A Comparison of Sequential Glaucoma Drainage Device Implantation Versus Cyclophotocoagulation Following Failure of a Primary Drainage Device

Abstract

Purpose To compare sequential glaucoma drainage device (GDD) implantation with transscleral diode cyclophotocoagulation (CPC) following failure of a primary GDD. Materials and Methods Retrospective review of all patients who underwent GDD implantation at a single institution over ten years. Patients who required an additional GDD and/or CPC were analyzed. Success was defined as absence of: loss of light perception, reoperation for glaucoma, and IOP >21 or < 6 at two consecutive visits after an initial 3-month period. Results Thirty-two patients received sequential GDD. Twenty-one underwent CPC. Cohorts were statistically similar in regards to age, sex, race, and number of previous surgeries. Preoperatively, the GDD cohort had a lower IOP and better visual acuity. The mean length of follow-up was 37.9 months for the GDD group and 46.3 months for CPC. Both procedures significantly reduced IOP, however CPC led to a greater reduction (p=0.0172). Survival analysis found the 5-year probability of surgical success to be 65.3% for sequential GDD and 58.0% for CPC (p=0.8678). No cases of phthisis occurred in either group. There were 2 cases of endophthalmitis (6.3%) in the GDD group, and none in the CPC group. In eyes without pre-existing corneal edema, estimated corneal decompensation probability at 3-years was 31.6% for GDD and 6.7% for CPC (p=0.0828). Conclusion Sequential GDD and CPC are both effective at reducing IOP following the failure of a primary GDD. CPC after GDD failure warrants further investigation as it led to a greater reduction in IOP with fewer serious adverse events.

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

“…Based on our findings, and supported by previously published literature, in patients with residual visual acuity, both a second glaucoma drainage device implantation or cyclodestructive procedure may be useful in reducing IOP with a sufficient safety profile [15,33,34]. The results of the running randomized clinical trial of the American Glaucoma Society (AGS): Second Aqueous Shunt Implant versus Transscleral Cyclophotocoagulation Treatment Study (ASSISTS, NCT02691455), might indicate the better treatment option after a first failed tube implant.…”

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

“…In cases where both a GDD and cyclodestruction may be indicated, no comparative study has provided sufficient evidence to clearly support a benefit/risk balance in favour of either technique (Yildirim et al 2009; Bloom et al 2013; Choy et al 2018). For the most advanced cases of refractory glaucoma, using diode laser cyclodestruction after positioning a GDD has been proposed by some authors with a low level of evidence (Semchyshyn et al 2002; Sood & Beck 2009; Francis et al 2011; Ness et al 2012; Panarelli et al 2014; Schaefer et al 2015; Levinson et al 2017; Murakami et al 2017). The reverse therapeutic sequence consisting in using a GDD after cyclodestruction is associated with an increased risk of suprachoroidal haemorrhage and late hypotony (Rosentreter et al 2013).…”

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

“…In a recent retrospective review, Levinson et al [ 40 ] compared the efficacy of sequential glaucoma drainage device implantation (GDD group, n = 32) versus DLCPC (CPC group, n = 21) after failure of a primary drainage device. In the GDD group, any of four different glaucoma tubes could have been used.…”