Five-Year Outcomes of Graft-Free Tube Shunts and Risk Factors for Tube Exposures in Glaucoma

Abstract

Précis: Use of a scleral tunnel technique instead of a patch graft can be considered in most cases of tube shunt implantation. Grafts may still be considered in younger (< 65 y old) East Asians. Purpose:(1) To assess the risk factors for tube exposure with a graftfree implantation technique and (2) to examine 5-year outcomes of graft-free tube shunt insertion.Methods: This was a retrospective case series of 204 consecutive eyes undergoing a glaucoma tube shunt implantation with a scleral tunnel technique in lieu of a graft. Preoperative and postoperative bestcorrected visual acuity, intraocular pressure, and number of glaucoma medications were compared. Failure was defined as the following: (1) intraocular pressure > 21 mm Hg or ≤ 5 mm Hg on 2 consecutive visits after 3 mo; (2) required additional glaucoma surgery; (3) loss of light perception. Univariable and multivariable regression analyses were conducted to identify risk factors of tube exposures.Results: Intraocular pressure and the number of glaucoma medications were significantly decreased at all postoperative time points (P < 0.001). Success rates were 91% at year 1, 75% at year 3, and 67% at year 5. The most common early (< 3 mo) complication was tube malpositioning. The most common late ( > 3 mo to 5 y) complications were corneal complications and uncontrolled intraocular pressure. By year 5, 6.9% of tubes were exposed. Multivariable regression showed that age less than 65 years old (odds ratio: 3.66, P = 0.04) and East Asian ethnicity (odds ratio: 3.36, P = 0.04) were associated with significantly increased risk of tube exposure.Conclusions: Graft-free glaucoma tube implantation has comparable long-term outcomes and complication rates to shunts with a graft. Younger (< 65 y old) East Asians are at greater risk of tube exposure without a graft.