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Monica A. Levine, Helen Koenigsman, Mark B. Sherwood, Fran M. Smith; Outcomes Of Sequential Glaucoma Drainage Device Versus Cyclophotocoagulation After Failure Of Primary Drainage Implant. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3711.
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The purpose of this study is to compare IOP lowering efficacy and visual outcomes of implantation of a second tube versus cyclophotocoagulation (CPC) when initial glaucoma drainage implant surgery (GDD) fails.
A retrospective chart review was conducted of patients that had received either a double plate Molteno implant or a Baerveldt implant. Those with inadequate IOP control requiring an additional procedure were identified. For eyes that had both CPC and subsequent tubes, we analyzed whichever procedure occurred first. A total of 46 eyes of 45 patients were identified with 28 having CPC and the remaining 18 having an additional GDD.
Mean pre-operative IOP for patients with an existing GDD was 24.8 mmHg and 27.5 mmHg on an average of 2.0 and 2.3 hypotensive medicines for the secondary GDD and the secondary CPC groups respectively. At 1 year post second procedure the mean IOP was 18.8 and 15.4 mmHg for the GDD and CPC groups respectively on a mean of 1.2 and 1.1 glaucoma meds; at two years, 16.9 and 18.6 on a mean of 1.3 and 0.9 meds; and at 3 years 16.5 and 17.6 mmHg on 1.7 and 1.6 meds respectively. 30% and 12.5 % of patients maintained an IOP between 6 and 18 mmHg throughout this 3-year period. Length of follow up from the time of the second procedure until either another glaucoma procedure or the most recent appointment (for eyes that required no further intervention) was four months to twenty one years with a mean of 4.5 years. 33% of second tube patients and 18 % of CPC patients required yet further glaucoma surgical intervention to control IOP, with average time between the second and third interventions being 72 months and 10 months respectively.Approximately 42% of the second GDD patients had a visual acuity of 20/100 or better pre-operatively, as opposed to 75% of the pre-CPC patients. 50% and 11% were improved or within 1 line of Snellen acuity from pre-op at 3 years.
Both procedures appear to lower IOP; however, a minority of patients required further surgery after the second operation and this tended to occur sooner following CPC. Neither second tubes nor CPC consistently maintained the patients’ visual acuity.
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