To evaluate the effect of intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation.

Participants belonged to one of the following four groups; 1) neovascular glaucoma, 2) uveitic glaucoma, 3) previously failed trabeculectomy and 4) AGV implantation in the setting of other diseases. Patients in each group were randomly assigned to conventional AGV (non-TA group) or AGV with adjunctive triamcinolone (TA group).In the TA group, TA 10 mg was injected in the subtenon space around the AGV plate intraoperatively. All patients were followed for one year.

90 patients completed the follow-up period and were included in the intention-to-treat analysis. Mean IOP was lower in the TA group at the most of the follow-up visits however, the difference was statistically significant only at the first month (P= 0. 004). The mean peak IOP postoperatively was higher in the non-TA group (26±14 mmHg) compared with the TA group (19.4±3.9 mmHg). Linear mixed model showed that on average mean IOP was 1.5 mmHg higher in the non-TA group compared to the TA group through the study period. Rates of success (defined as 6 < IOP < 21 mmHg) were similar in both groups at 12 months. Loss of BCVA > 2 line was more common in the non-TA group. A case of endophthalmitis happened in the TA group.

Adjunctive intraoperative TA injection during AGV implantation can blunt peak IOP levels after the procedure and reduce mean IOP up to one year. Visual outcomes also seem to be superior to standard surgery. However, success rates and the frequency of hypertensive phase were comparable with both methods of surgery.