• Bruno Barbosa Ribeiro, Rita Vieira, André Ferreira, Ana Marta, Ana Figueiredo, Rita Reis, Isabel Sampaio, Melo BeirãoJoãoJ0000-0001-8642-7010Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal.Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal., and Maria João Menéres.
• Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
• Amyloid. 2024 Sep 10: 171-7.

BackgroundTo compare the efficacy of modified Ex-PRESS technique (ExP) versus Ahmed Glaucoma Valve (AGV) as primary surgery in hereditary transthyretin amyloidosis (ATTRv) secondary glaucoma.MethodsRetrospective study at the national amyloidosis centre. Success was defined as an IOP ≥ 6 mmHg and ≤ 21 mmHg with no need for further glaucoma surgery or laser trabeculoplasty and without loss of light perception at the time of the last follow-up. Secondary outcomes included surgical complications, need for hypotensive drugs, and endothelial cell loss. Patients submitted to previous glaucoma surgery were excluded.ResultsWe included 180 eyes of 150 patients, 121 in AGV and 59 in ExP group. No significant baseline differences were found between groups. At the time of last follow-up, both groups exhibited significant intraocular pressure (IOP) reduction (p < .001) and number of glaucoma medications (p < .001). Kaplan-Meyer analysis showed higher cumulative probability of success for AGV group (80.1% vs. 41.1%, p < .001) and higher mean time to failure (54.5 vs. 36.9 months, respectively, p < 0.001) at 60 months follow-up. AGV showed lower hazard (HR 0.21, 95% CI [0.111-0.407], p < .001) for failure.ConclusionAGV and ExP are safe and effective techniques in the treatment of ATTRv secondary glaucoma. However, AGV's efficacy seems to be more durable.

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