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Ryan Lamrani, Jae-Chiang Wong, Daniel Lee, Jonathan S Myers; Tube Shunt Surgery for Glaucoma Management: 12-year data. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1662 – A0157.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the long-term surgical outcomes of tube shunt (TS) surgery in patients with various types of glaucoma.
This retrospective chart review included patients who underwent TS surgery from 01/2006 to 01/ 2012. Patients with at least 10-years of follow-up data were included. Demographic and clinical data were collected at the pre-operative and post-operative follow-up visits until their latest visit (up to 01/2022). Surgical failures were defined as eyes that required reoperation or progressed to no light perception (NLP).
30 eyes of 26 patients were included. Mean age was 60.4±10.2 with a mean follow-up of 12.1±1.8 years after their first TS surgery. At the last visit, BCVA in the operated eye declined from 0.9±0.8 to 1.4±0.9 (p=0.006), CDR increased from 0.6±0.2 to 0.8±0.2 (p=0.01), VF progressed from -11.7±7.4 to -16.4±7.1 (p=0.53), IOP lowered from 31.0±11.0 mmHg to 12.5±11.9 mmHg (p<0.01) but lowered to 12.6 ±14.5 mmHg among patients with no reoperation (p<0.01), and glaucoma medication use reduced from 3.1±1.2 to 2.1±1.6 regardless of need for reoperation (p=0.013). 18 eyes (60%) had vision worse than 20/200 at their last visit and 2 eyes (6.7%) progressing to NLP. 6 eyes (20%) required additional TS surgery within 10-years with a mean IOP of 27.6±15.4 before the subsequent TS surgery. Among the 16 eyes with an Ahmed valve, 6 eyes (37.5%) required additional surgical intervention: 3 eyes underwent cyclophotocoagulations (CPC) (18.7%), 1 trabeculectomy (Trab) (6.2%), and 2 needed a second TS (12.5%). Among the 13 eyes with a Baerveldt implant, 4 eyes (31.2%) required additional surgery, 2 (15.6%) of which required two procedures. 1 eye required a new TS, 1 needed a Trab, 1 eye underwent Trab + CPC (7.8%), and 1 eye needed both a TS (switched to Ahmed valve) + CPC (7.8% each). During the follow-up period, 7 eyes (23.3%), 4 eyes (13.3%), and 3 eyes (10%) required one, two, and three TS revisions, respectively.
In this long-term retrospective study, patients undergoing TS surgery overall had maintained a therapeutic IOP and useful vision. However, a significant portion of patients underwent additional procedures with approximately a third of eyes requiring additional surgical interventions.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
Table 1. Demographic Data
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