Intermediate Term Safety and Efficacy of Transscleral Cyclophotocoagulation After Tube Shunt Failure

Ness, Peter J.; Khaimi, Mahmoud A.; Feldman, Robert M.; Tabet, Rania; Sarkisian, Steven R.; Skuta, Gregory L.; Chuang, Alice Z.; Mankiewicz, Kimberly A.

doi:10.1097/ijg.0b013e31820bd1ce

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…18–23 Among patients who failed initial tube shunt surgery in the TVT Study, the cumulative probability of success was 57% at 4 years with repeat glaucoma surgery. This result is similar to the rates reported in previous studies (Table 7), including success rates of 37% to 86% for second tube shunts 24–29 and 67% to 71% for cyclodestruction 29–31 in patients who failed tube shunt implantation.…”

Section: Discussionsupporting

confidence: 92%

Outcomes of Glaucoma Reoperations in the Tube Versus Trabeculectomy (TVT) Study

Saheb

Gedde²,

Schiffman³

et al. 2014

American Journal of Ophthalmology

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Purpose To describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study. Design Cohort study of patients in a multicenter randomized clinical trial. Methods The TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350-mm2 Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/ml for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP > 21 mm Hg or not reduced by 20%, IOP ≤ 5 mm Hg, additional glaucoma surgery, or loss of light perception vision). Results Additional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (p = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in tube group and 30.5 ± 20.4 months in the trabeculectomy group (p = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (p = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (p = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43% respectively in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (p = .28). Reoperations to manage complications were required in 1 (13%) patient in the tube group and 5 (28%) patients in the trabeculectomy group (p = .63). Conclusions The rate of reoperation for glaucoma was higher following trabeculectomy with mitomycin C than tube shunt surgery in the TVT Study. Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of initial randomized treatment in the study.

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Section: Discussionsupporting

confidence: 92%

Outcomes of Glaucoma Reoperations in the Tube Versus Trabeculectomy (TVT) Study

Saheb

Gedde²,

Schiffman³

et al. 2014

American Journal of Ophthalmology

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“…CPC significantly reduced IOP and mean number of glaucoma medications 16 . Later studies by Panarelli et al 17 and Ness et al 18 also found transscleral CPC to be an effective treatment following shunt failure.…”

Section: Discussionmentioning

confidence: 95%

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

Levinson

Giangiacomo

Beck

et al. 2017

Journal of Glaucoma

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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.

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“…16 TSCPC has a significant ocular hypotensive effect on glaucoma refractory to both tube shunt and medical therapy. 17 An unqualified success after cycloablation would be the attainment of a target IOP without the need for further medication, coupled with preservation of visual function. CycloDiode therapy appears to be effective in lowering IOP, in both the short and long term.…”

Section: Methods and Considerationsmentioning

confidence: 99%

“…Glaucoma following penetrating keratoplasty, which has an incidence ranging from 10-52%, often proves refractory to medical treatment.1-3 We introduce a case of refractory post-PKP glaucoma in order to demonstrate the efficacy of ECP in treating post-PKP glaucoma and to describe its potential delayed effect in achieving intraocular pressure control Diode Laser Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Medically Uncontrolled Chronic Angle Closure Glaucoma Long-Term Clinical Outcomes. 17 Endoscopic cyclophotocoagulation (ECP) was introduced as an alternative to trans-scleral cyclophotocoagulation for treating refractory glaucomas in order to minimise complications such as phthisis and hypotony by providing direct visualisation of the ciliary processes. Glaucoma following penetrating keratoplasty, which has an incidence ranging from 10-52%, often proves refractory to medical treatment.…”

Section: Methods and Considerationsmentioning

confidence: 99%