Outcome of trabeculectomy versus Ahmed glaucoma valve implantation in the surgical management of glaucoma in patients with Sturge-Weber syndrome

Aims To compare the surgical outcomes of trabeculectomy versus Ahmed glaucoma valve (AGV) implantation in the surgical management of glaucoma in patients with Sturge-Weber syndrome (SWS). Methods A retrospective chart review was performed on 40 eyes of secondary glaucoma in patients with SWS separated into two groups: AGV (N=20) and trabeculectomy with mitomycin C (N=20). Demographic data, intraocular pressure (IOP), visual acuity and the number anti-glaucoma medications (AGM) needed were evaluated prior to and following surgery. Surgical success was defined as an IOP of <= 21 mm Hg, with or without the use of topical AGM. Complete success was achieved when IOP values were obtained without AGM. Results Mean follow-up duration was 23.15 +/- 2.36 months and 22.95 +/- 2.87 months in the AGV and trabeculectomy groups, respectively (p=0.811). Both the AGV (34.50 +/- 4.65 mm Hg at baseline to 15.20 +/- 3.31 mm Hg at last visit) and trabeculectomy (32.10 +/- 5.86 mm Hg to 16.10 +/- 3.02 mm Hg) groups achieved a statistically significant fall in IOP following surgery (p=0.000). Kaplan-Meier survival of complete success after 24 months was 80% and 70% after AGV implant and trabeculectomy, respectively, but the difference between two groups was not statistically significant (p=0.442). Conclusions Both AGV implant and trabeculectomy appear to be safe and efficacious in controlling glaucoma secondary to SWS, although the potential for serious complications such as choroidal detachment must be anticipated when planning surgeries in patient with SWS, and the authors recommend the maintenance of a stable IOP during and following the surgery to avoid such complications.