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Maya S. Bitar, Judith Mohay; Outcomes of Glaucoma Drainage Devices in a Resident Teaching Facility: A Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3718.
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To determine the characteristics of patients implanted with aqueous shunts for refractory glaucoma in a resident eye clinic serving a challenging population of low socio economic status with multiple comorbidities and to evaluate the efficacy and complications of drainage devices in this setting.
Retrospective chart review of consecutive records of all patients who were treated with a glaucoma drainage device in the resident eye clinic at the Kentucky Lions Eye Center within the past 10 years and who met the inclusion criteria of at least 3 months of post operative follow-up. Outcome measures at 3, 6, 12 months, every year thereafter and at last follow-up included intraocular pressure (IOP), Snellen visual acuity, number of glaucoma medications, and complications.
A total of 28 eyes of 23 patients were included in the study with a mean follow-up period of 33 months (range 3-223). Seventy six percent of eyes received an Ahmed valve implant (FP7 Flexible Plate, New World Medical, Inc., CA). Thirty eight percent were diagnosed with neovascular glaucoma. At one year postoperatively, IOP significantly decreased from 37.4±16.5 to 18.3±6 (P= 0.0000074). Complications occurred in 55% of eyes but only 13% necessitated a surgical intervention. Qualified success rate, which was defined as intraocular pressure between 5 and 21 mmHg and no loss of light perception, was 50%. Neovascular glaucoma eyes had significantly higher initial IOP than primary open angle glaucoma patients (46.9±17 versus 27.2±7.6, P=0.006) and qualified success rates were 50% and 85.7% respectively.
In contrast to cataract surgery, very few studies have evaluated resident outcomes in glaucoma drainage device implantation. Our study showed that tube shunt surgery was effective in lowering intra ocular pressure and relatively safe when performed by a surgeon in training and in a patient population with very advanced disease state.
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