Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device After Initial Glaucoma Drainage Device Failure

Wang, Margaret Y.; Patel, Kishan; Blieden, Lauren S.; Chuang, Alice Z.; Baker, Laura A.; Bell, Nicholas P.; Feldman, Robert M.

doi:10.1097/ijg.0000000000000766

Cited by 19 publications

(24 citation statements)

References 11 publications

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“…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.…”

Section: J Clin Med 2020 9 2039 8 Of 12supporting

confidence: 74%

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

Posarelli

Toro

Ręjdak

et al. 2020

JCM

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Background: Refractory glaucoma still represents a challenge for ophthalmologists to manage intraocular pressure. The present study aimed to evaluate long term efficacy and safety of a second Ahmed valve implantation after the failure of a first implant in patients with refractory glaucoma and elevated intraocular pressure (IOP). Methods: Retrospective, multicenter non-comparative case series. Twenty-eight patients were retrospectively recruited between January 2011 and December 2017. Demographic data, glaucoma type, visual acuity, intraocular pressure, medical therapy, and complications were registered. Three criteria of success were established: Type 1 surgical success: IOP ≤ 15 mmHg and a reduction of IOP ≥ 40% from baseline; Type 2 surgical success: IOP ≤ 18 mmHg and a reduction of IOP ≥ 30% from baseline; and Type 3 surgical success: IOP ≤ 21 mmHg and a reduction of IOP ≥ 20% from baseline. Surgical failure has been established as IOP less than 5 mmHg or over 21 mmHg and less than a 20% reduction of IOP from baseline despite medications in two consecutive visits, light perception loss referable to glaucoma, and the necessity for further glaucoma surgery. Failure was observed in six (21%) patients. (3) Results: Mean IOP and mean glaucoma medication number significantly reduced from baseline after the second implantation, and the surgical success rate at 72 months ranged from 10% to 78% based on the different criteria of success. Failure was observed in six (21%) patients. Conclusions: This study confirmed the safety and efficacy of a second Ahmed valve implantation in patients with refractory glaucoma and elevated IOP at baseline.

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Section: J Clin Med 2020 9 2039 8 Of 12supporting

confidence: 74%

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

Posarelli

Toro

Ręjdak

et al. 2020

JCM

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“…Although the power of the study was inadequate for the statistical analysis of postoperative complications, eyes in the CPC group had fewer serious adverse events. In a similar retrospective study, Wang et al [ 41 ] recently examined the efficacy and safety of a second glaucoma drainage device ( n = 35) versus transscleral CPC ( n = 40) following failure of a previous drainage device. The authors found that although both groups achieved significant IOP reduction, eyes implanted with a second drainage device had longer mean survival time (45.0 months) than eyes treated with CPC (26.5 months), but they suffered significantly more postoperative complications (60% versus 20% of eyes) [ 41 ].…”

Section: Techniques and Evidence On Efficacymentioning

confidence: 99%

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

et al. 2018

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The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

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“…Despite being a second AGV implantation, our success rates are comparable to that of initial AGVs in current literature. is could reflect the long-term efficacy of a second FP7 AGV as a treatment option following a failed first GDD, as supported by Levinson et al [10,11]. Several other studies have also evaluated the outcomes of second GDDs in general (not confined to AGV implants).…”

Section: Discussionmentioning

confidence: 91%

“…Shah et al reported that additional tube shunt has better IOP control than tube shunt revision by excision of an encapsulated bleb [9]. Levinson et al demonstrated that while both second GDDs and cyclodestructive procedures effectively reduce IOP after a failed primary GDD, a second GDD had better long-term success rates [10,11].…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma

Ong

Aquino

Chew

et al. 2020

Journal of Ophthalmology

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Introduction. When the initial glaucoma tube shunt fails in eyes with refractory glaucoma, one option is implantation of an additional Ahmed glaucoma valve (AGV) to control intraocular pressure (IOP). We aim to evaluate the outcomes of a second AGV in Asian glaucoma. Material and Methods. This is a retrospective interventional study, consisting of 21 eyes belonging to 20 patients which underwent a second FP7 AGV. Data collected included demographic characteristics, best corrected visual acuity, IOP, and number of medications. Both intraoperative and postoperative complications or interventions were recorded. The primary outcome measurement was success rate: complete success (IOP ≥5 mmHg and ≤21 mmHg without IOP-lowering medications) and qualified success (IOP ≥5 mmHg and ≤21 mmHg with IOP-lowering medications). Failure was defined as IOP ≥5 mmHg and ≤21 mmHg, reoperations for IOP-related indications, removal of second AGV implant, or loss of light perception. Postoperative complications were included as secondary outcomes. Results. The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6 mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline (P<0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%). Conclusion. An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.

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Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device After Initial Glaucoma Drainage Device Failure

Abstract: Although both second procedures are efficacious in lowering IOP and number of IOP-lowering medications, TSCPC failed earlier, whereas a second GDD had significantly more complications.

Cited by 19 publications

References 11 publications

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma

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

Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma

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