Anatomic Considerations in the Implantation of the Ahmed Glaucoma Valve-Reply

In reply  We would like to thank Melamed and colleagues for pointing out that the construction of the Ahmed glaucoma valve results in a more posterior location of aqueous outflow, and how, in their experience, it may allow a more anterior placement of the implant without compromising function. In general, anterior placement of seton plates may be associated with an increased risk of conjunctival breakdown and implant extrusion. The risk of these complications may also be greater with a limbal-based rather than a fornix-based conjunctival flap.We reported¹ that placement of the Ahmed glaucoma valve at least 8 to 10 mm behind the limbus (as suggested by the manufacturer) in the superonasal quadrant may place the optic nerve at risk of impingement. We recommended that caution be exercised in instances when this implant must be placed in either the superonasal quadrant of eyes with normal axial lengths or in