Frontiers in Ophthalmology (Dec 2023)

Meta-analysis of Molteno glaucoma implants and Ahmed glaucoma valves: insights into efficacy and safety for complex glaucoma

  • Adarsh Raja,
  • Sunaina Bhimani,
  • Hafsah Alim Ur Rahman,
  • Madiha Salman,
  • Afrah Saeed Shaikh,
  • Sandesh Raja,
  • Bushra Zafar Sayeed,
  • Ahsan Feroze,
  • Muhammad Ahmed

DOI
https://doi.org/10.3389/fopht.2023.1307439
Journal volume & issue
Vol. 3

Abstract

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BackgroundGlaucoma is a leading cause of irreversible blindness globally and for decades, Molteno and Ahmed glaucoma implants, operating on different mechanisms, have been used to treat complicated glaucoma with varying success.ObjectiveTo assess the safety and efficacy of the Molteno glaucoma implant (MGI) versus the Ahmed glaucoma valve (AGV) in patients with complicated glaucoma.MethodsWe comprehensively searched PubMed, Google Scholar, Cochrane Library and Science Direct) from inception till July 2023 and studies comparing patients with MGI and those with AGV in patients with complicated glaucoma. The primary outcome was intra-ocular pressure reduction at different time intervals. Secondary outcomes included surgical success rate, hypertensive phase, anti-glaucoma medication (AGM) and total complications. ResultsIn this meta-analysis, four studies were included with a patient population of 257 with refractory, neovascular or advanced uncontrolled glaucoma. Postoperative intra-ocular pressure reduction did not show significant difference between the two groups (MD: -1.34, 95% CI [-2.78, 0.09]). From the secondary outcomes, surgical success rate (RR: 0.88, 95% CI [0.51,1.53]), hypertensive phase (RR: 0.74, 95% CI [0.39,1.40]) were insignificant. Postoperative anti-glaucoma medication (MD: -0.07, 95% CI [-0.79, -0.65] and total complications (RR:1.36, 95% CI [1.07, 1.72]) were significant. ConclusionNo significant difference was observed between the patients with MGI and AGV for the primary outcome. From the secondary outcome, AGV was associated with reduced anti-glaucoma medication use and significantly lowered the number of complications.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=475539, identifier CRD42023475539.

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