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Joshua Levinson, Annette Giangiacomo, Allen Beck, Paul Pruett, Anastasios Costarides; A Comparison of Sequential Glaucoma Drainage Device Implantation versus Cyclophotocoagulation Following Failure of a Primary Drainage Device. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4764. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare implantation of a sequential glaucoma drainage device (GDD) with trans-scleral cyclophotocoagulation (CPC) for intraocular pressure (IOP) control following failure of a primary GDD.
A retrospective chart review was performed for all patients who underwent GDD implantation at a single institution over ten years. Patients who required an additional GDD and/or CPC were identified and included for analysis. Success was defined as an absence of all of the following: loss of light perception, reoperation for glaucoma, and IOP >21 or < 6 at two consecutive visits after an initial three month period.
Thirty-two patients had a sequential GDD implanted, and 21 patients underwent CPC. These patients were statistically similar in regards to age, sex, race, glaucoma diagnosis, and number of previous incisional surgeries. The GDD cohort had a significantly lower pre-operative IOP (27.8 vs 33.2 mmHg, p=0.0275) and better LogMAR visual acuity (0.94 vs 1.41, p=0.0299). The mean length of follow-up was 37.9 months for the GDD group and 46.3 months for the CPC group. Both procedures significantly reduced IOP between the pre-operative and final visits. IOP decreased 40.7% (p<0.0001) in the GDD group and 56.3% (p<0.0001) in the CPC group. Success occurred in 62.5% (20 of 32) of the GDD group and 52.4% (11 of 21) of the CPC group. In survival analysis of the GDD and CPC groups, mean survival time was 61.5 and 62.2 months, respectively (p=0.873). There were 2 cases of endophthalmitis (2 of 32, 6.3%) in the GDD group, and none in the CPC group. Both cases were associated with exposure of the GDD through the conjunctiva. Corneal decompensation and/or graft failure was more likely to occur in patients undergoing additional GDD implantation (9 of 31, 29.0% vs 1 of 19, 5.3%, p=0.011).
The implantation of a sequential GDD and CPC are both effective means of reducing IOP in patients with refractory glaucoma following the failure of an initial GDD. CPC has traditionally been used in eyes that are considered poor candidates for surgery or those with poor visual potential. CPC after primary GDD failure warrants further investigation for use in eyes with preserved vision as it may provide similar IOP-lowering effects without exposing patients to the risks associated with intraocular surgery and implantation of an additional foreign body.
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