Need for Additional Glaucoma Surgery and Complications Following Glaucoma Drainage Device Surgery

Abstract

Précis: In this longitudinal study of patients with open-angle (OAG), pseudoexfoliative (PXE), or neovascular glaucoma (NVG) receiving glaucoma drainage devices (GDD), posttube cumulative rates of reoperation, corneal graft, and visually threatening complications (VT-complications) increased beyond 5 years and were not significantly affected by glaucoma type.Purpose: To study the need for additional glaucoma surgery and development of complications after first GDD surgery in eyes with primary OAG, PXE, or NVG glaucoma.Patients and Methods: There were 306 eyes with OAG (n = 185), PXE (n = 60), or NVG (n = 61) glaucoma who received a first GDD between 1996 and 2017. Outcomes including glaucoma reoperation, corneal graft procedure, and VT-complications after GDD were measured. Kaplan-Meier analysis was used to compare cumulative rate of reaching outcomes over time after GDD placement among the 3 glaucoma groups.Results: When comparing the OAG, PXE, and NVG groups, there were no significant differences in post-GDD cumulative rates of reoperation (P = 0.33), corneal graft (P = 0.26), or VT-complications (P = 0.65) over time. For all eyes, the overall cumulative rates for each outcome measure increased beyond 5 years, and specific Kaplan-Meier rates (5-y, 10-y) included: reoperation (16%, 25%), corneal graft (6%, 12%), VT-complications (9%, 14%). When comparing specific GDDs, the Ahmed FP7 had a higher cumulative reoperation rate over time compared with the Baerveldt 350 (P = 0.019).Conclusion: Glaucoma type did not significantly affect post-GDD cumulative rates of reoperation, corneal graft, and VT-complication among the OAG, PXE, and NVG groups. For all eyes, cumulative rates of reoperation, corneal graft, and VT-complications increased beyond 5 years. The Ahmed FP7 had a significantly higher cumulative reoperation rate compared with the Baerveldt 350 over time.

Real-World Outcomes of Glaucoma Filtration Surgery Using Electronic Health Records: An Informatics Study

“…25 Furthermore, the Ahmed versus Baerveldt study has previously demonstrated lower failure rates and lower IOP with the Baerveldt group, 26 with subsequent studies also showing higher re-operation rates with Ahmed tubes. 27 While we found a trend toward a higher hazard of failure for Ahmed tubes compared with Baerveldt tubes, this did not reach statistical significance. Furthermore, the higher preoperative IOP for Ahmed patients compared with Baerveldt patients likely reflected tube shunt practice patterns, favoring the valved tube for patients with higher IOP requiring more immediate IOP lowering as compared with the nonvalved Baerveldt.…”

“…However, the primary Ahmed versus trabeculectomy trial showed no difference in adjunctive medications at a mean of 31 months of follow-up, although trabeculectomy patients were found to have lower IOPs in the first year 25. Furthermore, the Ahmed versus Baerveldt study has previously demonstrated lower failure rates and lower IOP with the Baerveldt group,26 with subsequent studies also showing higher re-operation rates with Ahmed tubes 27. While we found a trend toward a higher hazard of failure for Ahmed tubes compared with Baerveldt tubes, this did not reach statistical significance.…”

The surgical management of glaucoma: A review

“…122 The TVT, ABC and AVB all reported 5-year rates of corneal endothelial surgery between 2.1% and 8.4%. 123 Persistent corneal oedema occurred in 16% at 5 years in the TVT study. 29 Corneal graft failures are also high for an AC tube at 81.6% over 10 years.…”

“…127 A longitudinal study reported the 5-year rate of vision threatening complications (hypotony, tube erosion, infection, loss of light perception, suprachoroidal haemorrhage) at 9.1%. 123…”

Outcomes of reimplantation of a new Glaucoma Drainage Device after explantation of an older implant from exposure-related complications

“…[ 24 ] Kung et al . [ 25 ] in a long retrospective series over 21 years noticed a significantly higher cumulative reoperation rate in the Ahmed implant (FP7 model) compared with the Baerveldt 350 model. We have observed that once a major part of the implant body is exposed, it may be advisable to remove the implant rather than attempting to close it, as chances for necrosis and re-exposure remain very high.…”