Purchase this article with an account.
Victor Li Quan, Dianna Liu, Noureen Khan, Angelo P Tanna, Lisa Rosenberg; Outcomes of Tube Shunt Surgery By Fellows in Training. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4965.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Proficiency in glaucoma surgery is a central goal of glaucoma fellowship training. Outcomes of glaucoma drainage device (GDD) surgery by fellows are important to determine areas for improvement and for patient safety. This is a retrospective, observational study that evaluates outcomes of tube shunt surgery performed by glaucoma fellows as primary surgeon.
We identified 136 eyes that underwent either Ahmed or Baerveldt tube shunt implantation by a fellow with attending surgeon supervision at the Feinberg School of Medicine, Northwestern University, from 2011 to 2016. We included 105 eyes with either uncontrolled open- or closed angle glaucoma. Only one eye per patient was included. All eyes had at least one year of follow-up. Primary outcome measures compared intraocular pressure (IOP), number of IOP lowering medications, and visual acuity before and after surgery. The number and variety of intra-operative and post-surgical complications and requirement for additional surgical intervention were analyzed.
Of the eyes studied so far, implantation of a GDD reduced IOP by 9.3 ± 12.4 mmHg, 12.3 ± 11.2 mmHg, 14.0 ± 9.6 mmHg, 14.6 ± 9.8 mmHg at post-operative month 1, 3, 6, 12 respectively. P < 0.001 for all time points compared to baseline. Overall, there was a 14 mmHg or 45% reduction in IOP after 1 year. The number of IOP lowering medications decreased after implantation of a GDD by 1.3 ± 2.2, 1.3 ± 2.0, 1.4 ± 2.2, and 1.0 ± 2.4 at post-operative month 1, 3, 6, 12 respectively. P < 0.001 for all time points compared to baseline. Overall, one less medication was required at 1 year. LogMAR visual acuity at the most recent visit was 0.64 ± 0.7 compared to the pre-operative value of 0.51 ± 0.5, p = 0.087. Post-surgical complications such as choroidal detachment, tube occlusion, tube erosion, infection, or corneal decompensation was 36% (19/53). The need for secondary surgical intervention including placement of another tube shunt or trabeculectomy, removal of the drainage device, or tube irrigation was 23% (12/53).
Our preliminary results show that GDD surgery in the hands of glaucoma fellows have outcomes and complication rates that compare favorably to published GDD outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only