Abstract
Purpose:
The aim of this study is to report the long term outcomes of glaucoma drainage implant (GDI) surgery, Ahmed glaucoma implant (AGI) and Baervelt glaucoma implant (BGI), in uveitic glaucoma. Our hypothesis is that glaucoma drainage implants are able to effectively control intraocular pressure in the long term despite chronic intraocular inflammation with relatively low risk of postoperative complications.
Methods:
A retrospective review of patients with uveitic glaucoma who underwent GDI surgery from October 1, 2001 to December 31, 2012 was performed. Outcome parameters collected include visual acuity, intraocular pressure prior to surgery and at last follow up, type of glaucoma implant, number of glaucoma medications, prior and additional surgeries performed, and postoperative complications.
Results:
Fifty eyes of thirty nine patients were identified as undergoing glaucoma drainage implantation for management of uveitic glaucoma refractory to medical management. The average age was 34 years (range 5-69 years) with 11 males and 28 females. The most frequently performed surgery prior to the GDI was cataract extraction in eleven eyes followed by trabeculectomy in seven eyes. The average visual acuity (VA) preoperatively was 20/116 (logMAR 0.764, range 20/20 to hand motions) with an intraocular pressure (IOP) on average measuring 31mmHg (±10.7mmHG) on an average of 3 (±0.9) IOP lowering medications. Thirty one eyes underwent AGI and 19 eyes underwent BGI. The average follow up was 31 months (range 3 - 129 months). Postoperatively, the average VA was 20/150 (logMAR 0.874, range 20/20 to no light perception) with an average IOP of 12mmHG (±4.7mmHG) on an average of 1 (±1.3) IOP lowering medications - 16 eyes required no medications and all but one patient had IOP of ≤ 21mmHG on last follow up. The most frequently performed surgery after the GDI was tube revision in seven eyes, followed by cataract extraction in six eyes. Four eyes needed additional glaucoma procedures to manage intraocular pressure and all underwent transcleral cyclophotocoagulation. Complications included: two eyes with corneal decompensation requiring corneal transplantion, one case of endophthalmitis, one eye with total vision loss, one eye with suprachoroidal hemorrhage and one eye with hypotony.
Conclusions:
GDI effectively controls intraocular pressure in refractory uveitic glaucoma in the long term with relatively low risk of postoperative complications.
Keywords: 568 intraocular pressure •
557 inflammation