Comparison of choroidal detachment with and without hypotony after Ahmed valve implantation

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Methods This retrospective, consecutive case series included glaucoma patients who underwent AVI. We divided the patients into CD and non-CD. The patients with CD were divided into those with and without hypotony. Data collected from the chart review before and after AVI included patient demographics and ocular characteristics. We analyzed the risk factors for CD development. Moreover, the relationship between hypotony and CD development was analyzed. Results Among the 387 eyes, 63 developed CD. Among the 63 eyes, 42 had CD with hypotony and 21 had CD without hypotony. Multivariate regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of diabetes mellitus (DM) (P = 0.011), and history of hypertension (HTN) (P = 0.002) were significant predictors of CD development. Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than that of primary open angle glaucoma (POAG) and exfoliative glaucoma (XFG). The rate of anterior chamber formation as treatment of CD was significantly higher in CD with hypotony than in CD without hypotony. Conclusions Older age, pseudophakic eyes, DM, and HTN are significantly associated with CD development after AVI. NVG has higher incidence rate of CD without hypotony compared with POAG and XFG. Therefore, clinicians should pay attention to CD development after AVI especially in NVG, even if a patient is not in a hypotonic state. choroidal detachment hypotony Ahmed valve SUMMARY What was know before Some studies have reported the risk factors for choroidal detachment (CD) development after glaucoma drainage device (GDD) implantation. However, no studies have investigated CD associated with or without hypotony after GDD implantation, such as Ahmed valve implantation (AVI). What this study adds Older age, pseudophakic eyes, hypertension, and DM are significantly associated with CD development after AVI. Neovascular glaucoma (NVG) has a higher incidence rate of CD without hypotony compared with primary open angle glaucoma and exfoliative glaucoma. Unlike previous studies, we found that DM was a new risk factor for CD development. Clinicians should consider CD development after AVI especially in NVG, even if a patient is not in a hypotonic state. 1. Introduction Glaucoma drainage device (GDD) implantation is a commonly performed surgical method in patients with uncontrolled intraocular pressure (IOP) despite the maximum tolerated medical or laser therapy. 1, 2 Among the GDDs, the Ahmed valve is one of the most commonly used valve-type implants and has been developed to reduce hypotony and related complications, which commonly occur in non-valve-type implants. 3, 4 However, despite this effort, hypotony and related complications are still observed in Ahmed valve implantation (AVI). 5 Choroidal detachment (CD) is a relatively common early postoperative complication of AVI. 6 Reported rates of CD after GDD implantation range from 11.7–35.1%. CD is often asymptomatic, and small CD is considered clinically insignificant. However, CD can lead to serious sequelae, such as suprachoroidal hemorrhage, retinal folds, and hypotony maculopathy, with a risk of vision loss. 5–9 The pathophysiology of CD, which is typically an acute drop in IOP combined with an inflammatory process, causes a sudden shift in hydrostatic pressure. Consequently, serum transudates across the choriocapillaries and accumulates in the suprachoroidal space. 7, 10 However, CD has also been reported in some cases after GDD implantation despite normal IOP. 7, 8 Therefore, it is important to identify the risk factors for CD development that are not related to hypotony. Some studies have reported the risk factors for CD development after GDD implantation, such as demographics and ocular characteristics. However, no studies have investigated CD associated with or without hypotony after GDD implantation, such as AVI. 5, 8 In this study, we aimed to compare the clinical manifestations of and risk factors for CD development with and without hypotony after AVI. 2. Methods 2.1 Patients We retrospectively reviewed the medical records of patients with glaucoma who underwent AVI between January 2017 and December 2022 at Dong-A University Medical Center (Busan, Republic of Korea). This study was approved by the Institutional Review Board of Dong-A University Hospital (DAUHIRB-23-114), and everyone in the study team adhered to the tenets of the Declaration of Helsinki. Eligible patients met the following criteria: ( 1 ) patients aged > 18 years, ( 2 ) patients with glaucoma who underwent AVI, and ( 3 ) patients with a follow-up period > 12 months. The right eye was selected for the analysis if both eyes met the eligibility criteria. In monocular cases, the affected eye was used for analysis. All enrolled patients underwent a complete ophthalmic examination. Visual acuity (VA) was measured using Snellen values and converted to logarithm of the minimum angle of resolution values for statistical analyses. IOP was measured using a Goldmann applanation tonometer or noncontact tonometry. Fundus images were obtained using wide-field fundus photography (Optos Panoramic Ophthalmoscope Daytona P200T; Optos, Dunfermline, UK). The visual field test was performed using an automated perimetry test (Humphrey Field Analyzer, C24-2 Swedish Interactive Thresholding Algorithm standard program; Carl Zeiss Meditec). Central corneal thickness (CCT) was measured using tomography (Pentacam; Oculus, Wetzlar, Germany). The enrolled patients were divided into two steps. First, all enrolled patients were classified into two groups: ( 1 ) the CD group, comprising patients with CD after AVI, and ( 2 ) the non-CD group, comprising patients with CD after AVI. Second, the CD groups were classified into two groups: ( 1 ) the CD with hypotony group (IOP < 6 mmHg) and ( 2 ) the CD without hypotony group (IOP ≥ 6 mmHg). Data collected from the chart review before and after AVI included patient demographics, glaucoma type, lens status, VA, IOP, CCT, mean deviation, and number of topical antiglaucoma agents. 2.2 Surgical technique and postoperative topical regimen All surgical procedures were performed by a single glaucoma surgeon (SWJ). All AVIs were performed using a fornix-based conjunctival incision in the superotemporal or superonasal quadrant. After conjunctival incision, posterior dissection was performed for inserting Ahmed valve (New World Medical, Rancho Cucamonga, CA, USA). The Ahmed valves were primed using BSS irrigation. After the Ahmed valve was positioned in the middle of the quadrant, 8–10 mm posterior to the limbus, it was fixed to the sclera with 9 − 0 Nylon sutures, and a 5 × 5-mm limbal-based scleral flap was made to cover the silicone tube. A scleral track was created under the scleral flap by inserting a 23-gauge needle into the anterior chamber (AC). The tube tip was positioned with the bevel up at the maximal distance from the corneal endothelium and anterior to the iris through the scleral track. The tube was covered with a scleral flap using 8 − 0 Vicryl sutures. The conjunctiva and Tenon’s capsule were closed using 10 − 0 Nylon sutures. The postoperative standard topical regimen was as follows: The patients were instructed to stop all antiglaucoma agents after surgery and received topical antibiotic prophylaxis for 2 weeks (initially four times a day) and topical steroids (1.0% prednisolone acetate) for a minimum of 6–8 weeks (initially four times a day) in a tapering dose. 2.3 Definition of choroidal detachment (CD) and hypotony CD was defined as a solid-appearing light-brown elevation of the peripheral retina and choroid, as observed using wide-field fundus photography. Hypotony was defined as IOP < 6 mmHg at two consecutive visits within 1 month after AVI. 11, 12 2.4 Treatment protocol of CD Our management protocols for CD were as follows: ( 1 ) medical treatment, including topical and/or systemic corticosteroids and topical cycloplegic eye drops, ( 2 ) AC formation (injection of viscoelastic into the AC) (in-clinic-based procedure), and ( 3 ) surgical drainage of the choroidal effusion. 2.5 Statistical analyses Statistical analyses were performed using the R statistical software (version 4.2.2). The Shapiro–Wilk test was used for normality testing. Categorical variables were analyzed using the chi-squared or Fisher’s exact test. Student’s t -test or Mann–Whitney U test was used to analyze continuous variables. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CD development or hypotony. P-values < 0.05 indicated statistical significance. 3. Results During the study period, 387 eyes from 387 patients who underwent AVI were identified. Among the 387 eyes, 63 (16.3%) developed CD. Among the 63 eyes, 42 (66.7%) had CD with hypotony and 21 (33.3%) had CD without hypotony. The comparison results of demographic and ocular characteristics between the non-CD and CD groups are shown in Table 1 . The CD group was older (P < 0 .001) and had higher proportion of pseudophakic eyes (P < .001), diabetes mellitus (DM) (P = 0.13), hypertension (HTN) (P < 0.001), and combined cataract surgery (P < .001) than the non-CD group (Table 1 ). Table 1 Comparison of demographics and ocular characteristics between non-choroidal detachment and choroidal detachment Characteristics Non-CD ( N = 324) CD ( N = 63) P-value Age, years 63.6 ± 13.2 72.6 ± 7.7 < 0.001 * Female, n (%) 114 (35.2%) 18 (28.6%) 0.386 † Glaucoma type, n (%) POAG PACG XFG Uveitic glaucoma NVG Others 129 (39.8%) 9 (2.8%) 24 (7.4%) 30 (9.3%) 96 (29.6%) 36 (11.1%) 30 (47.6%) 0 9 (14.3%) 0 21 (33.3%) 3 (4.8%) 0.009 † Lens status Phakic Pseudophakic 201 (62.0%) 123 (38.0%) 24 (38.1%) 39 (61.9%) < 0.001 † Baseline VA, LogMAR 1.16 ± 1.02 1.40 ± 1.07 0.050 * Baseline IOP, mmHg 30.2 ± 8.19 32.5 ± 8.98 0.025 * Postoperative IOP, mmHg 14.0 ± 6.16 12.6 ± 6.82 0.945 * No. of antiglaucoma agents 3.83 ± 0.54 3.71 ± 0.77 0.931 * CCT 553 ± 43.3 544 ± 50.6 0.932 * History of DM 56 (17.3%) 20 (31.7%) 0.013 † History of HTN 96 (29.6%) 36 (57.1%) < 0.001 † Combined cataract surgery 78 (24.1%) 30 (47.6%) < 0.001 † Values are presented as means ± standard deviations, unless otherwise indicated. POAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma; NVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness; DM, diabetes mellitus; HTN, hypertension; CD, choroidal detachment * Independent t-test, statistical significance: P < 0.05 † Chi-squared test, statistical significance: P < 0.05 The results of the univariate and multivariate logistic regression analyses for identifying the risk factors for CD development are shown in Table 2 . Univariate logistic regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of DM (P = 0.009), history of HTN (P < 0.001), and combined cataract surgery (P < 0.001) were significantly associated with CD. However, multivariate logistic regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of DM(P = 0.011), and history of HTN (P = 0.002) were significant predictors of CD development (Table 2 ). Table 2 Logistic regression analysis for variables associated with choroidal detachment Characteristics Univariate Multivariate OR, 95% CI P-value * OR, 95% CI P-value * Age, years 1.08, 1.05–1.12 < 0.001 1.10, 1.06–1.15 < 0.001 Sex 1.36, 0.76–2.51 0.312 Glaucoma type POAG PACG XFG Uveitic glaucoma NVG Others (Ref.) NA 1.61, 0.65–3.73 NA 0.94, 0.50–1.74 0.36, 0.08–1.08 0.990 0.278 0.982 0.846 0.106 Lens status 0.38, 0.21–0.65 < 0.001 3.23, 2.08–13.66 < 0.001 Baseline VA, LogMAR 1.24, 0.96–1.61 0.102 Baseline IOP, mmHg 1.03, 1.00–1.06 0.050 Postoperative IOP, mmHg 0.96, 0.92–1.01 0.112 No. of antiglaucoma agents 0.75, 0.51–1.14 0.146 CCT 1.00, 0.98–1.14 0.998 History of DM 2.23, 1.20–4.04 0.009 2.23, 2.08–3.58 0.011 History of HTN 3.17, 1.83–5.55 < 0.001 2.72, 1.39–5.42 0.002 Combined cataract surgery 2.87, 1.64–5.01 < 0.001 Values are presented as means ± standard deviations, unless otherwise indicated. POAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma; NVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness; DM, diabetes mellitus; HTN, hypertension; OR, odds ratio; CI, confidence interval; NA, not applicable * Logistic regression analysis, statistical significance: P < 0.05 The comparison results of the demographic and ocular characteristics between the CD without hypotony and CD with hypotony groups are shown in Table 3 . There were no statistically significant differences, except for glaucoma type, between the two groups (Table 3 ). Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than that of primary open-angle glaucoma (POAG) (30.0%) and exfoliative glaucoma (XFG) (11.1%). Table 3 Comparison of demographics and ocular characteristics between choroidal detachment with and without hypotony Characteristics CD without hypotony ( N = 21) CD with hypotony ( N = 42) P-value Age, years 74.4 ± 5.5 71.7 ± 8.5 0.905 * Female, n (%) 6 (28.6%) 12 (28.6%) 1.000 † Glaucoma type, n (%) POAG PACG XFG Uveitic glaucoma NVG Others 9 (42.9%) 0 1 (4.8%) 0 9 (42.9%) 2 (9.5%) 21 (50.0%) 0 8 (19.0%) 0 12 (28.6%) 1 (2.4%) 0.033 ‡ Lens status Phakic Pseudophakic 6 (28.6%) 15 (71.4%) 18 (42.9%) 24 (57.1%) 0.409 † Baseline VA, LogMAR 1.32 ± 1.12 1.44 ± 1.06 0.342 * Baseline IOP, mmHg 34.9 ± 12.2 32.4 ± 8.31 0.830 * Postoperative IOP, mmHg 15.3 ± 2.55 11.3 ± 7.85 0.987 * No. of antiglaucoma agents 3.57 ± 1.08 3.79 ± 0.57 0.151 * CCT 540.7 ± 44.6 546.1 ± 53.8 0.348 * History of DM 6 (28.6%) 14 (33.3%) 0.924 † History of HTN 15 (71.4%) 21 (50.0%) 0.177 † Combined cataract surgery 9 (42.9%) 21 (50.0%) 0.789 † Values are presented as means ± standard deviations, unless otherwise indicated. POAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma; NVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness; DM, diabetes mellitus; HTN, hypertension; CD, choroidal detachment * Independent t-test, statistical significance: P < 0.05 † Chi-squared test, statistical significance: P < 0.05 ‡ Fisher’s exact test, statistical significance: P < 0.05 According to the results of the univariate and multivariate logistic regression analyses identifying the risk factors for CD development without hypotony compared with CD with hypotony, there were no statistically significant factors for CD development without hypotony. A comparison of the treatment outcomes between patients with CD with and without hypotony is shown in Table 4 . The rate of AC formation (45.2%) in patients with CD with hypotony was significantly higher than that in patients with CD without hypotony (14.3%). The time to onset and resolution of CD were not significantly different between the two groups. Table 4 Comparison of treatment outcomes between choroidal detachment with and without hypotony Characteristics CD without hypotony ( N = 21) CD with hypotony ( N = 42) P-value Observation:AC formation 18:3 23:19 0.032 * Time to onset CD, days 6 (3.25, 3–7) 4 (4, 3–21) 0.805 † Resolution time of CD, days 13 (8, 7–23) 10 (14, 3–26) 0.564 † Values are presented as medians (interquartile ranges, minimum–maximum), unless otherwise indicated. AC, anterior chamber; CD, choroidal detachment * Chi-squared test, statistical significance: P < 0.05 † Mann–Whitney U test, statistical significance: P < 0.05 After AC formation, 4 (18.2%) eyes showed a transient increase in IOP. However, the complication was self-limiting and did not require further treatment. 4. Discussion In this study, we investigated the risk factors for CD development after AVI. The relationship between hypotony and CD development was also analyzed. Our results showed that CD developed in 16.3% of the patients who underwent AVI. Older age, pseudophakic eyes, DM, and HTN were potential risk factors for CD development. NVG had a higher incidence rate of CD without hypotony compared with POAG and XFG. AC formation was required more than observation in CD with hypotony. Several studies have reported the incidence rate of CD. Park and Cho 26 and Ying et al. 25 reported that 17.7% and 18% of patients who underwent GDD implantation, respectively, developed CD. Shin et al. 5 and Ercalik et al. 14 reported that the incidence rates of CD after AVI were 35.1% and 34.3%, respectively. In our study, CD developed in 16.3% of the patients who underwent AVI. It is difficult to directly compare our results with the findings of other studies, our study suggested a lower incidence rate of CD compared with the studies of Shin et al. 5 and Ercalik et al. 14 This difference between previous studies and our study was also likely a product of a difference in the study population and surgical techniques. There are several surgical techniques for AVI that prevent the early postoperative hypotensive phase. 27, 28, 29 According to the surgical technique, the incidence rate of CD or hypotony may differ. Therefore, through further studies comparing the incidence rate of CD according to surgical technique, preventive effect on CD development of specific surgical technique can be confirmed. Previous studies have evaluated the risk factors for CD development after AVI. 5, 13, 14 Shin et al. 5 found the risk of CD after AVI was associated with XFG, increased age, HTN, and pseudophakia. Fu et al. 13 reported that previous surgical history and shorter axial length were risk factors for CD following AVI. Ercalik et al. 14 reported that high preoperative IOP, IOP < 9 mmHg on the first postoperative day, and male sex were significantly associated with CD after penetrating glaucoma surgery. In our study, we confirmed that old age, HTN, and pseudophakic eyes were risk factors for CD development, which is consistent with the results of previous studies. In addition, unlike previous studies, we found that DM was a new risk factor for CD development. Leakage of serum from the choroidal blood vessels into the suprachoroidal space with decreased uveal reabsorption or scleral clearance is a possible mechanism for CD development. 15 DM increases vascular permeability, including choroidal vasculature permeability. 16, 17 Therefore, patients with glaucoma with DM who underwent AVI had a high risk of CD development because of increased vascular permeability, resulting in leakage from the choroidal vessels. In addition to the leakage of serum from the choroidal blood vessels, hypotony also acts as a possible mechanism for CD development. 18, 19 However, CD also develops in patients without hypotony. It is important to analyze the effect of the non-hypotonic state on CD development. Therefore, we divided patients with CD into those with and without hypotony and analyzed the differences between the two groups. In our study, NVG was associated with a higher incidence of CD without hypotony compared with POAG and XFG. NVG, which is characterized by a deficiency of functional blood vessels, is frequently associated with vascular leakage and hypoxia. 20, 21 It is thought that the increased vascular permeability observed in NVG may have caused CD development, even in the absence of hypotony. Anti-vascular endothelial growth factor (VEGF) plays a role in decreasing vascular permeability, resulting in decreased leakage from vessels. 22 Intravitreal anti-VEGF is a useful adjunctive method for GDD implantation in NVG. 23, 24 For these reasons, intravitreal anti-VEGF can be used to prevent CD after AVI. However, further studies on the effects and safety of intravitreal anti-VEGF therapy are required. CD treatment consists of medical treatment, AC formation (in-clinic-based procedure), and surgical drainage of the choroidal effusion. Several studies have reported the treatment outcomes of CD. 25, 26 Ying et al. 25 reported that medical treatment, AC formation, and surgical treatment led to the resolution of CD in 53 (48%), 38 (35%), and 19 patients (17%), respectively. Park and Cho reported that all patients with CD after AVI achieved CD resolution by observation. 26 In our study, 41 (65.1%) eyes and 22 (34.9%) eyes achieved CD resolution by medical treatment and AC formation, respectively. None of the patients required surgical treatment. Comparing the results of treatment methods between CD with hypotony and without hypotony, the rate of AC formation (45.2%) in CD with hypotony was significantly higher than that in CD without hypotony (14.3%). Therefore, CD without hypotony may require AC formation more than medical treatment. This study has some limitations. First, the retrospective design of the tertiary care setting may have introduced selection bias. Second, the ability to detect potential risk factors for CD development with or without hypotony was limited because of the lack of statistical power owing to the small number of patients with CD. Therefore, further studies with larger cohorts are warranted. However, to the best of our knowledge, little is known about the effects of non-hypotonic conditions on CD development. Our study confirmed the effects of non-hypotony on CD development. In conclusion, older age, pseudophakic eyes, HTN, and DM are significantly associated with CD development after AVI. NVG has a higher incidence rate of CD without hypotony compared with POAG and XFG. Therefore, clinicians should consider CD development after AVI especially in NVG, even if a patient is not in a hypotonic state. Declarations FUNDING/SUPPORT This work was supported by the Dong-A University Research Fund. The funders had no role in the design or conduct of this study. Conflict of interest : The authors declare no conflicts of interest. CONTRIBUTORSHIP STATEMENT Design and conduct of the study: S.W. Jin, J.W. Heo, H.B. Ahn, collection of data: J.W. Heo, and management, analysis, and interpretation of data and preparation of the manuscript: S.W.Jin, J.W.Heo. All the authors reviewed the manuscript. Ethics approval All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board of Dong-A University Hospital (DAUHIRB-23-114) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to participate Informed consent was waived because of the study’s retrospective design. References Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology . 2007;114:2265-2270. Desai MA, Gedde SJ, Feuer WJ, Shi W, Chen PP, Parrish RKII. 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Posterior segment complications of Ahmed valve implantation. BMC Ophthalmol . 2022;22:78. Kee C. Prevention of early postoperative hypotony by partial ligation of silicone tube in Ahmed glaucoma valve implantation. J Glaucoma . 2001;10:466-469. Arpa P, Arpa C. Ahmed glaucoma valve in vitrectomized eyes: an implantation technique to minimize early postoperative fluid-loss hypotony. Eur J Ophthalmol . 2021;31:2759-2764. Riva I, Roberti G, Oddone F, Konstas AG, Quaranta L. Ahmed glaucoma valve implant: surgical technique and complications. Clin Ophthalmol . 2017;11:357-367. Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3786933","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":272247024,"identity":"b985747f-1d43-41a0-86e1-de54cee6d1c4","order_by":0,"name":"Sang Wook Jin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACxmYGBmYgLWcA5hpYEK/FGKpFggHCJwBAShI3QNhEaGFu5z32uKBmW/p29rNHN/wokGAwZ+8/QMBhfOnGM47dzt3Zk5d2swfoMMuew4T8wmMmzcN2O3fDgRyzGzxALQY3konR8u92usH5N2Y3/4C03H9MhBbettsJBjdyzG5DbCHgfYiWvtuGG268MbstYyDBY3Am2QCvFsP+M0CHfbstb3A+x+zmmz82cgbHDz7Ar6UBTYAHv6uAQJ6gilEwCkbBKBgFAGfqQgHh1AIJAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-7485-3303","institution":"Dong-A University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Sang","middleName":"Wook","lastName":"Jin","suffix":""},{"id":272247025,"identity":"ff5ec363-1f67-479f-9bb6-8a580a8fe324","order_by":1,"name":"Tae Hwan Kim","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Tae","middleName":"Hwan","lastName":"Kim","suffix":""},{"id":272247026,"identity":"bc676399-001d-4fda-b850-7c1dfe1c00de","order_by":2,"name":"Hee Bae Ahn","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hee","middleName":"Bae","lastName":"Ahn","suffix":""}],"badges":[],"createdAt":"2023-12-21 12:41:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3786933/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3786933/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53659838,"identity":"413fbee9-314f-4d3c-9e0a-eee762a08f0a","added_by":"auto","created_at":"2024-03-28 16:03:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":347544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3786933/v1/89949820-0ad3-42af-987c-65bb20ddb15c.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"Comparison of choroidal detachment with and without hypotony after Ahmed valve implantation","fulltext":[{"header":"SUMMARY","content":"\u003cp\u003e \u003cb\u003eWhat was know before\u003c/b\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eSome studies have reported the risk factors for choroidal detachment (CD) development after glaucoma drainage device (GDD) implantation. However, no studies have investigated CD associated with or without hypotony after GDD implantation, such as Ahmed valve implantation (AVI).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003e \u003cb\u003eWhat this study adds\u003c/b\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eOlder age, pseudophakic eyes, hypertension, and DM are significantly associated with CD development after AVI.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNeovascular glaucoma (NVG) has a higher incidence rate of CD without hypotony compared with primary open angle glaucoma and exfoliative glaucoma.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUnlike previous studies, we found that DM was a new risk factor for CD development.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClinicians should consider CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eGlaucoma drainage device (GDD) implantation is a commonly performed surgical method in patients with uncontrolled intraocular pressure (IOP) despite the maximum tolerated medical or laser therapy.\u003csup\u003e1, 2\u003c/sup\u003e Among the GDDs, the Ahmed valve is one of the most commonly used valve-type implants and has been developed to reduce hypotony and related complications, which commonly occur in non-valve-type implants.\u003csup\u003e3, 4\u003c/sup\u003e However, despite this effort, hypotony and related complications are still observed in Ahmed valve implantation (AVI).\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChoroidal detachment (CD) is a relatively common early postoperative complication of AVI.\u003csup\u003e6\u003c/sup\u003e Reported rates of CD after GDD implantation range from 11.7\u0026ndash;35.1%. CD is often asymptomatic, and small CD is considered clinically insignificant. However, CD can lead to serious sequelae, such as suprachoroidal hemorrhage, retinal folds, and hypotony maculopathy, with a risk of vision loss.\u003csup\u003e5\u0026ndash;9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe pathophysiology of CD, which is typically an acute drop in IOP combined with an inflammatory process, causes a sudden shift in hydrostatic pressure. Consequently, serum transudates across the choriocapillaries and accumulates in the suprachoroidal space.\u003csup\u003e7, 10\u003c/sup\u003e However, CD has also been reported in some cases after GDD implantation despite normal IOP.\u003csup\u003e7, 8\u003c/sup\u003e Therefore, it is important to identify the risk factors for CD development that are not related to hypotony. Some studies have reported the risk factors for CD development after GDD implantation, such as demographics and ocular characteristics. However, no studies have investigated CD associated with or without hypotony after GDD implantation, such as AVI.\u003csup\u003e5, 8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this study, we aimed to compare the clinical manifestations of and risk factors for CD development with and without hypotony after AVI.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u003c/h2\u003e \u003cp\u003eWe retrospectively reviewed the medical records of patients with glaucoma who underwent AVI between January 2017 and December 2022 at Dong-A University Medical Center (Busan, Republic of Korea). This study was approved by the Institutional Review Board of Dong-A University Hospital (DAUHIRB-23-114), and everyone in the study team adhered to the tenets of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eEligible patients met the following criteria: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) patients aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) patients with glaucoma who underwent AVI, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) patients with a follow-up period\u0026thinsp;\u0026gt;\u0026thinsp;12 months. The right eye was selected for the analysis if both eyes met the eligibility criteria. In monocular cases, the affected eye was used for analysis.\u003c/p\u003e \u003cp\u003eAll enrolled patients underwent a complete ophthalmic examination. Visual acuity (VA) was measured using Snellen values and converted to logarithm of the minimum angle of resolution values for statistical analyses. IOP was measured using a Goldmann applanation tonometer or noncontact tonometry. Fundus images were obtained using wide-field fundus photography (Optos Panoramic Ophthalmoscope Daytona P200T; Optos, Dunfermline, UK). The visual field test was performed using an automated perimetry test (Humphrey Field Analyzer, C24-2 Swedish Interactive Thresholding Algorithm standard program; Carl Zeiss Meditec). Central corneal thickness (CCT) was measured using tomography (Pentacam; Oculus, Wetzlar, Germany).\u003c/p\u003e \u003cp\u003eThe enrolled patients were divided into two steps. First, all enrolled patients were classified into two groups: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the CD group, comprising patients with CD after AVI, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the non-CD group, comprising patients with CD after AVI. Second, the CD groups were classified into two groups: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the CD with hypotony group (IOP\u0026thinsp;\u0026lt;\u0026thinsp;6 mmHg) and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the CD without hypotony group (IOP\u0026thinsp;\u0026ge;\u0026thinsp;6 mmHg).\u003c/p\u003e \u003cp\u003e Data collected from the chart review before and after AVI included patient demographics, glaucoma type, lens status, VA, IOP, CCT, mean deviation, and number of topical antiglaucoma agents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgical technique and postoperative topical regimen\u003c/h2\u003e \u003cp\u003eAll surgical procedures were performed by a single glaucoma surgeon (SWJ). All AVIs were performed using a fornix-based conjunctival incision in the superotemporal or superonasal quadrant. After conjunctival incision, posterior dissection was performed for inserting Ahmed valve (New World Medical, Rancho Cucamonga, CA, USA). The Ahmed valves were primed using BSS irrigation. After the Ahmed valve was positioned in the middle of the quadrant, 8\u0026ndash;10 mm posterior to the limbus, it was fixed to the sclera with 9\u0026thinsp;\u0026minus;\u0026thinsp;0 Nylon sutures, and a 5 \u0026times; 5-mm limbal-based scleral flap was made to cover the silicone tube. A scleral track was created under the scleral flap by inserting a 23-gauge needle into the anterior chamber (AC). The tube tip was positioned with the bevel up at the maximal distance from the corneal endothelium and anterior to the iris through the scleral track. The tube was covered with a scleral flap using 8\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl sutures. The conjunctiva and Tenon\u0026rsquo;s capsule were closed using 10\u0026thinsp;\u0026minus;\u0026thinsp;0 Nylon sutures.\u003c/p\u003e \u003cp\u003eThe postoperative standard topical regimen was as follows: The patients were instructed to stop all antiglaucoma agents after surgery and received topical antibiotic prophylaxis for 2 weeks (initially four times a day) and topical steroids (1.0% prednisolone acetate) for a minimum of 6\u0026ndash;8 weeks (initially four times a day) in a tapering dose.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Definition of choroidal detachment (CD) and hypotony\u003c/h2\u003e \u003cp\u003eCD was defined as a solid-appearing light-brown elevation of the peripheral retina and choroid, as observed using wide-field fundus photography.\u003c/p\u003e \u003cp\u003eHypotony was defined as IOP\u0026thinsp;\u0026lt;\u0026thinsp;6 mmHg at two consecutive visits within 1 month after AVI.\u003csup\u003e11, 12\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Treatment protocol of CD\u003c/h2\u003e \u003cp\u003eOur management protocols for CD were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) medical treatment, including topical and/or systemic corticosteroids and topical cycloplegic eye drops, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) AC formation (injection of viscoelastic into the AC) (in-clinic-based procedure), and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) surgical drainage of the choroidal effusion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using the R statistical software (version 4.2.2). The Shapiro\u0026ndash;Wilk test was used for normality testing. Categorical variables were analyzed using the chi-squared or Fisher\u0026rsquo;s exact test. Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test or Mann\u0026ndash;Whitney U test was used to analyze continuous variables. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CD development or hypotony. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eDuring the study period, 387 eyes from 387 patients who underwent AVI were identified. Among the 387 eyes, 63 (16.3%) developed CD. Among the 63 eyes, 42 (66.7%) had CD with hypotony and 21 (33.3%) had CD without hypotony.\u003c/p\u003e \u003cp\u003eThe comparison results of demographic and ocular characteristics between the non-CD and CD groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The CD group was older (P\u0026thinsp;\u0026lt;\u0026thinsp;0 .001) and had higher proportion of pseudophakic eyes (P\u0026thinsp;\u0026lt;\u0026thinsp;.001), diabetes mellitus (DM) (P\u0026thinsp;=\u0026thinsp;0.13), hypertension (HTN) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and combined cataract surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;.001) than the non-CD group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographics and ocular characteristics between non-choroidal detachment and choroidal detachment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-CD (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;324)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma type, n (%)\u003c/p\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003cp\u003ePACG\u003c/p\u003e \u003cp\u003eXFG\u003c/p\u003e \u003cp\u003eUveitic glaucoma\u003c/p\u003e \u003cp\u003eNVG\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (39.8%)\u003c/p\u003e \u003cp\u003e9 (2.8%)\u003c/p\u003e \u003cp\u003e24 (7.4%)\u003c/p\u003e \u003cp\u003e30 (9.3%)\u003c/p\u003e \u003cp\u003e96 (29.6%)\u003c/p\u003e \u003cp\u003e36 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (47.6%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e9 (14.3%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e21 (33.3%)\u003c/p\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens status\u003c/p\u003e \u003cp\u003ePhakic\u003c/p\u003e \u003cp\u003ePseudophakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201 (62.0%)\u003c/p\u003e \u003cp\u003e123 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (38.1%)\u003c/p\u003e \u003cp\u003e39 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline VA, LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.050\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.945\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of antiglaucoma agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.931\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e553\u0026thinsp;\u0026plusmn;\u0026thinsp;43.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e544\u0026thinsp;\u0026plusmn;\u0026thinsp;50.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.932\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of HTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePOAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eDM, diabetes mellitus; HTN, hypertension; CD, choroidal detachment\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eIndependent t-test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eChi-squared test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the univariate and multivariate logistic regression analyses for identifying the risk factors for CD development are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Univariate logistic regression analysis revealed that age (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lens status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of DM (P\u0026thinsp;=\u0026thinsp;0.009), history of HTN (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and combined cataract surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with CD. However, multivariate logistic regression analysis revealed that age (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lens status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of DM(P\u0026thinsp;=\u0026thinsp;0.011), and history of HTN (P\u0026thinsp;=\u0026thinsp;0.002) were significant predictors of CD development (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis for variables associated with choroidal detachment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR, 95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR, 95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08, 1.05\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10, 1.06\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36, 0.76\u0026ndash;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma type\u003c/p\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003cp\u003ePACG\u003c/p\u003e \u003cp\u003eXFG\u003c/p\u003e \u003cp\u003eUveitic glaucoma\u003c/p\u003e \u003cp\u003eNVG\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Ref.)\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003e1.61, 0.65\u0026ndash;3.73\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003e0.94, 0.50\u0026ndash;1.74\u003c/p\u003e \u003cp\u003e0.36, 0.08\u0026ndash;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003cp\u003e0.278\u003c/p\u003e \u003cp\u003e0.982\u003c/p\u003e \u003cp\u003e0.846\u003c/p\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38, 0.21\u0026ndash;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.23, 2.08\u0026ndash;13.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline VA, LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24, 0.96\u0026ndash;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03, 1.00\u0026ndash;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96, 0.92\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of antiglaucoma agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75, 0.51\u0026ndash;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00, 0.98\u0026ndash;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.23, 1.20\u0026ndash;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.23, 2.08\u0026ndash;3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of HTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.17, 1.83\u0026ndash;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.72, 1.39\u0026ndash;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.87, 1.64\u0026ndash;5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ePOAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDM, diabetes mellitus; HTN, hypertension; OR, odds ratio; CI, confidence interval; NA, not applicable\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003eLogistic regression analysis, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison results of the demographic and ocular characteristics between the CD without hypotony and CD with hypotony groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There were no statistically significant differences, except for glaucoma type, between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than that of primary open-angle glaucoma (POAG) (30.0%) and exfoliative glaucoma (XFG) (11.1%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographics and ocular characteristics between choroidal detachment with and without hypotony\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCD without hypotony\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD with hypotony\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.905\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma type, n (%)\u003c/p\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003cp\u003ePACG\u003c/p\u003e \u003cp\u003eXFG\u003c/p\u003e \u003cp\u003eUveitic glaucoma\u003c/p\u003e \u003cp\u003eNVG\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (4.8%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003cp\u003e2 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e8 (19.0%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e12 (28.6%)\u003c/p\u003e \u003cp\u003e1 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens status\u003c/p\u003e \u003cp\u003ePhakic\u003c/p\u003e \u003cp\u003ePseudophakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (28.6%)\u003c/p\u003e \u003cp\u003e15 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (42.9%)\u003c/p\u003e \u003cp\u003e24 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.409\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline VA, LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.830\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative IOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.987\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of antiglaucoma agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e540.7\u0026thinsp;\u0026plusmn;\u0026thinsp;44.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e546.1\u0026thinsp;\u0026plusmn;\u0026thinsp;53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.924\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of HTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.177\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.789\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePOAG, primary open-angle glaucoma; PACG, primary angle closure glaucoma; XFG, exfoliative glaucoma;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNVG, neovascular glaucoma; VA, visual acuity; IOP, intraocular pressure; CCT, central corneal thickness;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eDM, diabetes mellitus; HTN, hypertension; CD, choroidal detachment\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eIndependent t-test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eChi-squared test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003eFisher\u0026rsquo;s exact test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of the univariate and multivariate logistic regression analyses identifying the risk factors for CD development without hypotony compared with CD with hypotony, there were no statistically significant factors for CD development without hypotony.\u003c/p\u003e \u003cp\u003eA comparison of the treatment outcomes between patients with CD with and without hypotony is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The rate of AC formation (45.2%) in patients with CD with hypotony was significantly higher than that in patients with CD without hypotony (14.3%). The time to onset and resolution of CD were not significantly different between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of treatment outcomes between choroidal detachment with and without hypotony\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCD without hypotony\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD with hypotony\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation:AC formation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18:3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23:19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to onset CD, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3.25, 3\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4, 3\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResolution time of CD, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (8, 7\u0026ndash;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (14, 3\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.564\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as medians (interquartile ranges, minimum\u0026ndash;maximum), unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAC, anterior chamber; CD, choroidal detachment\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eChi-squared test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eMann\u0026ndash;Whitney U test, statistical significance: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter AC formation, 4 (18.2%) eyes showed a transient increase in IOP. However, the complication was self-limiting and did not require further treatment.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, we investigated the risk factors for CD development after AVI. The relationship between hypotony and CD development was also analyzed. Our results showed that CD developed in 16.3% of the patients who underwent AVI. Older age, pseudophakic eyes, DM, and HTN were potential risk factors for CD development. NVG had a higher incidence rate of CD without hypotony compared with POAG and XFG. AC formation was required more than observation in CD with hypotony.\u003c/p\u003e \u003cp\u003eSeveral studies have reported the incidence rate of CD. Park and Cho\u003csup\u003e26\u003c/sup\u003e and Ying et al.\u003csup\u003e25\u003c/sup\u003e reported that 17.7% and 18% of patients who underwent GDD implantation, respectively, developed CD. Shin et al.\u003csup\u003e5\u003c/sup\u003e and Ercalik et al.\u003csup\u003e14\u003c/sup\u003e reported that the incidence rates of CD after AVI were 35.1% and 34.3%, respectively. In our study, CD developed in 16.3% of the patients who underwent AVI. It is difficult to directly compare our results with the findings of other studies, our study suggested a lower incidence rate of CD compared with the studies of Shin et al.\u003csup\u003e5\u003c/sup\u003e and Ercalik et al.\u003csup\u003e14\u003c/sup\u003e This difference between previous studies and our study was also likely a product of a difference in the study population and surgical techniques. There are several surgical techniques for AVI that prevent the early postoperative hypotensive phase.\u003csup\u003e27, 28, 29\u003c/sup\u003e According to the surgical technique, the incidence rate of CD or hypotony may differ. Therefore, through further studies comparing the incidence rate of CD according to surgical technique, preventive effect on CD development of specific surgical technique can be confirmed.\u003c/p\u003e \u003cp\u003ePrevious studies have evaluated the risk factors for CD development after AVI.\u003csup\u003e5, 13, 14\u003c/sup\u003e Shin et al.\u003csup\u003e5\u003c/sup\u003e found the risk of CD after AVI was associated with XFG, increased age, HTN, and pseudophakia. Fu et al.\u003csup\u003e13\u003c/sup\u003e reported that previous surgical history and shorter axial length were risk factors for CD following AVI. Ercalik et al.\u003csup\u003e14\u003c/sup\u003e reported that high preoperative IOP, IOP \u0026lt; 9 mmHg on the first postoperative day, and male sex were significantly associated with CD after penetrating glaucoma surgery. In our study, we confirmed that old age, HTN, and pseudophakic eyes were risk factors for CD development, which is consistent with the results of previous studies. In addition, unlike previous studies, we found that DM was a new risk factor for CD development. Leakage of serum from the choroidal blood vessels into the suprachoroidal space with decreased uveal reabsorption or scleral clearance is a possible mechanism for CD development.\u003csup\u003e15\u003c/sup\u003e DM increases vascular permeability, including choroidal vasculature permeability.\u003csup\u003e16, 17\u003c/sup\u003e Therefore, patients with glaucoma with DM who underwent AVI had a high risk of CD development because of increased vascular permeability, resulting in leakage from the choroidal vessels.\u003c/p\u003e \u003cp\u003eIn addition to the leakage of serum from the choroidal blood vessels, hypotony also acts as a possible mechanism for CD development.\u003csup\u003e18, 19\u003c/sup\u003e However, CD also develops in patients without hypotony. It is important to analyze the effect of the non-hypotonic state on CD development. Therefore, we divided patients with CD into those with and without hypotony and analyzed the differences between the two groups. In our study, NVG was associated with a higher incidence of CD without hypotony compared with POAG and XFG. NVG, which is characterized by a deficiency of functional blood vessels, is frequently associated with vascular leakage and hypoxia.\u003csup\u003e20, 21\u003c/sup\u003e It is thought that the increased vascular permeability observed in NVG may have caused CD development, even in the absence of hypotony. Anti-vascular endothelial growth factor (VEGF) plays a role in decreasing vascular permeability, resulting in decreased leakage from vessels.\u003csup\u003e22\u003c/sup\u003e Intravitreal anti-VEGF is a useful adjunctive method for GDD implantation in NVG.\u003csup\u003e23, 24\u003c/sup\u003e For these reasons, intravitreal anti-VEGF can be used to prevent CD after AVI. However, further studies on the effects and safety of intravitreal anti-VEGF therapy are required.\u003c/p\u003e \u003cp\u003eCD treatment consists of medical treatment, AC formation (in-clinic-based procedure), and surgical drainage of the choroidal effusion. Several studies have reported the treatment outcomes of CD.\u003csup\u003e25, 26\u003c/sup\u003e Ying et al.\u003csup\u003e25\u003c/sup\u003e reported that medical treatment, AC formation, and surgical treatment led to the resolution of CD in 53 (48%), 38 (35%), and 19 patients (17%), respectively. Park and Cho reported that all patients with CD after AVI achieved CD resolution by observation.\u003csup\u003e26\u003c/sup\u003e In our study, 41 (65.1%) eyes and 22 (34.9%) eyes achieved CD resolution by medical treatment and AC formation, respectively. None of the patients required surgical treatment. Comparing the results of treatment methods between CD with hypotony and without hypotony, the rate of AC formation (45.2%) in CD with hypotony was significantly higher than that in CD without hypotony (14.3%). Therefore, CD without hypotony may require AC formation more than medical treatment.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, the retrospective design of the tertiary care setting may have introduced selection bias. Second, the ability to detect potential risk factors for CD development with or without hypotony was limited because of the lack of statistical power owing to the small number of patients with CD. Therefore, further studies with larger cohorts are warranted. However, to the best of our knowledge, little is known about the effects of non-hypotonic conditions on CD development. Our study confirmed the effects of non-hypotony on CD development.\u003c/p\u003e \u003cp\u003eIn conclusion, older age, pseudophakic eyes, HTN, and DM are significantly associated with CD development after AVI. NVG has a higher incidence rate of CD without hypotony compared with POAG and XFG. Therefore, clinicians should consider CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFUNDING/SUPPORT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Dong-A University Research Fund.\u003c/p\u003e\n\u003cp\u003eThe funders had no role in the design or conduct of this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCONTRIBUTORSHIP STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDesign and conduct of the study: S.W. Jin, J.W. Heo, H.B. Ahn, collection of data: J.W. Heo, and management, analysis, and interpretation of data and preparation of the manuscript: S.W.Jin, J.W.Heo. All the authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board of Dong-A University Hospital (DAUHIRB-23-114) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e Informed consent was waived because of the study\u0026rsquo;s retrospective design.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRamulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. \u003cem\u003eOphthalmology\u003c/em\u003e. 2007;114:2265-2270.\u003c/li\u003e\n\u003cli\u003eDesai MA, Gedde SJ, Feuer WJ, Shi W, Chen PP, Parrish RKII. Practice preferences for glaucoma surgery: a survey of the American Glaucoma Society in 2008. \u003cem\u003eOphthalmic Surg Lasers Imaging\u003c/em\u003e. 2011;42:202-208.\u003c/li\u003e\n\u003cli\u003eColeman AL, Hill R, Wilson MR, et al. Initial clinical experience with the ahmed glaucoma valve implant. \u003cem\u003eAm J Ophthalmol\u003c/em\u003e. 1995;120:23-31.\u003c/li\u003e\n\u003cli\u003eHong CH, Arosemena A, Zurakowski D, Ayyala RS. Glaucoma drainage devices: a systematic literature review and current controversies. \u003cem\u003eSurv Ophthalmol\u003c/em\u003e. 2005;50:48-60.\u003c/li\u003e\n\u003cli\u003eShin DY, Jung KI, Park HYL, Park CK. Risk factors for choroidal detachment after Ahmed valve implantation in glaucoma patients. \u003cem\u003eAm J Ophthalmol\u003c/em\u003e. 2020;211:105-113.\u003c/li\u003e\n\u003cli\u003eLamping KA, Bellows AR, Hutchinson BT, Afran SI. Long-term evaluation of initial filtration surgery. \u003cem\u003eOphthalmology\u003c/em\u003e. 1986;93:91-101.\u003c/li\u003e\n\u003cli\u003eSchrieber C, Liu Y. Choroidal effusions after glaucoma surgery. \u003cem\u003eCurr Opin Ophthalmol\u003c/em\u003e. 2015;26:134-142.\u003c/li\u003e\n\u003cli\u003eYing S, Coulon SJ, Lidder AK, et al. Choroidal effusions after glaucoma drainage implant surgery: risk factors and surgical management. \u003cem\u003eOphthalmol Glaucoma\u003c/em\u003e. 2023;S2589-4196(23)00060-1.\u003c/li\u003e\n\u003cli\u003eAltan T, Temel A, Bavbek T, Kazokoglu H. Hypotonic maculopathy after trabeculectomy with postoperative use of 5-fluorouracil. \u003cem\u003eOphthalmologica\u003c/em\u003e. 1994;208:318-320.\u003c/li\u003e\n\u003cli\u003eBakir B, Pasquale LR. Causes and treatment of choroidal effusion after glaucoma surgery. \u003cem\u003eSemin Ophthalmol\u003c/em\u003e. 2014;29:409-413.\u003c/li\u003e\n\u003cli\u003eHeuer DK, Barton K, Grehn F, Shaarawy T, Sherwood M. Consensus of definitions of success. In: Shaarawy T, Grehn F, eds. \u003cem\u003eGuidelines on Design and Reporting of Glaucoma Surgical Trials\u003c/em\u003e. The Hague, Amsterdam, The Netherlands: World Glaucoma Association, Kugler Publications; 2008:15-24.\u003c/li\u003e\n\u003cli\u003eEl-Saied HMA, Abdelhakim MASE. Different surgical modalities for management of uveitic glaucoma: 2 year comparative study. \u003cem\u003eActa Ophthalmol\u003c/em\u003e. 2022;100:e246-e252.\u003c/li\u003e\n\u003cli\u003eFu L, Chan YK, Nie L, et al. Ciliochoroidal detachment after Ahmed glaucoma valve implantation: a retrospective study. \u003cem\u003eBMC Ophthalmol\u003c/em\u003e. 2019;19:46.\u003c/li\u003e\n\u003cli\u003eErcalik NY, Tekcan H, Mangan MS, Ozcelik Kose A, Imamoglu S. Analysis of risk factors and ocular hypotony characteristics in choroidal detachment after penetrating glaucoma surgery. \u003cem\u003eInt Ophthalmol\u003c/em\u003e. 2022;42:3431-3440.\u003c/li\u003e\n\u003cli\u003eDiep MQ, Madigan MC. Choroidal detachments: what do optometrists need to know? \u003cem\u003eClin Exp Optom\u003c/em\u003e. 2019;102:116-125.\u003c/li\u003e\n\u003cli\u003eChu TG, Green RL. Suprachoroidal hemorrhage. \u003cem\u003eSurv Ophthalmol\u003c/em\u003e. 1999;43:471-486.\u003c/li\u003e\n\u003cli\u003eSaxena RC, Kumar D. Choroidal detachment (a clinicoaetiopathological study). \u003cem\u003eIndian J Ophthalmol\u003c/em\u003e. 1983;31:238-241.\u003c/li\u003e\n\u003cli\u003ePederson JE, Gaasterland DE, MacLellan HM. Experimental ciliochoroidal detachment. Effect on intraocular pressure and aqueous humor flow. \u003cem\u003eArch Ophthalmol\u003c/em\u003e. 1979;97:536-541.\u003c/li\u003e\n\u003cli\u003eMoses RA. Detachment of ciliary body \u0026ndash; anatomical and physical considerations. \u003cem\u003eInvest Ophthalmol\u003c/em\u003e. 1965;4:935-941.\u003c/li\u003e\n\u003cli\u003eVascular plasticity--the role of the angiopoietins in modulating ocular angiogenesis. Joussen AM. \u003cem\u003eGraefes Arch Clin Exp Ophthalmol\u003c/em\u003e. 2001;239:972-975.\u003c/li\u003e\n\u003cli\u003eYoshida N, Hisatomi T, Ikeda Y, et al. Intravitreal bevacizumab treatment for neovascular glaucoma: histopathological analysis of trabeculectomy specimens. \u003cem\u003eGraefes Arch Clin Exp Ophthalmol\u003c/em\u003e. 2011;249:1547-1552.\u003c/li\u003e\n\u003cli\u003eTang M, Fu Y, Wang Y, et al. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma. \u003cem\u003eBMC Ophthalmol\u003c/em\u003e. 2016;16:7.\u003c/li\u003e\n\u003cli\u003eEid TM, Radwan A, el-Manawy W, el-Hawary I. Intravitreal bevacizumab and aqueous shunting surgery for neovascular glaucoma: safety and efficacy. \u003cem\u003eCan J Ophthalmol\u003c/em\u003e. 2009;44:451-456.\u003c/li\u003e\n\u003cli\u003eArcieri ES, Paula JS, Jorge R, et al. Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation: 2-year follow-up. \u003cem\u003eActa Ophthalmol\u003c/em\u003e. 2015;93:e1-e6.\u003c/li\u003e\n\u003cli\u003eYing S, Coulon SJ, Lidder AK, et al. Choroidal effusions after glaucoma drainage implant surgery: risk factors and surgical management. \u003cem\u003eOphthalmol Glaucoma\u003c/em\u003e. 2023;S2589-4196(23)00060-1.\u003c/li\u003e\n\u003cli\u003ePark Y, Cho KJ. Posterior segment complications of Ahmed valve implantation. \u003cem\u003eBMC Ophthalmol\u003c/em\u003e. 2022;22:78.\u003c/li\u003e\n\u003cli\u003eKee C. Prevention of early postoperative hypotony by partial ligation of silicone tube in Ahmed glaucoma valve implantation. \u003cem\u003eJ Glaucoma\u003c/em\u003e. 2001;10:466-469.\u003c/li\u003e\n\u003cli\u003eArpa P, Arpa C. Ahmed glaucoma valve in vitrectomized eyes: an implantation technique to minimize early postoperative fluid-loss hypotony. \u003cem\u003eEur J Ophthalmol\u003c/em\u003e. 2021;31:2759-2764.\u003c/li\u003e\n\u003cli\u003eRiva I, Roberti G, Oddone F, Konstas AG, Quaranta L. Ahmed glaucoma valve implant: surgical technique and complications. \u003cem\u003eClin Ophthalmol\u003c/em\u003e. 2017;11:357-367.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"choroidal detachment, hypotony, Ahmed valve","lastPublishedDoi":"10.21203/rs.3.rs-3786933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3786933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo compare the clinical manifestations of and risk factors for choroidal detachment (CD) with or without hypotony after Ahmed valve implantation (AVI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective, consecutive case series included glaucoma patients who underwent AVI. We divided the patients into CD and non-CD. The patients with CD were divided into those with and without hypotony. Data collected from the chart review before and after AVI included patient demographics and ocular characteristics. We analyzed the risk factors for CD development. Moreover, the relationship between hypotony and CD development was analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 387 eyes, 63 developed CD. Among the 63 eyes, 42 had CD with hypotony and 21 had CD without hypotony. Multivariate regression analysis revealed that age (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lens status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of diabetes mellitus (DM) (P\u0026thinsp;=\u0026thinsp;0.011), and history of hypertension (HTN) (P\u0026thinsp;=\u0026thinsp;0.002) were significant predictors of CD development. Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than that of primary open angle glaucoma (POAG) and exfoliative glaucoma (XFG). The rate of anterior chamber formation as treatment of CD was significantly higher in CD with hypotony than in CD without hypotony.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOlder age, pseudophakic eyes, DM, and HTN are significantly associated with CD development after AVI. NVG has higher incidence rate of CD without hypotony compared with POAG and XFG. Therefore, clinicians should pay attention to CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.\u003c/p\u003e","manuscriptTitle":"Comparison of choroidal detachment with and without hypotony after Ahmed valve implantation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-13 06:36:47","doi":"10.21203/rs.3.rs-3786933/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d79f417f-7c98-4ce9-82fd-a44ad374ca0d","owner":[],"postedDate":"February 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-28T15:55:45+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-13 06:36:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3786933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3786933","identity":"rs-3786933","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}