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Tan MCJ, Ong CW, Aquino MC, LUN KW, Sng CCA, Lim DKA, Loon SC, KOH VTC, CHEW PTK. Three-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma. J Glaucoma 2024; 33:478-485. [PMID: 38506749 PMCID: PMC11210944 DOI: 10.1097/ijg.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
PRCIS In our case series, the 3-year failure for Paul Glaucoma Implant (PGI) implantation was 14.6%. At 3 years postoperatively, there was a significant reduction in mean intraocular pressure (IOP) and the number of glaucoma medications used. OBJECTIVE To determine the 3-year efficacy and safety of the PGI, a novel glaucoma tube shunt in patients with glaucoma. METHODS Retrospective review of all patients who had undergone PGI implantation in a single tertiary institution in Singapore between May 1, 2017 and January 1, 2022. Data were extracted from electronic health records (Computerized Patient Support System 2 and Epic). The primary outcome measure was failure, defined as IOP >18 mm Hg or <6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant, or loss of light perception vision. Complete success was defined as the absence of failure without medications at 36 months, and qualified success similarly, but with medications. Postoperative mean IOP, mean number of IOP-lowering medications used, and visual acuity were also assessed. RESULTS Forty-eight eyes in 48 patients were identified. Thirty-one patients (64.6%) had primary open angle and angle closure glaucoma, and 18 (37.5%) had previous existing tube implants or trabeculectomy. At 3 years postoperatively, 7 cases (14.6%) fulfilled the criteria for failure and 36 (75%) met the criteria for complete success. The mean IOP at 36 months was 14.9 ± 4.11 mm Hg, from the mean preoperative IOP of 20.6 ± 6.13 mm Hg ( P < 0.001). The mean number of IOP-lowering medications used was reduced from 3.13 ± 0.959 preoperatively to 0.167 ± 0.476 at 36 months ( P < 0.001). The most common postoperative complication was hypotony (n = 17, 35.4%), of which the majority were self-limiting, followed by hyphema (n = 5, 10.4%) and tube exposure (n = 4, 8.3%). CONCLUSION The PGI demonstrated sustained IOP reduction and a reduction of medication burden at 3 years postoperatively.
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Affiliation(s)
- Marcus Chun Jin Tan
- Department of Ophthalmology, National University Hospital, National University Health System
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Wui Ong
- Department of Ophthalmology, National University Hospital, National University Health System
| | - Maria Cecilia Aquino
- Department of Ophthalmology, National University Hospital, National University Health System
| | - Katherine Wanxian LUN
- Department of Ophthalmology, National University Hospital, National University Health System
| | | | - Dawn Ka Ann Lim
- Department of Ophthalmology, National University Hospital, National University Health System
| | - Seng Chee Loon
- Department of Ophthalmology, National University Hospital, National University Health System
| | - Victor Teck Chang KOH
- Department of Ophthalmology, National University Hospital, National University Health System
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Tec Kuan CHEW
- Department of Ophthalmology, National University Hospital, National University Health System
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Neaves-Mendez J, Hernandez-Oteyza A, Alvarez-Ascencio D, Campos-Martinez G, Jimenez-Roman J. Prevalence of hypertensive phase and outcomes in patients with Ahmed valve implantation at one year of follow-up and evaluation of associated risk factors. Indian J Ophthalmol 2023; 71:1966-1971. [PMID: 37203066 PMCID: PMC10391440 DOI: 10.4103/ijo.ijo_2541_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure. Methods A cross-sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow-up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors. Results A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found. Conclusion A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group.
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Affiliation(s)
| | | | | | - Giselle Campos-Martinez
- Departamento de Neurodesarrollo y Fisiología, División de Neurociencias, Instituto de Fisiología Celular, UNAM. Mexico City, Mexico
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Ciociola EC, Yang SA, Hall N, Lorch AC, Miller JW, Friedman DS, Boland MV, Elze T, Zebardast N. Effectiveness of Trabeculectomy and Tube Shunt with versus without Concurrent Phacoemulsification: Intelligent Research in Sight Registry Longitudinal Analysis. Ophthalmol Glaucoma 2023; 6:42-53. [PMID: 35840047 PMCID: PMC9839888 DOI: 10.1016/j.ogla.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the effectiveness of trabeculectomy and glaucoma drainage device (GDD) surgery performed with concurrent phacoemulsification compared with stand-alone procedures. DESIGN Multicenter retrospective cohort study. PARTICIPANTS Patients in the Intelligent Research in Sight Registry who underwent trabeculectomy or GDD from 2013 through 2019. METHODS The Kaplan-Meier survival analysis was used to determine reoperation rates. Reoperation was defined as any subsequent glaucoma surgery occurring 1 month to 3 years after the initial procedure. Multivariable Cox proportional hazard models were used to determine reoperation risk factors. MAIN OUTCOME MEASURES Reoperation rate, intraocular pressure (IOP), visual acuity, reoperation procedure type, postoperative complications, and predictors of surgical failure. RESULTS A total of 117 697 eyes undergoing glaucoma surgery alone and 35 657 eyes undergoing surgery with phacoemulsification were included. The cumulative reoperation rates at postoperative years 1 and 3 were 4.9% and 11.5%, respectively, for trabeculectomy alone and 3.0% and 7.3%, respectively, for trabeculectomy combined with phacoemulsification (P < 0.001). The reoperation rates at postoperative 1 and 3 years were 3.8% and 7.8%, respectively, for GDD alone and 2.1% and 5.4%, respectively, for GDD with phacoemulsification (P < 0.001). Stand-alone procedures achieved greater IOP reduction by percentage change from baseline (trabeculectomy alone, 35.3% vs. trabeculectomy with phacoemulsification, 23.1%, P < 0.001; and GDD alone, 36.0% vs. GDD with phacoemulsification, 29.3%; P < 0.001). Visual acuity improved by 0.12 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI], 0.11-0.12) and 0.10 logMAR (95% CI, 0.08-0.11) after trabeculectomy and GDD with phacoemulsification and declined by 0.15 logMAR (95% CI, 0.14-0.15) and 0.12 logMAR (95% CI, 0.11-0.12) after stand-alone trabeculectomy and GDD. The overall documented complication rate was 2.9% for GDD and 1.4% for trabeculectomy. Age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical failure risk. The most common reoperation procedure was GDD. CONCLUSIONS Reoperation rates within the first 3 years after trabeculectomy and GDD with and without phacoemulsification were low. Trabeculectomy and GDD with phacoemulsification had lower reoperation rates than those with stand-alone procedures. However, stand-alone procedures resulted in greater IOP reduction compared with combined procedures. Postoperative complications were uncommon overall. Patient age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical success.
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Affiliation(s)
| | - Shuang-An Yang
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Rajendrababu S, Puthuran GV, Alia LA, Uduman MS, Wijesinghe HK. Intermediate-term outcomes of combined phacoemulsification and Aurolab aqueous drainage implant in eyes with refractory glaucoma and coexistent cataract. Int Ophthalmol 2022; 42:2609-2618. [PMID: 35445344 DOI: 10.1007/s10792-022-02251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy and safety of non-valved Aurolab aqueous drainage implant (AADI) surgery combined with phacoemulsification in eyes with refractory glaucoma and coexistent cataract. METHODS Included patients of 18 years or older who underwent combined AADI-Phacoemulsification from June 2015 to January 2017 with at least 12 months of consecutive follow-up. The best-corrected visual acuity, intraocular pressure (IOP), and the number of IOP-lowering medications were recorded at baseline, 2 weeks, 1, 3, 6, 12, 18, and 24 months. Cumulative probability of success was defined as IOP < 18 mmHg or 30% reduction from the baseline at two consecutive postoperative visits after 3-months. Loss of light perception or reoperation for uncontrolled glaucoma or a complication was considered failure apart from IOP criteria. RESULTS Seventeen eyes of 17 patients with a mean follow-up of 22.6 ± 4.0 months were included. Baseline IOP and ocular hypotensive drugs reduced significantly from 27.9 ± 7.6 mmHg to 14.0 ± 3.0 mmHg (p < 0.001) and 3.24 ± 0.7 to 1.33 ± 1.1 (p = 0.001), respectively, at 24 months. Cumulative probability of qualified success was 71.4% (95% Confidence Interval [CI] 40.6-88.2%) at 3 months and was maintained from 6 months onwards at 64.3% (95% CI 34.3-83.3%), up to 2 years. Intravitreal steroid was injected in one eye (5.9%) of chronic cystoid macular edema, and tube repositioning was done in another for focal corneal decompensation. CONCLUSIONS Combined AADI-Phacoemulsification surgery is a safe and effective option in providing favorable visual and IOP outcomes at an affordable cost in eyes with refractory glaucoma and coexistent cataract.
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Affiliation(s)
- Sharmila Rajendrababu
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India.
| | - George Varghese Puthuran
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
| | - Laxmi Ananya Alia
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
| | - Mohammed Sithiq Uduman
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
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Marta A, Coelho J, Vieira R, Figueiredo A, Reis R, Sampaio I, Menéres MJ, Menéres P. Biometric Predictability in Combined Cataract Surgery and Ahmed Glaucoma Valve Implantation Depending on Tube Position. Clin Ophthalmol 2021; 15:2037-2045. [PMID: 34017168 PMCID: PMC8131069 DOI: 10.2147/opth.s315940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the predictability of biometric results in patients undergoing cataract surgery combined with Ahmed glaucoma valve (AGV) implantation according to tube position. Methods A retrospective cohort study was performed in patients who underwent phacoemulsification surgery combined with AGV implantation with the tube in posterior (group PC) and anterior (group AC) chamber, between November 2012 and April 2020. The main outcome was the mean biometric prediction error, according to tube position, using different formulas. Results The study included 49 eyes of 36 patients, 23 eyes in group PC and 26 eyes in group AC. Gender (p=0.774), age (p=0.822), type of glaucoma (p=0.168), preoperative correct distance visual acuity (p=0.139), axial length (p=0.765), anterior chamber depth (p=0.351), keratometry (p=0.577) and intraocular lens power (p=0.608) were similar between groups. Only preoperative intraocular pressure was higher in group PC (p=0.005). The mean prediction errors using Haigis, SRK/T, Hoffer Q, Holladay 1, Barrett Universal II, Kane and Hill RBF formulas were all positive in group PC (hyperopic) and all negative (myopic) in group AC. In group PC, there was no significant difference in prediction error between these formulas (p>0.05). In group AC, the formula with the worst prediction error was Haigis (p=0.001), and the best was Barrett Universal II (p=0.043). Conclusion The biometric predictability and expected final refraction in phacoemulsification surgery combined with AGV implantation are modified by the position of the tube.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - João Coelho
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Vieira
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Ana Figueiredo
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Isabel Sampaio
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Maria João Menéres
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
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Fu L, Chan YK, Nie L, Dai Q, Qian Z, Shih KC, Lai JSM, Huang R, Pan W. Ciliochoroidal detachment after Ahmed glaucoma valve implantation: a retrospective study. BMC Ophthalmol 2019; 19:46. [PMID: 30736749 PMCID: PMC6368733 DOI: 10.1186/s12886-019-1060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/30/2019] [Indexed: 12/05/2022] Open
Abstract
Background To investigate the occurrence of ciliochoroidal detachment (CCD), its risk factors and its impact on the success rate after Ahmed glaucoma valve (AGV) implantation. Methods This is a retrospective observational study carried out at Eye Hospital of Wenzhou Medical University, Zhejiang, China. Patients with uncontrolled glaucoma who underwent AGV implantation alone or combined with phacoemulsification (AGV-Phaco) in the hospital from April 1, 2013 to July 31, 2016 were included. The preoperative and postoperative CCD was defined when the detachment between ciliary body and choroid was detected by the ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) respectively. The main outcomes included the incidence of CCD and the success rate at 6 months after surgery. Results In total, 97 male and 56 female patients were included. CCD was observed in 92 (57.8%) eyes. The glaucoma diagnosis in the Non-CCD and CCD group included primary open angle glaucoma (21(31.3%) vs 33(35.9%)), primary angle closure glaucoma (10(14.9%) vs 13(14.1%)), secondary glaucoma (25(37.3%) vs (28(30.4%)) and so on. The preoperative median IOP (interquartile range) were 21.7(16.0,32.0) mmHg and 23.0(16.0,33.0) mmHg in the Non-CCD group and CCD group. Previous surgical history (95% confidence interval (CI), 1.24 to 13.34; odds ratio (OR) 4.06; p = 0.02) and shorter axial length (95% CI, 0.62 to 0.97 OR 0.78; p = 0.02) were the two risk factors of CCD. The success rate between the CCD and Non-CCD group was not significantly different (64.3% vs 62.5%, p = 0.86) at 6 months. Conclusions The incidence of CCD is 57.8% after AGV surgery. Eyes with previous surgical procedure was prone to CCD occurrence and longer axial length was protective against CCD. But at 6 months postoperatively, CCD did not reduce the success rate of AGV surgery and may not be a worrisome complication.
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Affiliation(s)
- Lin Fu
- Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Yau Kei Chan
- Department of Mechanical Engineering, Faculty of Engineering, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Li Nie
- Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Qi Dai
- Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Zhenbin Qian
- Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Kendrick Co Shih
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Jimmy Shiu Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rong Huang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weihua Pan
- Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China.
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Rao DP, Pathak-Ray V. Combined cataract extraction with a new nonvalved glaucoma drainage device in adult eyes with cataract and refractory glaucoma. Indian J Ophthalmol 2018; 66:1278-1283. [PMID: 30127140 PMCID: PMC6113813 DOI: 10.4103/ijo.ijo_195_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of the study is to report the outcomes of simultaneous cataract extraction (CE) and a new nonvalved glaucoma drainage device (GDD), Aurolab Aqueous Drainage Implant (AADI), in eyes with cataract and refractory glaucoma. Methods: This was a non-comparative, interventional, retrospective study. Consecutive patients who underwent AADI together with phacoemulsification from June-2015 to January-2017 by a single fellowship trained glaucoma surgeon with documented 3-months of follow-up were included. The main outcomes were intraocular pressure (IOP), antiglaucoma medication (AGM), visual acuity, and complications. Results: We included 19 eyes of 17 patients with average follow-up of 14.4 ± 8.4 months. IOP and AGM reduced from 36.9 ± 11.1 mmHg and 4 ± 0.8 preoperatively to 12 ± 4.5 mmHg and 0.8 ± 1.2, respectively (P < 0.001). Complications were seen in seven eyes (36.8%). Total success was seen in 17 eyes (89.5%). None of the patients lost vision. Conclusion: Combining cataract extraction with the new non-valved Aurolab Aqueous Drainage Implant, appears to be an effective and safe technique in eyes with refractory glaucoma and cataract. Larger studies and further follow-up is recommended for such patients.
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Affiliation(s)
- Divya P Rao
- VST Centre for Glaucoma, L.V Prasad Eye Institute, Hyderabad, India
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Kwon J, Sung KR. Factors Associated with Outcomes of Combined Phacoemulsification and Ahmed Glaucoma Valve Implantation. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:211-220. [PMID: 29770636 PMCID: PMC5990640 DOI: 10.3341/kjo.2017.0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation. Methods This retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg. Results The mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008). Conclusions Combined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.
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Affiliation(s)
- Junki Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kostanyan T, Shazly T, Kaplowitz KB, Wang SZ, Kola S, Brown EN, Loewen NA. Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching. Graefes Arch Clin Exp Ophthalmol 2017; 255:2423-2428. [PMID: 28944413 DOI: 10.1007/s00417-017-3804-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/08/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To apply propensity score matching to compare Baerveldt glaucoma drainage implant (BGI) to Trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma. METHODS BGI and AIT patients with at least 1 year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients with neovascular glaucoma, with prior glaucoma surgery, or without a close match were excluded. RESULTS Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma, the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6 ± 6.3 mmHg compared to 21.5 ± 7.4 for AIT on 2.8 ± 1.1 medications and 2.5 ± 2.3 respectively. At 30 months, the mean IOP was 15.0 ± 3.9 mmHg for AIT versus 15.0 ± 5.7 mmHg for BGI (p > 0.05), while the number of drops was 1.5 ± 1.3 for AIT (change: p = 0.001) versus 2.4 ± 1.2 for BGI (change: p = 0.17; AIT vs BGI: 0.007). Success, defined as IOP < 21 mmHg, < 20% reduction and no reoperation, was achieved at 1 year in 56% of AIT versus 55% of BGI (p > 0.05) and 50% versus 52% at 2.5 years. CONCLUSIONS A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through 1 year. AIT required fewer medications.
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Affiliation(s)
- Tigran Kostanyan
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tarek Shazly
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin B Kaplowitz
- Department of Ophthalmology, VA Loma Linda, Loma Linda University, Loma Linda, CA, USA
| | - Steven Z Wang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sushma Kola
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric N Brown
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nils A Loewen
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA.
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