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Daniel Moore, Sanjay Asrani; Outcomes of combined glaucoma tube shunt and fluocinolone acetonide implant placement in uveitic patients compared to outcomes in uveitic and open angle glaucoma patients with glaucoma tube shunt placement alone. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4752.
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To determine whether the outcomes of patients with uveitic glaucoma were different when a fluocinolone acetonide implant was combined with an Ahmed glaucoma valve (AV) (“FA/AV”) when compared to outcomes among patients with uveitic glaucoma or primary open angle glaucoma in whom an AV alone was placed (“uveitic AV” and “OAG AV”, respectively).
A retrospective review was conducted of consecutive patients evaluated at the Duke Eye Center between 2009-2012. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) between 5 and 18 mmHg and greater than 20% reduction of IOP at two consecutive visits without the need for additional IOP lowering, surgical procedure or removal of AV. Secondary outcome measures included IOP and number of glaucoma medications at the preoperative visit and postoperative months 1, 6, 12 and 24. Patients were excluded if they had undergone previous glaucoma surgery or if the AV was placed in the pars plana.
A total of 95 eyes (22 FA/AV, 27 uveitic AV, 46 OAG AV) were included in the study. The mean time of surgical success was significantly greater in uveitic FA/AV (630±54 days) compared to uveitic AV (433±61 days) and OAG AV (375±51 days) (p=0.0025). There were no significant IOP or medication differences between the two uveitic groups at any post-operative visit. When compared to OAG AV, uveitic FA/AV had a significantly greater decrease in IOP at postop month 12 (p= 0.021), while uveitic AV had a significantly greater decrease in IOP at all postoperative visits (p<0.05 all time points). There were significantly fewer medications required in uveitic AV as compared to OAG AV at 12 and 24 months postop (p=0.033 and 0.05). Inadequate IOP control was the predominant cause of failure in all groups.
FA combined with AV in eyes with uveitic glaucoma had a longer duration of surgical success than patients with uveitic glaucoma or OAG treated with AV insertion alone. Further, following AV placement, eyes with uveitic glaucoma had greater IOP control on fewer medications than eyes with OAG. These data should compel further investigation evaluating the expanded use of steroid implants in selected glaucomatous eyes undergoing placement of a drainage device.
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