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Umair Iqbal, Manpartap Bal, Ralf Buhrmann, Chloe Gottlieb; Comparison of IOP and postoperative complications in patients undergoing tube shunt or trabeculectomy surgery for uveitis-related intraocular pressure elevation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4793.
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To compare rates of successful IOP reduction and complications in patients with uveitis-related intraocular pressure elevation undergoing tube shunt or trabeculectomy surgery.
Patients were identified by an electronic search of one surgeon’s billing records for glaucoma surgical procedure codes. Inclusion criteria were: trabeculectomy or tube shunt surgery with diagnosis of uveitic glaucoma or elevated intraocular pressure associated with uveitis. A chart review was conducted and data tabulated for age, surgery type, complications and IOP at 6 months and 1 year. Eyes lost to follow-up were excluded from the analysis.
Data were collected from 28 eyes of 26 patients of whom 14 were male (53.8%) and 12 (46.2%) were female. The mean age at the time of surgery was 53.5 ± 16.5 years (range 23-89 years). Most eyes underwent trabeculectomy surgery with MMC (23 eyes, 82.1%) while an aqueous tube shunt was implanted in 5 eyes (17.9%). Four eyes (80%) had Baerveldt valve implanted and 1 (20%) had Ahmed valve implantation. Data was collected at 6 months and 1 year. At 6 months, 21 eyes (91.3%) in the trabeculectomy group met the success criteria of IOP ≤21mmHg while 4 eyes (80%) met the success criteria in tube shunt group. By 1 year, 5 eyes (2 trabeculectomies and 3 tubes) were lost to follow-up and tube shunt failed in 1 eye which required a second operation. Therefore, 19 eyes (90.5%; 21 eyes) in trabeculectomy group met the success criteria of IOP ≤21mmHg while 1 eye (50%, 2 eyes) in tube shunt group met the success criteria. Moreover, within the trabeculectomy group, 9 eyes (39.1%; 23 eyes) at 6 months required one or multiple post-op needling procedures to control IOP and by 1 year no additional needling was required in the remaining 21 eyes. Bleb leaks occurred in 4 eyes (17.4%, 23 eyes) at 6 months.
In the patients studied, trabeculectomy with MMC was the most common type of surgical treatment. By the end of 6 months, 91.3% eyes met success criteria in trabeculectomy group compared to 80% eyes in tube group. These numbers decreased to 90.5% and 50% respectively by 1 year. Complications also occurred after trabeculectomy which required needling or leak repairs to control IOP. No such complications threatening IOP control occurred in the tube shunt group.
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