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Matthew E. Emanuel, Joshua D. Levinson, Annette Giangiacomo, Allen D. Beck; Diplopia Following Glaucoma Drainage Implant Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3724.
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To determine the frequency of new onset post-operative diplopia after glaucoma drainage implant surgery.
A retrospective chart review of all patients receiving a glaucoma drainage implant at a single institution over a 10 year period. The primary outcome was new onset diplopia, with a secondary outcome of persistent diplopia lasting greater than six months.
Seven hundred sixty-six patients were found to have received a glaucoma drainage implant between January 2000 and December 2010. Sixty-three (8.4%) were documented to have experienced diplopia or documented to have strabismus. Of these, 27 (3.5%) were known to have new-onset diplopia for greater than 6 months: 11 (1.4%) were treated with prism glasses; 3 (0.4%) had or were recommended to have strabismus surgery; and 13 (1.7%) did not have documented intervention. Of the remaining 36 patients, 13 (1.7%) had short-term self-resolving diplopia, 13 (1.7%) had diplopia either predating glaucoma surgery or attributed to another cause, and 10 (1.3%) were either lost to follow-up prior to 6 months or did not have sufficient documentation available.Type of glaucoma drainage devices (GDD) among all patients with diplopia (n = 63) included: 32 (50.8%) Ahmed FP7 GDD, 6 (9.5%) Ahmed S2 GDD, 23 (36.5%) Baerveldt GDD, and 2 (3.1%) Ahmed GDD of unknown type. Furthermore, of the 27 patients with persistent diplopia, 15 (55.6%) had Ahmed FP7 GDD, 2 (7.4%) had Ahmed S2 GDD, and 10 (37.0%) had Baerveldt GDD.The most common types of strabismus associated with persistent diplopia or short-term self-resolving diplopia were either a pure vertical deviation or a vertical deviation with concomitant exotropia.
Symptomatic diplopia after placement of a glaucoma drainage device is relatively common. Most patients have short term, self-limited diplopia or can be adequately treated with prism glasses. A small percentage of patients have refractory symptomatic diplopia persisting more than six months with very few requiring surgical intervention.
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