Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma

Purpose: To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase.Design: Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up.Methods: Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit.Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM).Results: A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included.Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively.Baseline IOP was significantly higher in the HTN phase group (p = 0.001).Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180).At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups.PO complications were comparable and uncommon in both groups.Conclusion: Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6.However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term.