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Brandon James Wong, Grace Marie Richter, Narsing A Rao, Damien C Rodger; Long-term outcomes of glaucoma drainage implants in Vogt-Koyanagi-Harada disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3745.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the prevalence of ocular hypertension and glaucoma in patients with Vogt-Koyanagi-Harada disease (VKH) and to report the long-term outcomes of glaucoma drainage implant (GDI) surgery in patients with VKH.
Retrospective chart analysis of patients diagnosed with VKH from September 2008 to November 2016. Demographics of patients with ocular hypertension or glaucoma are reported as well as analysis of patients undergoing GDI surgery and the outcomes of surgery.
Of 37 patients who were diagnosed with VKH in this time period, 8 patients (21.6%) had ocular hypertension (13 eyes) that was medically controlled and 11 patients (29.7%) had ocular hypertension or glaucoma refractory to medical therapy requiring GDI surgery (19 eyes). The average age of patients undergoing GDI surgery was 35.1±13.6 years old, mean logMAR visual acuity was 0.93±0.84, mean IOP prior to surgery was 38±12.1 mm Hg, and mean number of ocular hypotensive medications was 3.4±0.8. Three eyes had iris bombe with angle closure, 12 eyes had open angles with steroid response, and 4 eyes had mixed mechanism glaucoma. Mean time to GDI surgery was 15.5±16.7 months. Seven eyes received a Baerveldt implant (four with combined cataract surgery) and 12 eyes received Ahmed implants (four with combined cataract surgery). The average follow up time after surgery was 41.5±31 months. At final follow up, mean logMAR visual acuity at final follow up was 0.56±0.72 (p=0.18), mean IOP was 15.5±5.8 mmHg (p<0.0001), and mean number of ocular hypotensive medications was 1.8±1.1 (p<0.0001). The initial IOP in patients with Baerveldt implants was 31.9±10.5mm Hg compared to 41.6±11.9mm Hg in patients with Ahmed implants (p=0.92). Eyes that received a Baerveldt implant had a final IOP of 12.1±5.9mm Hg compared to 17.4±4.9mm Hg in Ahmed implants (p=0.51). More post-operative complications were observed in eyes with Baerveldt implants, including early choroidal detachments (2 eyes), tube exposure (3 eyes), and tube failure requiring further surgery (1 eye).
Baerveldt and Ahmed implants are effective in lowering IOP in patients with VKH in the long term. There is no significant difference in IOP reduction between Baerveldt and Ahmed implants. Post-operative complications are relatively more common in Baerveldt implants. GDI surgery can reduce the number of ocular hypotensive medications required to control IOP in VKH patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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