Abstract
Purpose :
The use of glaucoma drainage devices (GDDs) has been associated with corneal decompensation. Corneal grafting is often performed to replace a damaged cornea. We recently found the 15-year risk of corneal grafting following GDD implantation to be 44% (5 year risk was 14%, similar to previous reports). Many mechanisms could contribute to corneal endothelial cell loss and corneal decompensation in patients with GDD. We have seen an association between advanced age and an increased risk of corneal decompensation, but no association with the number of previous ocular surgeries or sex. However, additional factors associated with corneal decompensation, which we define as the need for corneal grafting on patients with GDD, need further investigation.
Methods :
This retrospective cohort study utilized the medical records for patients that underwent GDD placement. Our inclusion criteria were patients aged >=18 who received a GDD (at Mayo Clinic or outside institution) and corneal graft in the same eye between 1/1/1994 and 12/31/2017 at Mayo Clinic in Rochester, MN. Data including procedure dates, patient age, race, and sex, number and type of surgeries prior to GDD and corneal grafts were recorded. Demographic factors were compared using student t-test for continuous variables or chi square test for categorical variables.
Results :
The number of patients receiving GDDs in our cohort was 557. Of these, 484 patients did not go on to receive a corneal graft. 73 patients received at least 1 GDD and required a corneal graft in the same eye. There was no significant difference in corneal outcomes in terms of progression to corneal graft based on patient sex (p=.64), race (p=0.83), device type (p=0.19), prior incisional procedures (0.19), injections (0.14), or laser procedures (0.19). However, superior temporal placement performs better than other locations (p=0.03).
Conclusions :
There was no association between corneal grafting in patients with GDD placement and sex, race, GDD type, prior incisional procedures, injections, or laser procedures. However, superior temporal placement of GDDs was associated with lessened need for corneal grafts. There are other factors such as medications used prior or after GDD placement or medical comorbidities that may put patients at increased risk for corneal decompensation. Further study of these associations might better predict corneal outcomes for patients undergoing GDD placement.
This is a 2020 ARVO Annual Meeting abstract.