Ahmed valve implant with restored vision.

Navigating Glaucoma: How New Surgical Techniques Offer Hope for Refractory Cases

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"A breakthrough study explores the combined power of Mitomycin C and selective 5-Fluorouracil injections with Ahmed valve implants, offering a beacon of hope for those with challenging glaucoma."

Glaucoma, a progressive optic neuropathy, poses a significant threat to vision worldwide. While various treatments exist, refractory glaucoma—cases that resist conventional medical and surgical interventions—presents a formidable challenge. These complex cases often require innovative approaches to manage intraocular pressure (IOP) and prevent further optic nerve damage.

Traditional surgical methods, such as trabeculectomy, sometimes fail to provide long-term IOP control in refractory glaucoma. This has spurred the development of glaucoma drainage devices (GDDs), including the Ahmed valve implant, which regulates aqueous humor outflow, reducing IOP. However, even with GDDs, fibrosis and scarring around the implant can limit their effectiveness over time.

A recent study published in the Journal of the Korean Ophthalmological Society investigates a combined surgical approach using the Ahmed valve implant, along with adjunctive Mitomycin C (MMC) and selective postoperative 5-Fluorouracil (5-FU) injections with a needling procedure. This comprehensive strategy aims to enhance the long-term success of Ahmed valve implantation in refractory glaucoma cases.

The Power of Three: Combining Ahmed Valve Implants with MMC and 5-FU Injections

Ahmed valve implant with restored vision.

The study, led by Il Suk Yun, MD, and colleagues, retrospectively analyzed data from 40 eyes of 40 patients who underwent Ahmed valve implant surgery with adjunctive MMC. All patients had been observed for at least one year, providing valuable insights into the procedure's long-term efficacy and safety.

The surgical technique involved implanting the Ahmed valve after a 5-minute application of 0.04% MMC to the scleral bed. MMC, an antifibrotic agent, helps prevent scarring and fibrosis around the implant, promoting better aqueous humor outflow. Selective 5-FU injections with a needling procedure were performed postoperatively based on individual IOP levels, tailoring the treatment to each patient's needs.

The mean follow-up period was 35.5 ± 12.4 months.
Preoperative intraocular pressure was 32.8 ± 7.5 mm Hg, which decreased to 14.0 ± 4.2 mm Hg postoperatively.
The number of glaucoma medications decreased significantly from 3.8 ± 0.5 to 2.0 ± 1.0.
Eleven of 40 eyes (27.5%) experienced a hypertensive phase at 6.0 ± 3.1 weeks after surgery.

Kaplan-Meier survival analysis demonstrated cumulative probabilities of surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years, respectively. These results suggest a sustained IOP control and a promising long-term outcome. The study also identified age as a potential risk factor for surgical failure, highlighting the importance of considering patient-specific factors in treatment planning.

A Promising Future for Glaucoma Management

The study's findings suggest that Ahmed valve implant surgery with adjunctive MMC and selective 5-FU injection, along with a needling procedure, offers a valuable treatment option for refractory glaucoma. This combined approach demonstrates good success rates in controlling IOP and reducing the need for glaucoma medications. While further research is needed to validate these results in larger, randomized controlled trials, this study provides a promising step forward in the management of challenging glaucoma cases, offering hope for improved visual outcomes and a better quality of life for patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is refractory glaucoma and why is it difficult to treat?

Refractory glaucoma refers to cases where the condition does not respond well to traditional medical and surgical treatments. This often involves high intraocular pressure (IOP) that continues to damage the optic nerve despite interventions like medications or procedures such as trabeculectomy. These cases are difficult because they require innovative approaches to control IOP and prevent further vision loss, which is why new techniques like the one using Ahmed valve implants with Mitomycin C and 5-Fluorouracil injections are being explored.

How does the Ahmed valve implant work, and why is it used in glaucoma treatment?

The Ahmed valve implant is a glaucoma drainage device (GDD) designed to regulate the outflow of aqueous humor, the fluid inside the eye. By creating a pathway for this fluid to drain, the Ahmed valve helps to reduce intraocular pressure (IOP). The implant is particularly useful in cases of refractory glaucoma, where other treatments have failed to adequately control IOP. The valve effectively bypasses the blocked or dysfunctional natural drainage pathways in the eye, offering an alternative route for fluid outflow and thus reducing pressure on the optic nerve. However, the effectiveness can be limited by fibrosis and scarring around the implant.

What role do Mitomycin C (MMC) and 5-Fluorouracil (5-FU) play in the combined surgical approach described?

In the combined surgical approach, Mitomycin C (MMC) and 5-Fluorouracil (5-FU) are used to enhance the success of the Ahmed valve implant. MMC is an antifibrotic agent, applied during surgery to the scleral bed to prevent scarring and fibrosis around the implant. This helps maintain the patency of the drainage pathway and promotes better aqueous humor outflow, reducing IOP. 5-FU is administered postoperatively through selective injections with a needling procedure. The injections are tailored to each patient's needs, helping to manage IOP and any potential complications, thus improving the long-term outcomes of the surgery.

What were the key findings of the study regarding the combined use of the Ahmed valve implant, MMC, and 5-FU?

The study revealed several key findings. The combined approach demonstrated a significant reduction in preoperative intraocular pressure (IOP), from 32.8 ± 7.5 mm Hg to 14.0 ± 4.2 mm Hg postoperatively. Furthermore, there was a significant decrease in the number of glaucoma medications required. Kaplan-Meier survival analysis showed sustained IOP control, with success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years, respectively. The study also identified age as a potential risk factor for surgical failure, indicating the importance of patient-specific factors in treatment planning.

What are the potential benefits and limitations of this new surgical approach for refractory glaucoma, and what does the future hold?

The potential benefits of the combined approach include good success rates in controlling intraocular pressure (IOP), reducing the need for glaucoma medications, and offering a promising treatment option for refractory glaucoma. However, a limitation is that further research is needed to validate these results in larger, randomized controlled trials. The future of glaucoma management with this method looks promising, as it may lead to improved visual outcomes and a better quality of life for patients. The combination of the Ahmed valve implant, Mitomycin C (MMC), and selective 5-Fluorouracil (5-FU) injections represents a significant advancement in the fight against this challenging condition, though it is important to consider individual patient factors and ongoing research to refine and optimize these treatments.