Glaucoma Drainage Devices - Evaluation of Surgical Modifications to Avoid Postoperative Complications

Abstract

In glaucoma therapy, there are many treatment options, such as glaucoma drainage devices (GDI). The aim of this study is to compare postoperative outcomes after using different surgical techniques. 269 eyes of 250 patients who received a GDI at the ophthalmological center at the university hospital in Cologne between February 2010 and September 2016 were included in this study. The patients' baseline parameters were collected: age, sex, intraocular pressure, visual acuity, glaucoma medication, diagnosis, operated eye (right or left), number of previous eye surgeries (including laser therapy), duration-of-stay at the hospital as well as all glaucoma complications and complication-related reoperations. The mean individual pressure reduction was 39, 42 and 46% after 6, 12 and 24 months respectively, while the use of medication was reduced by 38, 42 and 50%. The success rates after 1 to 5 years was 75, 60, 57, 50 and 37% with a median survival of 48 months. 86 eyes (32%) experienced early complications and 156 eyes (56%) experienced late complications. 52% of the eyes (n = 139) had to be re-operated. The technique of creating a track to enter the anterior chamber had statistically significant influence on the early postoperative hypotony (p < 0,001). Fibrin glue had no influence on early hypotony. In the univariate analysis of early postoperative hypertension requiring paracentesis, the implant type (p = 0,009), tracking-technique with a paracentesis knife or a 22-gauge needle (p = 0,004), the occlusion method (p = 0,001) and the application of viscoelastics (p = 0,001) were statistically significant parameters. If GDI were implanted as a second implant, significantly more conjunctival erosion was recorded (p = 0.040). The use of a 22-gauge needle entering the anterior chamber reduces the hypotony risk when compared to fibrin glue. That risk is not increased by adding venting slits. When implanting GDI as a second implant, the higher risk of conjunctival erosion should be considered.