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Arkadiy Yadgarov, Dan Liu, Albert S Khouri; Surgical Outcomes of Tube Shunt Implantation for Medically Uncontrolled Traumatic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6497.
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© ARVO (1962-2015); The Authors (2016-present)
To date, only a few small case series have been reported on outcomes of traumatic glaucoma after either Baerveldt or Ahmed tube implantation. We describe the outcomes and the surgical success rate of Ahmed or Baerveldt tube shunt implantation in eyes with medically uncontrolled traumatic glaucoma.
A retrospective review of charts was carried out and identified forty patients with traumatic glaucoma that required tube shunt implantation between 2009 and 2015. Inclusion criteria for the study were an intraocular pressure (IOP) > 21mmHg on at least two pre-operative visits despite maximum tolerated glaucoma medications, a known history of globe trauma, and a minimum 3-month post-operative follow up. Seventeen eyes met inclusion criteria. Main outcome measure was surgical success at last follow up. Qualified success was defined as IOP ≤ 21 mmHg on ocular hypotensive medications; complete success was defined as average IOP ≤ 21 mmHg without medication. Overall success rate was a combination of qualified and complete success rate. Failure was defined as IOP > 21 mmHg despite maximum tolerated medication, IOP persistently < 6 mmHg, tube explantation, enucleation, or progression to no light perception vision.
Mean pre-operative intraocular pressure was 34.1 +/- 8.2 mmHg on an average 3.1 ocular hypotensive medications. Ten eyes received an Ahmed valve shunt and seven eyes received Baerveldt tube shunt. The mean post-operative intraocular pressure was 16.1 +/- 3.5 mmHg on an average 1.3 ocular hypotensive medications at a mean follow up of 10 months. There was a statistically significant lowering of pre-operative IOP at all post-operative time points (Figure 1, p<0.05) There were two cases of surgical failures, one case due to hypotony and one case due to tube extrusion and subsequent explantation. Overall surgical success rate was 88% at an average ten-month follow up. Qualified success rate was 53%, complete success rate was 35%, and the failure rate was 12% of cases at last follow up.
Implantation of an Ahmed or Baerveldt tube provides successful control of intraocular pressure in most patients with medically uncontrollable traumatic glaucoma.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Pre- and post-operative average intraocular pressure measurements (with 95% confidence bars).
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