5-year outcomes of ahmed glaucoma valve implantation after failed trabeculotomy in primary congenital glaucoma.

PURPOSE: To evaluate the long-term efficacy, surgical survival, and complication profile of Ahmed Glaucoma Valve (AGV) implantation following failed trabeculotomy in eyes with primary congenital glaucoma (PCG). STUDY DESIGN: Retrospective observational cohort study. METHODS: Twenty-seven eyes of 27 children diagnosed with PCG who underwent AGV implantation after failed trabeculotomy at a tertiary referral center were included. Baseline demographics, intraocular pressure (IOP) measurements, postoperative interventions, and complications were recorded. Surgical success was defined as IOP between 6 and 21 mmHg with (qualified) or without (complete) medications and no major complications or additional glaucoma surgery. Failure was defined as uncontrolled IOP, repeated cyclophotocoagulation (CPC), visually significant complications, or loss of light perception. RESULTS: The mean age at trabeculotomy and AGV implantation was 4.8 ± 2.1 and 25.9 ± 7.4 months, respectively. Mean preoperative IOP was 37.0 ± 3.0 mmHg and decreased to 20.5 ± 2.0 mmHg at final follow-up (mean duration 66.5 ± 12.3 months). Only 1 eye (3.7%) achieved complete success and 5 eyes (18.5%) achieved qualified success, whereas 22 eyes (81.5%) met criteria for surgical failure. Kaplan-Meier analysis demonstrated a marked reduction in both complete and qualified survival probabilities after postoperative year 2, stabilizing at 3.7% and 18.5%, respectively, by year 5. All failed eyes required repeated CPC (mean 2.3 ± 0.6 sessions/year), and 6 eyes (22.2%) underwent needling procedures (mean 1.4 ± 0.3/year). CONCLUSIONS: AGV implantation following failed trabeculotomy provides meaningful initial IOP reduction in refractory PCG; however, long-term durability is limited, with success rates declining sharply beyond the second postoperative year.