Glaucoma Drainage Device Group Research Articles

Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery.

To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery-specific questionnaires. This cross-sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ-25), Glaucoma Quality of Life (GQL-15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared. The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ-25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL-15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ-25 showed a better QoL in the GDD group compared to the medical group, whereas GQL-15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups. NEIVFQ-25 questionnaire scores provided a holistic measure of QoL. GQL-15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision-specific and disease-specific questionnaires should always be used in conjunction.

Comparison of refractive outcomes after combined cataract and glaucoma surgery: trabeculectomy and glaucoma drainage device implantation.

To investigate the refractive outcome of combined cataract surgery and glaucoma drainage device (GDD) implantation compared with trabeculectomy and cataract surgery. Department of Ophthalmology, National University Health System, Singapore. Retrospective cohort study. 206 eyes were enrolled for analysis: 50 had combined cataract surgery and trabeculectomy (trabeculectomy group), 50 had combined cataract surgery and GDD implantation (GDD group), and 106 had cataract surgery alone (control group). Refractive prediction error and absolute prediction error of each glaucoma surgery group were compared with the control group. Subgroup analysis was performed in the following axial length (AL) subgroups: short (<22.5 mm), medium (≥22.5 to <25.5 mm), and long (≥25.5 mm). In total, 206 eyes were examined. There was no statistically significant difference in the overall refractive prediction error between the GDD (0.00 ± 0.54 diopters [D]) and the control group (0.10 ± 0.53 D, P = .58). There was significant myopic refractive prediction error in the trabeculectomy group (-0.18 ± 0.88 D, P = .020). In eyes with short AL, a greater absolute prediction error was observed in the GDD group (-0.75 ± 0.43 D, P = .039). Apart from a significant deviation in short AL eyes, combined cataract surgery and GDD implantation demonstrated no significant postoperative refractive prediction error.

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery.

There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.

Health-related quality of life in Ahmed FP7, and Baerveldt 250 and 350 patients compared with medical controls

PurposeTo compare health-related quality of life (HRQoL) in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250) and Baerveldt 350 (B350) glaucoma drainage device (GDDs), and medically treated controls.MethodsThis was a...

Increased rate of ptosis following glaucoma drainage device placement and other anterior segment surgery: a prospective analysis.

To determine the degreeand rate of ptosis in patients undergoing glaucoma and cataract surgery. Patients undergoing cataract extraction (CE), trabeculectomy, or glaucoma drainage device (GDD) placement, or a combination, were consecutively enrolled by a sole surgeon. Eyelid measurements, including margin reflex distance 1 (MRD1) and levator function, were obtained preoperatively and at 1 and 3months postoperatively. Primary outcome measures were the change in MRD1 pre- vs postoperatively; percentage of patients with ptosis (defined as MRD1 < 2mm pre- vs postoperatively). Secondary measures were the absolute change in MRD1 between groups, decrease in MRD1 of ≥ 2mm, and change in levator function. In total, 104 eyes of 73 patients underwent CE, trabeculectomy, or GDD placement and completed at least 1-month follow-up; 93 eyes of 65 patients completed 3-month follow-up. MRD1 decreased significantly in trabeculectomy and GDD groups at 1 and 3months postoperatively, while it did not change in the CE group. The GDD group had a significant increase in percentage of patients with ptosis at 3months postoperatively. Patients who underwent glaucoma surgery, especially those who underwent GDDplacement, were more likely to have postoperative ptosis than patients undergoing CE alone. High ptosis rates in patients undergoing glaucoma surgery may warrant preoperative counseling and post-operative referral to oculoplastic surgeons.

Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device After Initial Glaucoma Drainage Device Failure

Compare intraocular pressure (IOP) control and complication rates of a second glaucoma drainage device (GDD) to diode transscleral cyclophotocoagulation (TSCPC) following failure of an initial GDD. Eyes with 1 GDD that required a second GDD or TSCPC for glaucoma control were included. Exclusion criteria were a cyclodestructive procedure before initial GDD, no light perception vision, or follow-up <1 year. Failure was defined as ≥1 of (1) reoperation for lowering IOP; (2) explantation of second GDD; (3) persistent hypotony; (4) use of oral carbonic anhydrase inhibitor for lowering IOP in the study eye; or (5) loss of light perception. Reoperation for lowering IOP included additional GDD implantation or additional cyclodestruction, except if additional cyclodestruction was within 6 months of the initial session. A total of 75 eyes (35 in second GDD; 40 in TSCPC) were included (mean follow-up, 25.5 mo). Both procedures lowered IOP [-11.4 mm Hg (±13.6) for second GDD and -7.8 mm Hg (±11.8) for TSCPC groups] and decreased the number of IOP-lowering medications at the last visit. The second GDD group had significantly greater mean survival time [45.0 mo (±4.2)] than the TSCPC group [26.5 mo (±2.8)] but significantly more postoperative complications (60% of eyes) and non-IOP-related procedures (40% of eyes) than the TSCPC group (20% for postoperative complications and 18% for non-IOP-related procedures). Although both second procedures are efficacious in lowering IOP and number of IOP-lowering medications, TSCPC failed earlier, whereas a second GDD had significantly more complications.

Failed glaucoma drainage implant: long-term outcomes of a second glaucoma drainage device versus cyclophotocoagulation

Background/aimsTo evaluate long-term efficacy of a second glaucoma drainage device (GDD) versus cyclophotocoagulation (CPC) after failure of primary drainage implant.MethodsThis is a non-randomised, retrospective cohort study. A chart review was...

Surgical Outcomes of Superior Versus Inferior Glaucoma Drainage Device Implantation

To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus. A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis. Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47%) and 11/33 (33%) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8% and 9.1%, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test). No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.

Longitudinal Rates of Postoperative Adverse Outcomes after Glaucoma Surgery Among Medicare Beneficiaries: 1994 to 2005

To determine longitudinal rates of postoperative adverse outcomes after incisional glaucoma surgery in a nationally representative longitudinal sample. Retrospective, longitudinal cohort analysis. Medicare beneficiaries >or=68 years who underwent a primary trabeculectomy (PT), trabeculectomy with scarring (TS), or glaucoma drainage device (GDD) implantation from 1994 to 2003 with follow-up through 2005. Primary trabeculectomy, TS, and GDD were identified from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. Change in rates of postoperative adverse outcomes associated with these 3 surgical interventions was analyzed by cumulative incidence rates and Cox proportional hazards model regression; regression analysis controlled for prior adverse outcome measures (3-year run-up) and demographic variables. First-, second-, and sixth-year cumulative rates and probability of experiencing serious adverse outcomes (retinal detachment, endophthalmitis, suprachoroidal hemorrhage), less serious adverse outcomes (choroidal detachment, corneal edema, hypotony), and receipt of additional glaucoma surgery were identified through Medicare claims for each treatment group. At the 1-year follow-up, rates of severe adverse outcomes were higher among beneficiaries in the GDD group (2.0%) relative to the PT (0.6%) and TS groups (1.3%). Controlling for prior adverse outcomes to the surgery and demographic factors in Cox proportional analysis, differences were often reduced, but generally remained statistically and clinically significant. Rates of severe outcomes, less severe outcomes, corneal edema, and low vision/blindness were higher for persons undergoing GDD than PT or TS. However, rates of reoperation were higher for TS than GDD. The risk for adverse outcomes was higher in GDD than in PT surgery or TS, controlling for a number of important case mix and demographic factors.

Comparison of mitomycin C trabeculectomy, glaucoma drainage device implantation, and laser neodymium: YAG cyclophotocoagulation in the management of intractable glaucoma after penetrating keratoplasty

Purpose This study aimed to compare the surgical outcomes of mitomycin C trabeculectomy glaucoma drainage device (GDD) surgery and laser neodymium:YAG (Nd:YAG) cyclophotocoagulation (CPC) in the management of intractable glaucoma after penetrating keratoplasty (PKP) in a retrospective study. Design Interventional case series. Participants/methods The medical charts of consecutive patients who had pre-existing glaucoma or who developed glaucoma after PKP and underwent a surgical procedure to control the glaucoma at the University Eye Associates of Boston University Medical Center, New England Eye Center, and Massachusetts Eye and Ear Infirmary between January 1991 and July 1995 were reviewed. Follow-up ranged from 6 months to 4 years after the glaucoma procedure. A total of 38 patients were included consisting of 17 patients who underwent mitomycin C, 10 patients who underwent GDD surgery, and 11 patients who had CPC. Intervention Mitomycin C trabeculectomy, GDDs, or Nd:YAG CPC to control glaucoma after PKP was performed. Main outcome measures Graft status, postoperative intraocular pressure (IOP), and visual acuity were the main outcome measures. Results There were no differences among the three groups with respect to the follow-up time after the corneal graft operation ( P = 0.15) or after the glaucoma operation ( P = 0.98). At the final follow-up, the average decrease in the IOP was 17 mmHg ( P < 0.001) after mitomycin C, 15 mmHg ( P = 0.003) after GDD surgery, and 14.4 mmHg ( P = 0.001) after CPC. There were no differences in the proportion of patients who developed postoperative IOP above 20 mmHg ( P = 0.50) and in the proportion who developed hypotony ( P = 0.10) among the three groups. Two grafts failed after mitomycin C and one failed after CPC. Among the three procedures, there were no differences in the proportion of patients who experienced either an improvement ( P = 0.14) or a decrease ( P = 0.22) in the visual acuity by more than one line after the glaucoma procedure. One patient each in the GDD group and the CPC group lost light perception after the procedure. The risk of graft failure was almost three times higher for each additional PKP (odds ratio = 2.80, P = 0.02). Conclusions No differences were found among the three glaucoma procedures with respect to controlling IOP and graft failure. There was a trend for patients treated with CPC to have a higher incidence of graft failure, glaucoma failure, hypotony, and visual loss by more than one line, although this was not statistically significant. The number of PKPs was associated with graft failure, independent of the surgical procedure.