OBJECTIVE To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in Asian patients with refractory glaucoma. METHODS The study was a retrospective interventional case series conducted at a single institution between January 2004 and January 2006. The study population included 91 patients (91 eyes). RESULTS A total of 70 patients were successfully treated (74.5%). Postoperatively, the median intraocular pressures declined significantly to 13 mm Hg (interquartile range: 10-20 mm Hg) on day 1 (P<0.001) and 17 mm Hg (interquartile range: 12-19 mm Hg) at the last follow-up examination (P<0.001). The cumulative probability of success according to Kaplan-Meier life-table analysis was 74% at 12 months and 43% at 2 years. Hazard of failure increased slightly with age, HR: 1.03 (95% confidence interval (CI)=1.00-1.05; P=0.044). The most common complication was hyphaemia at 12.77%. There were no serious complications involving loss of visual acuity or sight. CONCLUSIONS AGV implantation is an acceptable treatment for refractory glaucoma in high-risk patients with few additional options.