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Veena Rao, Joseph Christenbury, Paul P Lee, Leon W Herndon, Pratap Challa; Simultaneous Implantation of Two Glaucoma Drainage Devices for Uncontrolled Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3194.
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To investigate a novel method of treatment for uncontrolled glaucoma with simultaneous double glaucoma tube implantation using a valved Ahmed implant for immediate intraocular pressure (IOP) control and a non-valved Baerveldt tube for better long-term IOP control. Outcome measures including IOP, visual acuity, visual field, cup-to-disc ratio, glaucoma medication requirement, and post-operative complications were analyzed.
A retrospective review of records was performed for 61 eyes (59 patients) with advanced glaucoma receiving simultaneous implantation of an Ahmed and Baervelt glaucoma implant for uncontrolled IOP between October 2004 and October 2009 at a single institution. IOP, visual acuity, visual field, number of glaucoma medications, cup-to-disc ratio, and postoperative complications were analyzed. Records of these patients were reviewed for preoperative data and at postoperative day 1, week 1, month 1, month 3, month 6, year 1, and then yearly until year 5.
Primary open angle glaucoma was the most common etiology of glaucoma (54%) with other etiologies, including neovascular glaucoma and normal tension glaucoma, also included. 81% of these patients had a history of prior glaucoma surgery that did not result in sufficient IOP reduction. A significant reduction in IOP was seen as early as post-op day 1 [approximately 50% reduction; pre-op IOP 25.08 ± 10 mmHg (SD) vs POD1 IOP 12.51 ± 7.0 mmHg]. Similar reductions in IOP persisted through post-operative year 5. Patients also enjoyed a reduction in number of glaucoma medications by post-op month 3 that persisted over the follow-up period. Cup-to-disc ratio and visual fields remained stable over the first postoperative year. Overall complication rate and visual acuity decrease were similar to that reported for single glaucoma drainage device surgery.
Patients with uncontrolled glaucoma may safely benefit from treatment with simultaneous double glaucoma tube implantation for improved immediate and long-term IOP control as well as simplified medication regimen. This study suggests this technique as a promising novel approach for management of recalcitrant IOP in advanced glaucoma.
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