Ahmed Valve Implant Surrounded by Dissolving Scar Tissue

New Hope for Glaucoma Patients: Combining Mitomycin C and 5-Fluorouracil in Ahmed Valve Implant Surgery

Rhea Morgan in Health & Wellness December 2025 • 5 min read.

"A Korean study reveals promising results using a combined surgical approach to tackle refractory glaucoma, offering a potential pathway to better vision outcomes."

Glaucoma, a leading cause of irreversible blindness, poses a significant challenge to ophthalmologists worldwide. Refractory glaucoma, a particularly difficult form of the disease, often resists conventional treatments like medications and laser therapy, leaving patients with limited options and a concerning prognosis. The need for innovative surgical techniques to manage this condition is paramount.

One such surgical intervention is the Ahmed valve implant, a device designed to regulate intraocular pressure (IOP) by creating a new drainage pathway for fluid within the eye. However, the long-term success of these implants can be compromised by scarring and fibrosis around the implant site, hindering fluid outflow and leading to increased IOP once again. This is where adjunctive therapies come into play.

Researchers have been exploring the use of antimetabolites, such as mitomycin C (MMC) and 5-fluorouracil (5-FU), to modulate the healing process and prevent excessive scarring after glaucoma surgery. A recent study published in the Journal of the Korean Ophthalmological Society investigates the effectiveness of combining MMC during Ahmed valve implantation with selective postoperative 5-FU injections in patients with refractory glaucoma. The results offer a glimmer of hope for improved surgical outcomes.

Tackling Refractory Glaucoma: How Does the Combined Approach Work?

Ahmed Valve Implant Surrounded by Dissolving Scar Tissue

The study, conducted by researchers in South Korea, retrospectively analyzed the outcomes of 40 eyes of 40 patients who underwent Ahmed valve implant surgery with adjunctive MMC. The Ahmed valve was implanted after a 5-minute application of 0.04% MMC to the sclera. What sets this study apart is the selective use of 5-FU injections postoperatively, guided by the patient's IOP. A needling procedure, a technique to release scar tissue around the implant, was also performed when necessary.

The success of the surgery was evaluated based on several factors, including IOP control, the number of glaucoma medications required, and the occurrence of complications. A hypertensive phase, defined as IOP higher than 21 mm Hg within 3 months after surgery, was closely monitored. Surgical failure was defined as IOP higher than 18 mm Hg at two consecutive visits, regardless of medication use, or the need for additional glaucoma surgery.

Mitomycin C (MMC): Applied during the initial surgery to reduce scarring.
Ahmed Valve Implant: Surgically placed to create a new drainage pathway for fluid.
Selective 5-Fluorouracil (5-FU) Injections: Administered post-operatively based on IOP levels to further prevent scarring.
Needling Procedure: Used to release scar tissue around the implant site as needed.

The results of the study demonstrated a significant reduction in IOP, from an average of 32.8 mm Hg before surgery to 14.0 mm Hg after surgery. The number of glaucoma medications needed also decreased substantially. Kaplan-Meier survival analysis, a statistical method to estimate the probability of an event occurring over time, showed cumulative surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 years post-surgery, respectively. This suggests that the combined approach provides sustained IOP control over the long term.

Hope for the Future

The study's findings suggest that Ahmed valve implant surgery with adjunctive mitomycin C and selective 5-FU injection with a needling procedure shows promise for managing refractory glaucoma. However, the authors acknowledge that further research is needed to confirm these findings and to identify the optimal parameters for 5-FU injection and needling. A control group without MMC would help clarify the specific contribution of this agent. Nevertheless, this study provides valuable insights into a potential strategy for improving the long-term outcomes of glaucoma surgery and preserving vision for patients with this challenging condition.

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Everything You Need To Know

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

Refractory glaucoma is a particularly severe form of glaucoma that doesn't respond well to conventional treatments like medications and laser therapy. This makes it a significant challenge for ophthalmologists. The primary difficulty lies in the disease's progression, which often leads to irreversible vision loss. The condition's resistance to standard treatments necessitates the development of innovative surgical techniques and adjunctive therapies to manage and slow down the progression of this challenging condition.

How does the Ahmed valve implant work in treating glaucoma?

The Ahmed valve implant is a surgically placed device designed to regulate intraocular pressure (IOP) in the eye. It works by creating a new drainage pathway for the fluid (aqueous humor) within the eye. This new pathway bypasses the eye's natural drainage system, which may be blocked or damaged in glaucoma patients, thereby reducing the pressure and preventing further damage to the optic nerve.

What is the role of Mitomycin C (MMC) and 5-Fluorouracil (5-FU) in this glaucoma treatment approach?

Mitomycin C (MMC) and 5-Fluorouracil (5-FU) are antimetabolites used as adjunctive therapies in this surgical approach to manage refractory glaucoma. MMC is applied during the Ahmed valve implant surgery to reduce scarring around the implant site, which can compromise the device's long-term effectiveness. Postoperative selective 5-FU injections are administered based on the patient's intraocular pressure (IOP) levels to further prevent scarring. This combined use aims to modulate the healing process and enhance the success of the surgery by maintaining a functional drainage pathway.

Can you explain the needling procedure and its importance in this combined approach?

The needling procedure is a technique used to release scar tissue that may form around the Ahmed valve implant site. Scar tissue can obstruct the drainage pathway created by the implant, leading to increased intraocular pressure (IOP). The needling procedure is performed as needed to address this issue. This procedure helps to ensure that the implant functions effectively, allowing proper fluid drainage and IOP control, which is critical for the long-term success of the surgery and for preserving the patient's vision. The decision to perform a needling procedure is guided by a patient's IOP levels postoperatively, making it a critical part of the approach.

What were the key outcomes of the Korean study regarding the combined use of Mitomycin C and 5-Fluorouracil with the Ahmed valve implant, and what do they mean for patients?

The Korean study showed promising results with the combined approach. The study found a significant reduction in intraocular pressure (IOP) from an average of 32.8 mm Hg before surgery to 14.0 mm Hg after surgery. Additionally, the number of glaucoma medications required decreased substantially. Kaplan-Meier survival analysis indicated that the surgical success rates were 82.5% at 1 year, 79.6% at 2 years, 72.7% at 3 years, and 58.8% at 4 years post-surgery. These outcomes suggest that the combined approach provides sustained IOP control over the long term. This means that patients with refractory glaucoma may have a better chance of preserving their vision and preventing further vision loss, offering new hope compared to the limited options previously available.