). 1 surgeon (LT) Demographic characteristics Indications Visual Acuity Complications IOP and antiglaucoma medications :  Complete success IOP < 21mmHg w/o medications  Qualified success IOP < 21mmHg with medications  Failure IOP > 21mmHg +/- medications Approved by FOLA Ethics Comittee Statistical Analysis was performed using SPSS 16.0

5. Results: Demographic characteristics N° of Eyes24 N° of Patients21 Age61 ± 19 y (13-91 y) Female / Male1.6 / 1 Follow-up15.9 ± 13 mo

6. INDICATIONS n% Reports** Previous failed trabeculectomy* 1354 47 – 48 % Neovascular Glaucoma28 3 – 22 % Uveitic Glaucoma521 16 % Post-Trauma14 3 % Iridocorneal Endothelial Sd 0- 9 % Chronic Angle-Closure Glaucoma 0- 3 – 6 % Blebitis / Leaking filtering bleb 0- 3 – 12 % Post Keratoplasty 0- 3 % Post Scleral Buckle 0- 6 % * 7 eyes -> 1 previous surgery / 5 eyes -> 2 previous surgeries / 1 eye -> 3 previous surgeries **Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant. Ophthalmology 2002 **Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

7. Visual Acuity FOLA Pre Postop 20/40 – 20/20 21% 54% 20/50 – 20/10025% 23% < 20/10054% 23% Visual Acuity  Mean VA Preop 20/400 (HM to 20/30)  Postop 20/80 (CF to 20/20)  Improved 79% (19), Maintened 21% (5) p < 0.0001

8. IOP (mmHg) Mean ± SD Range Preop 27,6 ± 11 8 a 45 Postop* 16,3 ± 4 7 a 20 ↓ 41% * IOP at last visit p < 0.0001

9. Antiglaucoma Medications Mean Range Preop 3,2 ± 0,83 1 to 4 Postop 1,3 ± 1,1 0 to 3 ↓ 60 % N° of antiglaucoma medications p < 0.0001

10. Overall Outcome n % Success 8 33.3 Qualified Success 16 66.6 Failure 0 - 1. Complete success IOP < 21mmHg w/o medications 2. Qualified success IOP < 21mmHg with medications 3. Failure IOP > 21mmHg +/- medications

11. COMPLICATIONSn% Reports** Early Hipotony28 19% Shallow AC28 6% Choroideal effusion416 6% Tube Oclussion 0- 3% Hiphema 14 3% Late Tube Retraction 14 3% Hypertensive phase1146 22% Tube Exposure 0- 3% Iritis 0- 3% Corneal decompensation 0- 6-9% **Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant. Ophthalmology 2002 **Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

12. Conclusions Combined phacoemulsification and Ahmed glaucoma drainage implant placement seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP, with low incidence of complications.