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Ingrid Chang, Divakar Gupta, Philip Chen, Mark A Slabaugh, Gurunadh Vemulakonda; Outcomes of Glaucoma Drainage Implant vs Combined Glaucoma Drainage Implant and Fluocinolone Acetonide Intravitreal Implant for Management of Uveitic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2711.
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To assess the safety and efficacy of glaucoma drainage implant (GDI) vs GDI combined with fluocinolone acetonide intravitreal implant (Retisert; Bausch and Lomb Inc) in the treatment of chronic uveitic glaucoma.
Retrospective case review of patients with uveitic glaucoma who underwent GDI or GDI combined with Retisert performed by a single glaucoma surgeon (MAS for GDI or MAS and GAV for combined cases) from January 2006 to June 2014. Outcome measures included intraocular pressure (IOP), glaucoma medication use, complications, and additional glaucoma surgery.
31 eyes in 25 patients were studied, with a mean age (±SD) of 45.1± 18.1, and mean follow-up duration of 70 weeks. There were 14 eyes in the GDI only group (13 Ahmed, 1 Baerveldt), and 17 eyes in the combined group (17 Ahmed). Prior to surgery, the GDI only group had a mean IOP of 32.0 ±8.35 mmHg on mean of 3.1 ±0.88 topical glaucoma medications. The combined group had a mean IOP of 18.5± 7.08 mmHg on a mean of 1.56 ±1.55 topical glaucoma medications. The pre-operative mean IOP and number of glaucoma drops were lower in the combined group (p<0.001 and p=0.002, respectively). At one year, mean IOP was 15.4 ±6.21 mmHg in the GDI group and 12.2 ±3.19 mmHg in the combined group (p=0.16). At one year, the mean IOP was lower compared to pre-operatively for both GDI only and combined group (p<0.001 and p=0.01 respectively). Glaucoma medications at one year were 1.57 ±0.98 in the GDI only group vs 0.08 ±0.29 in the combined group (p<0.001), which were significantly lower compared to pre-treatment for both GDI alone and combined group (p=0.002 and p=0.003, respectively). Hypotony occurred in 3 patients (21.4%) in the GDI only group and 3 patients (17.7%, p= 0.81) in the combined group. Hyphema occurred in 1 patient (7.1%) in the GDI only group, and endophthalmitis occurred in 1 patient (7.1%) in the GDI only group. One patient (5.9%) in the combined group received a second Ahmed GDI for intraocular pressure control.
Both the GDI only and combined method were effective in lowering IOP and reducing the number of glaucoma medications at 1 year after treatment. The use of fluocinolone acetonide intravitreal implants did not result in worse IOP control nor more complications. Complications included hypotony, hyphema and endophthalmitis.
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