Abstract
Purpose:This study evaluates the radiographic appearance of lacrimal gland tissue after placement of a glaucoma drainage implant (GDI) to characterize the impact of the device on the gland's imaging patterns.Methods:We performed retrospective chart review of departmental records at two urban academic medical centers, which were systematically searched using procedure codes to identify adult glaucoma patients who underwent unilateral superotemporal GDI from January 1995 to December 2015. Radiology records were cross-checked to identify the subset of patients who underwent postoperative orbital CT or MRI. Chart review collected data on glaucoma diagnosis, management, examination findings, and clinical complaints. Imaging studies were reviewed for orbital changes using qualitative assessment of the radiographic appearances and computer-guided calculations to quantify asymmetries.Results:A review of all eye operations in the inclusion period identified 315 patients with GDI, 13 of whom were eligible for inclusion. Elapsed time from device placement to imaging averaged 41.9 months, and the average clinical follow-up was 56.4 months. Radiographic lacrimal gland changes were appreciable in 69% (9 of 13) of patients, most commonly with posterior displacement and flattening of the gland (7 of 13). ImageJ analysis revealed significantly smaller lacrimal glands in orbits with GDI (P = 0.04). No clear correlation was found between gland changes and clinical dry eye symptoms.Conclusion:GDI placement was associated with radiographically-appreciable lacrimal gland changes in two-thirds of patients, with changes occurring in a predictable pattern of lacrimal gland flattening, posteriorization, and volume loss. Radiographic changes correlated with clinical symptoms in few patients.
Highlights
Advanced glaucoma treatment has trended toward increased use of glaucoma drainage implant (GDI) devices over the past 20 years
Lacrimal Gland Imaging After Glaucoma Drainage Implant; Jacobs, et al conducted among American Glaucoma Society (AGS) members indicate that GDI usage has increased from 17.5% of all glaucoma surgery cases in 1996 to 50.8% in 2008.[1]. Placement of GDI is often the treatment of choice in patients with uveitis, iris neovascularization, prior failed filtering surgery, or other complex ocular history.[1,2,3]
The radiographic appearance of the orbital soft tissues after GDI surgery has been described in case reports or small series with limited follow‐up intervals; to our knowledge, no study has focused on the effect of the GDI on the lacrimal gland itself.[4,5,6,7,8,9,10]
Summary
Advanced glaucoma treatment has trended toward increased use of glaucoma drainage implant (GDI) devices over the past 20 years. Lacrimal Gland Imaging After Glaucoma Drainage Implant; Jacobs, et al conducted among American Glaucoma Society (AGS) members indicate that GDI usage has increased from 17.5% of all glaucoma surgery cases in 1996 to 50.8% in 2008.[1] Placement of GDI is often the treatment of choice in patients with uveitis, iris neovascularization, prior failed filtering surgery, or other complex ocular history.[1,2,3] The device is most commonly positioned on the superotemporal quadrant of the eye, which places it adjacent to the lacrimal gland. The radiographic appearance of the orbital soft tissues after GDI surgery has been described in case reports or small series with limited follow‐up intervals; to our knowledge, no study has focused on the effect of the GDI on the lacrimal gland itself.[4,5,6,7,8,9,10] This study was conducted to evaluate the radiographic appearance of the lacrimal gland after GDI placement
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