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Megan Chambers, N. Douglas Baker, E Mitchel Opremcak, Robert Derick; Pars Plana Glaucoma Tube Drainage Device Implantation Combined with Vitrectomy and 20% SF6 Gas Tamponade for Treatment of Uncontrolled Uveitic Glaucoma in Patients with Juvenile Idiopathic Arthritis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6148. doi: https://doi.org/.
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To report the long-term efficacy of the posterior placement of glaucoma tube drainage device combined with vitrectomy and gas tamponade for the management of uveitic glaucoma associated with juvenile idiopathic arthritis (JIA).
This is a retrospective chart review of 7 patients (11 eyes) who underwent combined pars plana vitrectomy with 20% SF6 gas and posterior placement of Baerveldt or Molteno III tube with patch graft for treatment of uveitic glaucoma refractory medical management and/or surgical intervention. Outcomes measured were the pre and postoperative intraocular pressure (IOP), number anti-glaucoma medications, visual acuity, and postoperative complications. Results were evaluated with paired t-test.
Mean follow up after the combined glaucoma drainage tube implantation and vitrectomy was 60 months (range 6 - 218 months). The average preoperative IOP was 37 (range 23-50) and average postoperative IOP was 13 mmHg (range 5-18) with an overall reduction in IOP of 65% (p=0.0001). The number of antiglaucoma medications required to control IOP decreased on average from 2.6 to 0.8 (p=0.0001). Visual acuity was unchanged or improved in 91% of eyes. There were no significant visually threatening complications; however one eye required repeat vitrectomy for vitreous strand obstructing the drainage tube.
The placement of glaucoma tube drainage device in combination with vitrectomy and gas tamponade in patients with JIA for uncontrolled uveitic glaucoma was successful and resulted in an overall reduction of IOP and number of glaucoma medications without significant decrease in vision or threatening complications.
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