Abstract
Purpose :
The literature is mixed regarding the ideal surgical order for cataract extraction and glaucoma drainage device (GDD) implantation and whether cataract surgery (either before or after GDD implantation) affects GDD function. We performed a retrospective cohort study to assess the effect of lens status and cataract surgery on GDD efficacy, as many patients with glaucoma require both cataract extraction and GDD implantation at some point during their management.
Methods :
Retrospective review of 243 eyes of 216 patients with glaucoma at an academic center who underwent GDD implantation with ≥3 years follow up. Intraocular pressure (IOP) after GDD implantation (primary outcome) and number of glaucoma medications (secondary outcome) was recorded at 1, 3, 6, 12, 24, and 36 months after GDD implantation. Eyes were classified into three groups: (A) eyes phakic at time of implantation (group A, 65 eyes from 57 patients), (B) eyes phakic at time of implantation but subsequently underwent cataract surgery within 3 years of implantation (group B, 52 eyes from 45 patients), (C) eyes pseudophakic at time of implantation (group C, 126 eyes from 119 patients). Differences in outcome measures among the 3 groups were compared using generalized linear models adjusted by age and gender, and inter-eye correlation was accounted for by using generalized estimating equations.
Results :
Within group B, cataract surgery was performed a mean of 1.3±0.7 years after GDD implantation. Mean age at time of GDD implantation for groups A, B, and C were 52.4, 59.0, and 67.6 years, respectively (p<0.001). There were no statistically significant differences in mean IOP or number of medications among the 3 groups pre-operatively and at all study time points up to 3 years postoperatively (all p≥0.11, Table 1).
Conclusions :
Post-operative GDD efficacy as measured by IOP and number of glaucoma medications was not significantly different based on lens status at the time of GDD implantation. In this cohort, the sequence of surgeries had no significant impact on GDD outcomes or glaucoma control. These results may aid in surgical planning for patients with coexistent cataract and glaucoma.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.