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Ann Leu Thomas, George H Tanaka; Glaucoma drainage device implantation vs transcleral diode laser cyclophotocoagulation in blind painful eyes with neovascular glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6653.
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Surgical options in patients with blind painful eyes due to neovascular glaucoma (NVG) include implantation of a glaucoma drainage device (GDD) or application of transcleral diode laser cyclophotocoagulation (CPC). We performed a retrospective chart review to compare the outcomes of these two interventions.
Patient charts from April 2001 to August 2017 of one glaucoma surgeon were reviewed (some pre-dated anti-VEGF). Adult patients with NVG and visual acuity (VA) of count fingers or worse who underwent GDD implantation (N=16) or CPC (N=16) were included. Patients were excluded if they underwent prior treatment or had VA improvement due to other surgical interventions such as cataract surgery. Clinical outcomes studied included change in VA, intraocular pressure (IOP), IOP-lowering medications and pain; failure-free survival; need for additional interventions; complications; and number of follow-up visits. Failure was defined as a need (recommended or performed) for additional surgical intervention or a decrease in VA. Statistical analysis was performed with the t test, chi-square test, and rxc contingency table.
The proportion of patients with VA increase and decrease was higher after GDD (increased VA: 0.19 CPC vs 0.44 GDD; decreased VA: 0.063 CPC vs 0.38 GDD). Both interventions reduced the IOP (-25 mmHg for CPC vs -34 mmHg for GDD, p=0.16) and need for IOP lowering drops (-1.6 vs -2.5 drops, respectively, p=0.12). No patients were on systemic IOP lowering medications post-operatively. Both interventions reduced eye pain, but pain was not consistently reported. The proportions of patients meeting failure criteria (0.375 vs 0.5, p=0.48) and needing additional intervention were similar (0.38 vs 0.27, p=0.45). Complication rates were similar (0.69 vs 0.69) but the types of complications tended to be more serious in GDD. The number of follow-up visits was significantly higher in the GDD group (7.5 vs 17 visits, p<0.01).
A higher proportion of patients had VA changes with GDD, including increased VA. Both interventions lowered IOP, number of meds, and pain. The complication rate and need for additional interventions were similar. However complications with GDD were more complex, requiring more intensive follow up. This information can better inform clinical decisions of patients and providers regarding blind painful eyes with NVG.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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