Outcomes of Anterior Chamber, Sulcus, and Pars Plana Glaucoma Drainage Device Placement in Glaucoma Patients

Abstract

Purpose. To assess outcomes of anterior chamber (AC), sulcus, and pars plana (PP) glaucoma drainage device (GDD) placement in glaucoma patients. Patients and Methods. Retrospective evaluation of glaucoma patients who underwent GDD insertion in the AC, sulcus, or PP at Massachusetts Eye and Ear between November 2016 and May 2021. Patients who received AC, sulcus, and pars plana tubes were selected using simple random sampling, and the first 40 patients meeting inclusion criteria were analyzed. Main outcome measures were cumulative success probabilities from Kaplan-Meier (KM) analyses, intraocular pressure (IOP), medication burden, and complication rates. Results. The PP group had a larger proportion of Ahmed GDDs and was younger on average with less severe glaucoma compared to patients with AC or sulcus tubes. The PP group had a higher proportion of mixed-mechanism glaucoma and lower proportion of primary open-angle glaucoma. With success defined as IOP reduction ≥20% and 5 < IOP ≤ 21 mm Hg, the Kaplan-Meier cumulative success probabilities for all three GDD locations were not significantly different. No significant differences were found in complication rates between all groups after 3 months. Patients with PP GDD had significantly lower medication burden than those with AC or sulcus GDDs up to 1.5 years postoperatively (1.7 ± 1.1, 3.0 ± 1.4, and 2.8 ± 1.2 for PP, AC, and sulcus, respectively; P = 0.017 ). Conclusion. PP GDDs may be more effective in lowering medication burden than AC or sulcus tubes without compromising long-term safety.

Complications of Glaucoma Surgery

“…45,47 Pars plana tube insertions have also proven to have similar safety and efficacy profiles compared with the anterior chamber and sulcus insertions and may be even more effective than both alternatives in lowering postoperative medication burden. 6,48,49 Several studies suggest diplopia (Fig. 2) is more common after tube shunt surgery compared with trabeculectomy.…”

“…The hyphema tends to be mild in nature and typically self-resolves without additional intervention 45,47 . Pars plana tube insertions have also proven to have similar safety and efficacy profiles compared with the anterior chamber and sulcus insertions and may be even more effective than both alternatives in lowering postoperative medication burden 6,48,49 …”

Ahmed Glaucoma Valve Implantation to Reduce Intraocular Pressure: Updated Perspectives

“…So ciliary sulcus implantation can be considered especially in eyes with a high risk of corneal decompensation. Samuel et al 69 evaluated the outcomes of anterior chamber, ciliary sulcus, and pars plana glaucoma drainage device (AGV or BGI) placement retrospectively. A total of 120 eyes of 120 glaucoma patients were included in the study.…”

Three techniques for guidewire-assisted sulcus glaucoma tube shunt placement

“…When implanting a tube shunt, the tube tip can go into the anterior chamber (AC), ciliary sulcus, or pars plana. 1 While AC placement is traditional, it carries the risk of corneal decompensation, especially in patients with preexisting corneal pathology. 2 Pars plana placement helps avoid corneal complications, but requires concurrent or preexisting vitrectomy.…”