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Obi Umunakwe, Susan Wakil, Atalie C. Thompson, Glenn J Jaffe, Terry Kim, Leon Herndon; Clinical outcomes following the triple procedure. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6646.
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© ARVO (1962-2015); The Authors (2016-present)
To describe clinical outcomes of patients following combined corneal transplantation, pars plana vitrectomy, and glaucoma drainage device implantation, otherwise known as the “triple procedure.”
Retrospective review of eyes that underwent combined corneal transplantation, pars plana vitrectomy, and glaucoma drainage device implantation or revision through the pars plana for management of glaucoma and corneal pathology between 8/1/2008 and 8/16/2018. Patients over 18 years of age and with at least one month of post-operative follow-up were included in the study. Descriptive statistics were used to describe surgical failure and time to re-operation. Wilcoxon signed-rank test was used to assess the change in intraocular pressure and number of glaucoma drops between pre-operative and post-operative visits.
Thirty-one eyes in thirty-one patients underwent the triple procedure. The intraocular pressure was significantly lower than baseline (23.4±10.1) on post-op day 1 (15.9±11.1, p=0.004), and remained significantly lower on the post-op week 1 (16.1±9.0, p=0.03), post-op month 3 (17.8±7.9, p=0.01), and post-op year 1 (17.2±8.9, p<0.001) visits. The number of total glaucoma medications prescribed also significantly decreased from 2.59±1.47 at the pre-operative visit to 0 drops on post-op day 1 (p<0.001), 0.82±1.37 at post-op week 1 (p=0.005), 1.24±1.27 at post-op month 1 (p=0.0002), 1.6±1.27 at post-op month 3 (p=0.004), and 1.88±1.11 at post-op year 1 (p=0.11). 52% (N=16/31) of eyes gained at least 1 line of vision by 1 year. Subjects were followed for an average of 95.4±124.7 weeks until additional surgery if needed. Rejection of the corneal transplant graft was observed in 19.4% (N=6/31) of eyes in an average of 50.1 +/- 19.9 weeks. The corneal graft failed in 45.2% (14/31) of eyes in an average of 80.9±73.5 weeks. Approximately 61.3% (N=19/31) of eyes underwent at least one additional surgery after an average of 65.3±52.3 weeks. Overall, 26.3% (5/19) of eyes underwent additional glaucoma surgeries and 47.4% (9/19) underwent repeat corneal transplants.
A majority of eyes achieved a significant decline in number of glaucoma drops and in intraocular pressure that was sustained at one year of follow-up after the triple procedure. Approximately half of patients gained at least one line in visual acuity. Overall the procedure was safe, although at least one additional surgery was required in more than half of patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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