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Stergiani Gaki, André Rosentreter, Alexandra Lappas, Claus Cursiefen, Thomas S. Dietlein; Glaucoma Drainage Device Surgery After Previous Cyclodestructive Procedures: A Safe Approach?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3720.
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To investigate if previous cyclodestructive (e.g. cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery.
Retrospective analysis of 110 consecutive patients who had undergone glaucoma drainage device (Baerveldt 250 mm2 & 350 mm2 implant, AMO, USA) surgery between March 2006 and January 2010 in our departement and had a follow-up of 3 or more months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery before (II; 64 patients). Intraocular pressure (IOP), medication score, best corrected visual acuity and surgical treatments were recorded before and after drainage device implantation.
Patients of group I had a mean preoperative IOP of 32.1 mmHg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.3 mmHg (p = 0.16) and a mean medication score of 4.9 (p = 0.85). All patients who developed suprachoroidal hemorrhage (six cases) belonged to group I (6/47 = 12.8 %), no patient of group II (0/63 = 0 %) developed suprachoroidal hemorrhage (p = 0.003). Twelve patients developed late-onset (> 6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47 = 19.1 %) and three of them belonging to group II (3/63 = 4.8 %) (p = 0.02).
Although selection bias owing to retrospective study design should be considered, a history of previous cyclodestructive procedures before GDD surgery seems to be a risk factor for suprachoroidal hemorrhage and for late-onset postoperative hypotony.
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