Glaucoma Drainage Device Implantation Research Articles

Biodegradable material for glaucoma drainage devices - A pilot study in rabbits.

To study the morphological and histological characteristics of the fibrous capsule formed around a novel biodegradable glaucoma drainage device (GDD) implant made of oxidized regenerated cellulose (ORC) after 1 and 3 months of its implantation. It was a prospective, interventional, preclinical experimental study using New Zealand white rabbits. All animals underwent GDD implantation with a novel biodegradable device. The device's body was made of ORC and attached to a silicone tube, connecting the body to the anterior chamber. Histopathology (hematoxylin and eosin/Masson's trichrome staining) and immunohistochemistry (Alpha-Smooth Muscle Actin expression) characteristics of the bleb formed around the novel device were noted at 1 and 3 months. One month post implantation, the biodegradable material produced a significant foreign body type of reaction evidenced by the exuberant infiltration by macrophages, lymphocytes, and multinucleated giant cells. The granulomatous response subsided by 3 months with disorganized collagen deposition on Masson's trichrome staining. The silicone tube was an internal control, and histopathology demonstrated well-organized collagen deposition around it at 3 months. Immunohistochemistry for α-smooth muscle actin also demonstrated more myofibroblast transformation at the site of the tube than the biodegradable implant. Our results indicate that the tissue response around a biodegradable GDD was different from the response to conventional devices. A diffuse, loose vascularized mesh was observed to develop, which may be more compatible with sustained IOP control over a longer period, in contrast to the usual thick and dense capsule formed around the non-biodegradable devices.

A comparative study of cystoid macula edema following glaucoma drainage device surgery versus trabeculectomy

PurposeTo assess and compare the risk for development of cystoid macula edema (CME) after glaucoma drainage device (GDD) implantation versus conventional trabeculectomy with mitomycin (trab) for glaucoma.MethodsRetrospective review of consecutive patients receiving trab or GDD implantation between 2016 and 2018. Inclusion criteria were availability of pre- and postoperative spectral domain optical coherence tomography (SD-OCT) of the macula. SD-OCT images were evaluated for presence of CME qualitatively, central subfield thickness (CST) and macular volume (MV).Results73 eyes could be included, 42 received trab and 31 GDD surgery. Eyes receiving trab on average had 0.8 ± 0.8 previous intraocular operations, while eyes with GDD implantation had 3.1 ± 1.9 (p < 0.001). Occurrence of postoperative CME was significantly more frequent after GDD implantation (6 out of 31 (19.4%)) than after trab (2 out of 42 eyes = 4.8%), (p = 0.049). Mean preoperative CST as well as MV was comparable in both groups (CST before trab: 282.7 ± 23.0 µm, CST before GDD 284.2 ± 27.3 µm, p = 0.287; MV before trab: 7.8 ± 1.1 mm3, MV before GDD: 8.0 ± 0.8mm3, p = 0.305). Mean postoperative CST and MV were significantly higher after GDD (CST 338.5 ± 129.3 µm, MV 8.8 ± 2.6 mm3) than after trabeculectomy (CST 290.6 ± 60.2 µm, p = 0.038; MV 7.8 ± 1.2mm3, p = 0.039).ConclusionsIn real-life conditions, GDD surgery seems to be associated with a higher risk to develop CME when compared to conventional trabeculectomy. This information may be helpful for glaucoma surgeons to advise the patients on postoperative risks of surgery.

Incidence and Outcomes of Hypertensive Phase After Glaucoma Drainage Device Surgery

To describe the incidence, risk factors, clinical characteristics, and long-term outcomes of a hypertensive phase (HP) after glaucoma drainage device (GDD) implantation. Retrospective cohort study SUBJECTS: Eyes that underwent implantation of their first GDD from January 2010 to October 2020 at a tertiary care center. HP was defined as intraocular pressure (IOP) >21 mmHg occurring at 2 consecutive visits in the first 90 days after the date of surgery for Ahmed Glaucoma Valve (AGV) or in the first 90 days after tube opening for Baerveldt Glaucoma Implant (BGI). Generalized estimating equations and Fisher's exact tests were used to evaluate risk factors for HP and risk factors for failure of GDD surgery after occurrence of a HP. Incidence and risk factors for HP. Overall surgical success rates, defined as the absence of failure criteria: IOP >21 mmHg, ≤5 mmHg, or <20% reduction below baseline IOP after 3 months for 2 consecutive visits, with or without adjunctive ocular hypotensive therapy; additional glaucoma surgery; or loss of light perception. Among 419 eyes of 360 patients that underwent GDD implantation, 42 (10.0%) eyes developed HP. Onset of HP was 20.8±10.5 days after Ahmed Glaucoma Valve and 11.7±20.3 days from the date of tube opening after Baerveldt implantation. Mean IOP during HP was 26.5±3.2 mmHg with peak IOP of 30.0±5.9 mmHg. Median follow-up duration was 21.5 months after onset of HP. Younger age and neovascular glaucoma were significant risk factors for HP occurrence in a multivariable model. Resolution of HP occurred in 32 eyes (76.2%) after a mean duration of 48.0±53.0 days. Additional surgery with a second GDD or cyclophotocoagulation was performed for 12 eyes (28.6%). The overall success rate among eyes with a HP was 52.6% at 2 years, which was significantly lower than that observed among control eyes that did not experience HP (76.3%), P<0.01. The incidence of HP was 10.0%. Younger age and neovascular glaucoma were significant risk factors for HP in the multivariable model. The risk of surgical failure after HP is significantly higher compared to eyes that did not experience HP.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty.

To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.

SURGERY OUTCOMES OF GLAUCOMA DRAINAGE DEVICE IMPLANTATION IN REFRACTORY GLAUCOMA PATIENTS AT SARDJITO GENERAL HOSPITAL

Introduction: Glaucoma drainage device (GDD) implantation was an effective surgical procedure in treating uncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDD implants were classified into valved and non-valved in which its surgical outcomes in different types of device and various etiologies were not similar. This study aimed to evaluate the surgery outcomes of GDD implantation in patients with refractory glaucoma at Sardjito General Hospital.&#x0D; &#x0D; Methods: All 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at Sardjito General Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma, IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2 and 3. Type of GDD implants, postoperative glaucoma medications, complications and need for further glaucoma surgery were documented.&#x0D; &#x0D; Results: The mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreased after surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002) glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to 1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The most common early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated to ripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related to non-valved implant type (p=0.003).&#x0D; &#x0D; Conclusion: GDD implantation especially valved type appears to be safe and effective surgical option in treating refractory glaucoma patients&#x0D; &#x0D; Keywords: Glaucoma drainage device, refractory glaucoma, glaucoma surgery, intraocular pressure

ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD)

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis.&#x0D; Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased.&#x0D; Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous.&#x0D; Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.

SURGICAL THERAPHY FOR PRIMARY GLAUCOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG DURING JANUARY 2020 TO DECEMBER 2022

Introduction &amp; ObjectivesGlaucoma can be treated with medicamentose, non invasive surgery, and invasive surgery. Thisstudy aim to determine the frequency and type of invasive surgery for primary glaucoma in Dr.Kariadi General Hospital during January 2020 to December 2022.&#x0D; MethodsThis was a descriptive research using secondary data obtained from electronic medical records,consist of gender, age, diagnosis, and type of surgery. The sample were taken with purposivesampling which are fullfill the inclusion criteria.&#x0D; ResultsThere were total of 395 eyes (395 patients) with primary glaucoma who underwent surgery, consistof 33% patients with open angle glaucoma (POAG) and 67% patients with angle closure glaucoma(PACG). Most common surgical theraphy for POAG was trabeculectomy (37%), followed bycombination of trabeculectomy and cataract surgery (32%), cataract surgery (16%),cyclocryotheraphy (10%), implantation of glaucoma drainage device (4%), and goniosynechialysis(1%). For PACG, most often used was combination of trabeculectomy and cataract surgery (61%),cataract surgery (13%), cyclocryotheraphy (12%), trabeculectomy (11%), combination of cataractsurgery and goniosynechialysis (2%), and implantation of glaucoma drainage device (1%).&#x0D; ConclusionThe most common type of surgery was trabeculectomy for primary open angle glaucoma andcombination of trabeculectomy and cataract surgery for primary angle closure glaucoma.

SURGICAL THERAPY FOR PRIMARY GLAUCOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG DURING JANUARY 2020 TO DECEMBER 2022

Introduction and Objective: Glaucoma can be treated with medicamentose, non invasive surgery, and invasive surgery. This study aims to determine the frequency and type of invasive surgery for primary glaucoma in Dr. Kariadi General Hospital during January 2020 to December 2022. Methods: This was a descriptive research using secondary data obtained from electronic medical records, consist of gender, age, diagnosis, and type of surgery. The sample were taken with purposive sampling wherein patients meeting the predetermined inclusion and exclusion criteria were chosen to be part of the study. Result: There were total of 395 eyes (395 patients) with primary glaucoma who underwent surgery, consisted of 33% patients with open angle glaucoma (POAG) and 67% patients with angle closure glaucoma (PACG). Most common surgical therapy for POAG was trabeculectomy (37%), followed by combination of trabeculectomy and cataract extraction with intra ocular lens insertion (phacotrabeculectomy) (32%), cataract extraction with intra ocular lens insertion (16%), cyclocryotheraphy (10%), implantation of glaucoma drainage device (4%), and goniosynechialysis (1%). For PACG, most often chosen procedure was combination of trabeculectomy and cataract extraction with intra ocular lens insertion (phacotrabeculectomy) (61%), cataract extraction with intra ocular lens insertion (13%), cyclocryotheraphy (12%), trabeculectomy (11%), combination of cataract extraction with intra ocular lens insertion and goniosynechialysis (2%), and implantation of glaucoma drainage device (1%). Conclusion : The most common type of surgery for open angle glaucoma was trabeculectomy and for angle closure glaucoma was combination of trabeculectomy and cataract extraction with intra ocular lens insertion (phacotrabeculectomy)

Combined Virna Glaucoma Implant (VGI) Implantation and Pars Plana Vitrectomy for Refractory Aphakic Glaucoma

Introduction : Glaucoma drainage devices (GDDs) implantation are frequently indicated for refractory glaucoma. The preferable anterior chamber may be inaccessible for patients with anterior chamber abnormalities.&#x0D; Case Illustration : A 6-year-old boy presented with high intraocular pressure (IOP) on the right eye (RE) four months before admission. Cataract surgery on both eye was done four years prior, due to congenital cataract. On examination, the visual acuity of the RE was hand movement with IOP 61mmHg with medications. Anterior chamber was shallow, posterior synechiae was found and posterior segment was hard to be evaluated. The fellow eye was nonfunctional with IOP 31mmHg. Pars plana vitrectomy (PPV) was performed followed by implantation of GDD (Virna Glaucoma Implant) with posterior chamber sulcus tube placement without adding a new incision. Post-operatively, IOP was 3mmHg and choroidal detachment was found. With steroid medication, satisfactory IOP control was achieved within three weeks of follow-up. Visual acuity of RE was improved to 0.5/60.&#x0D; Discussion : In eyes with shallow anterior segments, tube placed in the anterior chamber may increase the risk of corneal endothelial injury. Placement of the silicone tube in the posterior chamber sulcus is an effective alternative technique. Although it is relatively safe in experienced hands, vitrectomy and insertion of the tube into the posterior segment carries significant risks, including choroidal detachment. Careful monitoring and management is needed to control IOP and maintain vision.&#x0D; Conclusion : Combined GDD implantation and PPV may be considered for refractory aphakic glaucoma, showing favorable outcomes with a relatively safe procedure.

Successful Rate of Glaucoma Surgery in Secondary Glaucoma after Vitrectomy in Kariadi General Hospital Semarang 2020-2022

Introduction &amp; ObjectivesGlaucoma is one of the most frequent complications of vitrectomy surgery. It can cause a significantrise in intraocular pressure (IOP). Glaucoma surgery can be planned in medically uncontrolledglaucoma. Trabeculectomy and Glaucoma Drainage Device (GDD) implantation are the mostfrequent filtering surgeries used in these cases. This study aims to define the success rate ofglaucoma surgery in secondary glaucoma after vitrectomy.&#x0D; MethodsThis study is an analytical observational study with retrospective data collection held from medicalrecords of patients with secondary glaucoma after vitrectomy who underwent glaucoma surgery inKariadi General Hospital Semarang from 2020-2022. Surgical success defined by postoperative IOPreduced by&gt;20% from baseline, with or without anti-glaucoma medication.&#x0D; ResultsThere were 16 eyes of trabeculectomy with 5-fluorouracil (5-FU), and 8 eyes of GDD implants. Themean preoperative IOP was 43.76+6.77 mmhg for trabeculectomy 5-FU, and 42.43+4.02 mmhg forGDD implant. IOP levels in both groups varied significantly after one day, one week, one month, andthree months after surgery (p&lt;0.05). The success rate for the trabeculectomy 5-FU group was81.25% and the GDD implant group was 87.5% in 3 months. There was no statistically significantdifference in the success rate between the trabeculectomy 5-FU and GDD implant groups (p=0.839).The complication for the GDD implant group was 25%. No complications were found in thetrabeculectomy 5-FU group.&#x0D; ConclusionThere was no significant difference in the success rate between trabeculectomy 5-FU and the GDDimplant group. Both groups are viable for glaucoma surgery in secondary glaucoma after vitrectomysurgery.

SUCCESSFUL RATE OF GLAUCOMA SURGERY IN SECONDARY GLAUCOMA AFTER VITRECTOMY IN KARIADI HOSPITAL SEMARANG 2020-2022

Introduction: Glaucoma is one of the most frequent complications of vitrectomy surgery. It can cause a significant rise in intraocular pressure (IOP). Glaucoma surgery can be planned in medically uncontrolled glaucoma. Trabeculectomy and Glaucoma Drainage Device (GDD) implantation are the most frequent filtering surgeries used in these cases. This study aims to define the success rate of glaucoma surgery in secondary glaucoma after vitrectomy. Methods: This study is an analytical observational study with retrospective data collection held from medical records of patients with secondary glaucoma after vitrectomy who underwent glaucoma surgery in Kariadi General Hospital Semarang from 2020-2022. Surgical success defined by postoperative IOP reduced by&gt;20% from baseline, with or without anti-glaucoma medication. Result: There were 16 eyes of trabeculectomy with 5-fluorouracil (5-FU), and 8 eyes of GDD implants. The mean preoperative IOP was 43.76+6.77 mmhg for trabeculectomy 5-FU, and 42.43+4.02 mmhg for GDD implant. IOP levels in both groups varied significantly after one day, one week, one month, and three months after surgery (p&lt;0.05). The success rate for the trabeculectomy 5-FU group was 75% and the GDD implant group was 87.5% in 3 months. There was no statistically significant difference in the success rate between the trabeculectomy 5-FU and GDD implant groups (p=0.069). The complication were 18.75% and 25% for trabeculectomy group and GDD implant group, respectively. Conclusion: There was no significant difference in the success rate between trabeculectomy 5-FU and the GDD implant group. Both groups are viable for glaucoma surgery in secondary glaucoma after vitrectomy surgery.

Surgery Outcomes of Glaucoma Drainage Device Implantation in Refractory Glaucoma Patients at Sardjito General Hospital

Introduction &amp; ObjectivesGlaucoma drainage device (GDD) implantation was an effective surgical procedure in treatinguncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDDimplants were classified into valved and non-valved in which its surgical outcomes in different typesof device and various etiologies were not similar. This study aimed to evaluate the surgery outcomesof GDD implantation in patients with refractory glaucoma at Sardjito General Hospital.&#x0D; MethodsAll 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at SardjitoGeneral Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma,IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2and 3. Type of GDD implants, postoperative glaucoma medications, complications and need forfurther glaucoma surgery were documented.&#x0D; ResultsThe mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreasedafter surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002)glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The mostcommon early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated toripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related tonon-valved implant type (p=0.003).&#x0D; ConclusionGDD implantation especially valved type appears to be safe and effective surgical option in treatingrefractory glaucoma patients.

Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring

Abstract: Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.

Glaucoma drainage devices in children: an updated review.

Implantation of glaucoma drainage devices is a valuable therapeutic option, particularly in children with glaucoma refractory to primary surgical treatment. Glaucoma drainage devices are typically used when conjunctival scarring hampers filtration surgery or prior angle procedures are not effective in controlling intraocular pressure. Despite known complications, the use of glaucoma drainage devices in children has increased in recent years, even as the primary surgical option. In this review, we evaluate the results of recent studies involving the implantation of glaucoma drainage devices in children, discussing new advances, and comparing the success rates and complications of different devices.

Surgical Outcomes of Ahmed Glaucoma Valve and Aurolab Aqueous Drainage Implant in Nepalese Eyes: Comparison in the First Year

Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. Objectives: To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. Materials and methods: We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. Results: There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P &lt;0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p &lt;0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Conclusion: Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.

Ahmed ClearPath vs. Baerveldt Glaucoma Implant: A Retrospective Noninferiority Comparative Study

To compare the efficacy and safety of two non-valved glaucoma drainage devices (GDDs): Ahmed ClearPath (ACP) vs. Baerveldt glaucoma implant (BGI). Single-center, retrospective, comparative study. Consecutive patients who underwent ACP or BGI surgery for glaucoma (250 mm2 or 350 mm2 models), and had ≥6 months of follow-up and no prior GDD implantation. Chart review of ACP or BGI surgery in patients with glaucoma at Wills Eye Hospital (2020-2023). The primary outcome measure was surgical failure at the end of follow-up, defined as intraocular pressure (IOP) >21 or <6 mmHg at 2 consecutive visits, progression to no light perception (NLP) vision, glaucoma reoperation, or implant removal. Secondary outcome measures included the rate of postoperative complications and changes in best corrected visual acuity (BCVA), IOP, and glaucoma medications. A total of 128 eyes of 113 patients (63 ACP, 65 BGI) with similar baseline characteristics and a mean follow-up duration of 19.6±10.8 (median 20.5) months were included. Surgical failure occurred in 12 eyes (9.4%) with no significant difference between ACP and BGI eyes (9.5% vs. 9.2%, respectively; P=0.810). Reasons for failure included IOP >21 mmHg (3/12, 25.0%), glaucoma reoperation (5/12, 41.7%), and tube removal (4/12, 33.3%). No eyes progressed to NLP vision. Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure in both groups (P=0.871). Both groups achieved significant IOP and medication reduction compared to their baseline. Final IOP, BCVA, and complication rate was similar in both groups, but medication number was significantly lower in the ACP group (P=0.012). Both the 250 mm2 and 350 mm2 models had similar outcomes, but diplopia was significantly associated with the 350 mm2 model of either implant (P=0.012). Univariate logistic regression analysis did not identify either tube type or plate size as predictors of surgical failure. To our knowledge, this is the first study to compare the recently approved ACP vs. the BGI. Both implants had similar surgical failure and complication rate. Final IOP was similar in both groups, but ACP achieved lower medication number. Diplopia was significantly associated with the use of 350 mm2 model of either implant. Neither tube type nor plate size were significant predictors of surgical failure.

Bilateral Glaucoma Drainage Device (GDD) Implantation in Steroid Induced Glaucoma

Objective: This study aims to report a case of Bilateral Glaucoma Drainage Device (GDD) implantation surgery in a patient with Steroid Induced Glaucoma. Case Presentation: A 18-year-old male patient with steroid-induced glaucoma and allergic conjunctivitis. The patient also complained about red eyes and itchy in both eyes and had been using steroid eye drops for 5 years. The patient also complained about headaches and blurry vision. The patient had undergone trabeculectomy surgery 5 months ago on the left eye. The visual acuity was 6/6 on the right eye and 6/7.5 on the left eye. His intraocular pressure (IOP) on the right eye was 24 mmHg, and his left eye was 23 mmHg with conjunctival left eye bleb, flat, and fibrosis. The patient then underwent a non-valve Virna’s GDD implant surgery on the right eye. On day two post-GDD, the IOP was 4 mmHg, and the COA was shallow, so reform the COA. At the first month follow-up, the patient's right eye pressure was still in normal condition with no complications, and then the plan was for left eye Virna’s GDD implantation surgery. At the first month follow-up after left eye GDD implantation, the visual acuity was 6/9 on the right eye and 6/24 on the left eye, with IOP RE 11mmHg and LE 16mmHg, from anterior segment deep anterior chamber, no plate exposed, no leakage, and tube not attached to the corneal endothelium. The patient's intraocular pressure was still in normal condition in both eyes, and no complications was found, although the patient was still using low-dose topical steroid eye drops. Conclusion: In steroid-induced glaucoma, after trabeculectomy failure, the implantation of GDD is the most effective option in controlling high IOP and slowing down glaucoma progressivity.

Outcomes of reimplantation of a new Glaucoma Drainage Device after explantation of an older implant from exposure-related complications.

To describe the clinical outcome of a series of seven eyes with an explanation of an original Glaucoma Drainage Device (GDD) arising from the complication of plate exposure and consequent reimplantation of another GDD at a second setting. This was a retrospective, interventional, and non-comparative study at two tertiary eye care hospitals in eastern and southern India. Electronic medical record data of the seven eyes where a GDD was explanted and a 2nd GDD was reimplanted over October 2010 and May 2021 was analyzed. Statistical analysis was done by SPSS (ver. 26). The first GDD survived for a mean of 168 days only till the plate got exposed and thereby got explanted. Possible predisposing factors noted were conjunctival and scleral thinning, ischemic conjunctiva, etc., The reimplantation surgery was technically easy in the absence of hypotony-opposite to what is reported in the literature. The final IOP (mean +/- SD) values (mm Hg) were 18.9 (+/-7.9), range = 10-30. The mean number of glaucoma medications reduced from 3.9 (+/-1.2; range, 2 to 5) after the explanation to 3.1 (+/-0.7; range, 2 to 4) after the 2nd GDD implantation, in the final follow-up. The second GDD was found to be stable till the last follow-up (mean = 1149 days). No other significant intraoperative or postoperative complications were seen. Reimplantation of a second GDD in a separate setting after explanations of an original implant due to exposure-related complication is both a safe and effective method.

Recent Advancements in Glaucoma Surgery-A Review.

Surgery has long been an important treatment for limiting optic nerve damage and minimising visual loss in patients with glaucoma. Numerous improvements, modifications, and innovations in glaucoma surgery over recent decades have improved surgical safety, and have led to earlier and more frequent surgical intervention in glaucoma patients at risk of vision loss. This review summarises the latest advancements in trabeculectomy surgery, glaucoma drainage device (GDD) implantation, and minimally invasive glaucoma surgery (MIGS). A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases, alongside subsequent hand searches-limited to the past 10 years for trabeculectomy and GDDs, and the past 5 years for MIGS-yielded 2283 results, 58 of which were included in the final review (8 trabeculectomy, 27 GDD, and 23 MIGS). Advancements in trabeculectomy are described in terms of adjunctive incisions, Tenon's layer management, and novel suturing techniques. Advancements in GDD implantation pertain to modifications of surgical techniques and devices, novel methods to deal with postoperative complications and surgical failure, and the invention of new GDDs. Finally, the popularity of MIGS has recently promoted modifications to current surgical techniques and the development of novel MIGS devices.

Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty.

We evaluated the factors that impacted time from glaucoma drainage implant (GDI) surgery to penetrating keratoplasty (PK) in eyes with previously clear corneas (ie, GDI-first sequence), and that specifically underwent a trabeculectomy before GDI surgery for intraocular pressure (IOP) control. To describe through an event-triggered data collection method the clinical course and the long-term outcomes of 2 procedures that are commonly performed sequentially in complex clinical situations: GDI surgery and PK. The study investigates the clinical factors associated with the progression to PK and determines the GDI success rate and graft survival. A single, tertiary-care center retrospective interventional cases series including patients with a sequential history of trabeculectomy, GDI surgery, and PK from 1999 to 2009. Outcome measures included IOP, visual acuity, graft failure, GDI failure, and time from GDI to PK. Of the eyes, 56% had primary open angle glaucoma. The time from the last trabeculectomy to GDI was 66.5 ± 66.7 months. Of the eyes, 84% received a Baerveldt GDI. Time from GDI to PK was 36.4 ± 28.4 months. IOP at the time of PK was between 5 mm Hg and 21 mm Hg in 90% of eyes. At the last follow-up, 48% of grafts were clear. At 5 years post-PK, 33% of corneal grafts remained clear, whereas 81% of tubes remained functional. Nearly half of the corneal grafts are clear at the last long-term follow-up. Graft failure occurs at a higher rate than tube failure suggesting that IOP control is only one and possibly not the most important factor in graft survival in eyes with prior glaucoma surgery.