Abstract: Objective  To investigate the efficacy and safety of combined viscoelastic and antimetabolites injection in the early bleb encapsulation after Ahmed glaucoma valve implantation. Design Retrospective case series. Participarts Seventy nine (84 eyes) patients with glaucoma who underwent Ahmed glaucoma valve implantation in The Eye Hospital of WMU at Zhijiang from April 2018 to September 2019 were included. Methods Injection was performed under the slitlamp. A needle was inserted into to the bleb through the incision 2 mm behind the middle point of the two fixative sutures between the plate and sclera. The viscoelastic agent with 0.4 ml volume was injected into the bleb and was pushed backwards. Thereafter, antimetabolite agent of 5-fluorouracil or MMC was subconjunctivally injected around the drainage plate. If intraocular pressure < 21mmHg, complete success was defined as not using glaucoma drugs. Main Outcome Measures The time of intraocular pressure ≥ 21 mmHg, intraocular pressure at the time of encapsulation, Intraocular pressure at the followed up point after injection, anterior chamber depth after injection, injection times, types of glaucoma drugs used. Results Eighty four eyes underwent AGV implantation, 48 (57.14%) eyes occurred intraocular pressures elevation after surgery. The mean duration of elevation was 24.6±14.5 days. Viscoelastic agents alone or combined with antimetabolites (5-FU or MMC) were injected in 48 eyes. Three months after injection, 14 eyes (38.9%) were complete success and 36 eyes (75%) were modified success respectively. There were 15 eyes (31.25%) with transient shallow anterior chamber and 5 eyes (10.41%) with anterior chamber disappearing. Multiple factor analysis showed that the intraocular pressure at the time of early encapsulation after glaucoma valve surgery was a factor influencing the effectiveness of soft separation (P=0.026). Conclusion Soft separation by viscoelastic agents in combination with antimetabolites is safe and effective to separate early encapsulated bleb after Ahmed valve implantation. (Ophthalmol CHN, 2021, 30: 25-29)

Key words: Ahmed glaucoma valve, viscoelastic, bleb encapsulation