Intraoperative Triamcinolone Acetonide Injection During Ahmed Glaucoma Valve Surgery Suppresses the Occurrence of the Postoperative Hypertensive Phase.

PRCIS: Intraoperative sub-plate injection of triamcinolone acetonide during Ahmed glaucoma valve implantation markedly reduced the incidence of the postoperative hypertensive phase without increasing complications. PURPOSE: The objective of this study was to evaluate whether intraoperative sub-plate injection of triamcinolone acetonide (TA) during Ahmed glaucoma valve (AGV) implantation reduces postoperative hypertensive phase (HP) incidence. PATIENTS AND METHODS: We included 182 eyes from 182 patients who underwent AGV implantation between June 2017 and December 2023 at five institutions in Japan and were followed for a minimum of 3 months. The eyes were divided into two groups: 103 eyes received intraoperative sub-plate TA injection (TA group), and 79 eyes did not (non-TA group). The HP was defined as an initial intraocular pressure reduction to ≤22 mm Hg within 1 week postoperatively, followed by an increase to >21 mm Hg on two or more occasions within 3 months. Fisher's exact test,nonparametric tests, and multivariate logistic regression were used for statistical analyses. RESULTS: HP occurred in 8 (7.8%) and 28 (35.4%) eyes in TA and non-TA groups, respectively (P<0.0001). Among the eyes with anterior chamber tube placement, no cases of HP were observed in the TA group, whereas 8 cases occurred in the non-TA group (P<0.0001). In pars plana cases, HP developed in 8 and 20 eyes in the TA and non-TA groups, respectively (P=0.016). Multivariate logistic regression analysis identified the absence of intraoperative TA injection as an independent risk factor for the HP (odds ratio: 0.16, P<0.0001). CONCLUSIONS: Intraoperative sub-plate TA injection may be associated with a reduced incidence of postoperative HP after AGV implantation.