Long-term surgical outcomes of patients with glaucoma secondary to the iridocorneal endothelial syndrome

Abstract

Purpose To report the long-term outcomes of patients with iridocorneal endothelial (ICE) syndrome who required surgery for glaucoma. Design Retrospective, noncomparative case series. Participants Twenty-six patients with ICE syndrome who underwent surgery for glaucoma at one institution between January 1987 and January 2000. Main outcome measures Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and further surgical interventions were measured. Results Five eyes had a trabeculectomy with an antifibrotic agent alone, seven eyes had a trabeculectomy with an antifibrotic agent and a subsequent glaucoma drainage implant (GDI), and 14 eyes had a GDI alone. In eyes that underwent a trabeculectomy with an antifibrotic agent, preoperative IOP was reduced from a mean of 38.8 ± 10.5 mmHg on 2.3 ± 0.8 glaucoma medications to a mean of 11.8 ± 4.3 mmHg on 1.2 ± 1.4 medications at last follow-up after surgery (83.8 ± 40.3 months). In eyes that underwent GDI surgery, preoperative IOP was reduced from a mean of 35.2 ± 13.0 mmHg on 2.0 ± 1.3 glaucoma medications to a mean of 8.7 ± 11.2 mmHg on 1.2 ± 1.1 medications at last follow-up after surgery (50.5 ± 40.7 months). Twenty-four eyes (92%) had an IOP less than 22 mmHg, and 22 eyes (85%) had visual acuity 20/400 or better at last follow-up (55.8 ± 41.5 months). Mean number of glaucoma surgeries per patient over the follow-up period was 1.6 ± 1.2. Trabeculectomy with antifibrotic agents had a survival of 73% at 1 year, 44% at 3 years, and 29% at 5 years. Glaucoma drainage implants had a survival of 71% at 1 year, 71% at 3 years, and 53% at 5 years. Conclusions Glaucoma associated with ICE syndrome can be managed successfully surgically, although multiple procedures are often needed.