Efficacy and Safety of Primary Glaucoma Device Implantation Surgery in Exfoliative Glaucoma: A Retrospective Consecutive Case Series.

Sang Yoong Park,Sang Wook Jin

doi:10.1155/2020/3168253

Abstract

Purpose To evaluate the efficacy and safety of primary glaucoma drainage implant (GDI) surgery for exfoliation glaucoma (XFG). Methods This study was a retrospective, consecutive case series study including 36 eyes of 36 patients with XFG who underwent primary GDI surgery. Intraocular pressure (IOP), the mean deviation (MD) from the visual field exam, corneal endothelial cell density (ECD), and the number of topical antiglaucoma agents used during the preoperative and postoperative periods were retrospectively analyzed. Surgical success was defined by the following criteria: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% with 1 or no medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% with 1 or no medication; and (3) IOP ≤ 12 mmHg and an IOP reduction of 30% with 1 or no medication. The probability of success of GDI surgery was determined via Kaplan–Meier survival analysis. Results The preoperative IOP was 25.9 ± 4.7 mmHg, and the postoperative IOP at 24 months was decreased to 14.2 ± 3.6 mmHg (p value < 0.001). The postoperative MD and ECD were similar to baseline (MD p value = 0.155; ECD p value = 0.055). However, a significant reduction in the number of antiglaucoma agents was observed (p value < 0.001). The surgical success rates were 77.8%, 63.9%, and 55.6% at 24 months for criteria 1, 2, and 3, respectively. Early hypotony (4 patients, 11.1%) and persistent corneal edema (5 patients, 13.9%) were the most common early and late postoperative complications, respectively. Conclusions In XFG, primary GDI surgery reduced IOP by 45.2% and had a 77.8% success rate according to criteria 1 at 24 months postoperatively. However, considering that ECD reduction continues to decline over time, primary GDI surgery should be carefully considered in XFG.

Highlights

Exfoliative glaucoma (XFG) is the most common identifiable cause of open-angle glaucoma and develops as a result of exfoliation syndrome (XFS), a generally progressive agerelated systemic disorder of the extracellular matrix in which white fibrillogranular material is deposited in ocular tissues, including the anterior lens surface, trabecular meshwork, and zonule; XFG is considered more severe than primary open-angle glaucoma (POAG) [1,2,3].In general, XFG has a more rapidly progressive course than POAG and is associated with higher mean intraocular pressure (IOP), higher peak IOP, wider IOP fluctuation, and greater optic disc damage and glaucomatous visual field defects [3,4,5,6]
XFG is more resistant than POAG to medical therapy and has a higher medical treatment failure rate. erefore, when XFG patients need greater IOP reduction or a lower target IOP, surgical intervention should be considered the treatment of choice [6,7,8,9]
Specific patients, such as those who have uveitic glaucoma or neovascular glaucoma or who have previously undergone conjunctival incisional surgery, are at a greater risk of surgical failure [16, 18]. e adjunctive use of antifibrotic agents, such as mitomycin-C (MMC) and 5fluorouracil (5-FU), improves the success rate of trabeculectomy but increases the risk of bleb-related complications [19]. e increased risk of bleb-related complications has contributed to the growing use of glaucoma drainage implant (GDI) as an alternative to trabeculectomy [20]

Summary

Introduction

Exfoliative glaucoma (XFG) is the most common identifiable cause of open-angle glaucoma and develops as a result of exfoliation syndrome (XFS), a generally progressive agerelated systemic disorder of the extracellular matrix in which white fibrillogranular material is deposited in ocular tissues, including the anterior lens surface, trabecular meshwork, and zonule; XFG is considered more severe than primary open-angle glaucoma (POAG) [1,2,3]. E purpose of this study was to evaluate the efficacy and safety of primary GDI surgery in XFG patients whose IOP is uncontrolled despite the maximum tolerated medical and laser therapy. Eligible patients met the following criteria: (1) age: 18–75 years; (2) XFG treated with primary GDI surgery because of uncontrolled IOP despite the maximum tolerated medical and laser therapy; and (3) follow-up period >24 months. E patient demographics, IOP, mean deviation (MD) value from the visual field exam, central corneal thickness (CCT), corneal endothelial cell density (ECD), and number of topical antiglaucoma agents were retrospectively analyzed. Persistent corneal edema Cystoid macular edema Tube erosion Choroidal effusion Persistent diplopia Endophthalmitis Blebitis Total number of patients with complications∗. Values are presented as the number of patients (percentage). ∗Some patients had more than 1 complication

Discussion

Findings

Disclosure