Glaucoma Drainage Device Implantation Research Articles

Minimally Invasive Tube Surgery (MITS)-A Novel Method in Glaucoma Drainage Device Implantation.

Background/Objectives: We introduce a new surgical technique for inserting the eyePlate-300-a glaucoma drainage device (GDD). The flexibility of the eyePlate-300 allows for folding and insertion through a smaller conjunctival incision. The procedure is termed minimally invasive tube surgery (MITS). Methods: We performed a retrospective analysis of thirteen eyes to assess the efficacy of the MITS technique in a large London tertiary teaching eye hospital with 12 months follow-up. The primary outcome was complete success: defined as 'IOP > 5 mmHg, <21 mmHg and off drops'. Secondary outcomes: best corrected visual acuity at 12 months, complications, a reduction in the number of drops and need for further pressure-lowering surgery. Results: Twelve eyes (92%) achieved a lower IOP. The mean pre-operative IOP was 35.69 mmHg (20-53 mmHg); post-operatively, it was reduced to 11.08 mmHg (5-20 mmHg) (p < 0.001). The mean pre-operative drops were 3.462 (3-4), reducing to 0.85 (0-3) at 12 months (p < 0.001). There was no change in the mean BCVA. No intraoperative complications were recorded, and no further IOP lowering surgeries were required. Conclusions: The MITS technique facilitates the implantation of a glaucoma drainage device through a smaller, less traumatic incision. Preliminary one-year data suggest that the procedure may be safe and effective.

Risk factors for receiving both scleral buckle and glaucoma drainage device in children

We conducted a retrospective review of patients (< 18 years) between 2013 and 2021 to determine risk factors of pediatric patients receiving a glaucoma drainage device (GDD) needing a scleral buckle (SB) and vice versa. The first population underwent an SB placement with no prior GDD. The second underwent a GDD implantation with no prior SB. We analyzed 133 eyes in the SB-first group. The common indications were retinal detachment associated with a syndrome/disease (41.2%), blunt trauma (21%), and non-syndromic pathologic myopia (11%). Twelve eyes (9%) required subsequent GDD implantation with a mean time to reoperation of 19.73 months (median 2.3 months). Eyes with trauma had a 5-fold risk (hazard ratio [HR] 4.81, p = 0.0069) of requiring a subsequent GDD. Each additional glaucoma medication before initial SB surgery increased the risk by 1.81 (p = 0.0096). 135 eyes were in the GDD-first group. Four eyes (3%) required a subsequent SB. The mean time to reoperation was 17 months (median 9.2 months). There was a statistically significant association with trauma (HR 12.3, p = 0.0341) only. Pediatric eyes with a history of trauma and/or multiple glaucoma medications before intervention have a high risk of requiring both an SB and GDD.

Long-term outcome of surgical management in neovascular glaucoma: A retrospective, multicentric study.

This study aimed to evaluate and compare surgical outcomes among neovascular glaucoma patients undergoing trabeculectomy (Trab), glaucoma drainage device (GDD) implantation, or trans-scleral cyclophotocoagulation (TSCPC). This study analyzed the records of 176 neovascular glaucoma cases treated surgically between January 2017 and December 2021 at four Indian centers. Procedures included trabeculectomy with MMC in 80 eyes, GDD implantation in 25 eyes, and TSCPC in 71 eyes. Outcome measures comprised intraocular pressure (IOP) reduction, antiglaucoma medication (AGM) usage, complications, and best-corrected visual acuity (BCVA). Following surgery, all groups exhibited a significant reduction in IOP. One year postoperatively, complete success rates were 42.9% for the implant group, 54.3% for the Trab group, and 33.3% for the TSCPC group, with corresponding qualified success rates of 57.1%, 36.7%, and 58.9%, respectively. Improvement in postoperative vision was noted, with an increase of 0.24 LogMAR in the Trab group, 0.11 in the GDD group, and a decrease of 0.35 in the TSCPC group. Complications occurred in 27% of Trab and 14% of TSCPC cases, while the GDD group experienced a hypertensive phase in 40% of eyes. In managing neovascular glaucoma, trabeculectomy, GDD, and TSCPC provide comparable IOP control, with GDD showing a higher medication dependency. Trabeculectomy yields superior vision outcomes but carries a higher risk of postoperative complications, emphasizing the importance of individualized treatment selection and vigilant postoperative care.

Complications Following XEN45 Gel Stent and Glaucoma Drainage Device Implantation During Glaucoma Fellowship.

Purpose XEN45 Gel Stent and glaucoma drainage device (GDD) implantation is safe and effective for glaucoma treatment and should be taught during glaucoma fellowship training. However, complications may still occur, with potentially sight-threatening consequences. The purpose of this study is to describe the management of complications following a series of XEN45 Gel Stent and GDDsurgeries performed over the course of glaucoma fellowship training. Methods This is a retrospective case series of XEN45 Gel Stent surgeries performed on 16 eyes and GDD surgeries performed on seven eyes. Patient demographics, disease characteristics, and complications are reviewed. The intra- and postoperative course of five select cases with complications are described in detail. Results The most frequent complications following XEN45 implantation were transient hypotony (10 eyes, 63%), reduced visual acuity (VA) (five eyes, 31%), choroidal effusion (three eyes, 19%), hyphema (two eyes, 13%), and intraocular pressure (IOP) spike (two eyes, 13%). Thirteen eyes (81%) required bleb needling, and three eyes (19%) required XEN45 replacement. Complications following GDD implantation included hypotony (three eyes, 43%), reduced VA (two eyes, 29%), choroidal effusion (two eyes, 29%), IOP spike (two eyes, 29%), implant exposure (two eyes, 29%), and shallow anterior chamber (one eye, 14%). Three eyes (43%) required revision or explantation with a secondary glaucoma surgery. One choroidal effusion following XEN45 surgery and one following GDD surgery were hemorrhagic choroidal effusions requiring surgical drainage. Conclusion Significant and potentially sight-threatening complications may occur following XEN45 Gel Stent and GDD implantation performed over the course of fellowship training. Glaucoma fellows should be ably equipped to recognize, diagnose, and manage these complications both intra- and postoperatively.

36-Month Outcomes of Ahmed ClearPath® Glaucoma Drainage Device in Severe Primary Open Angle Glaucoma.

To evaluate the safety and effectiveness of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG). This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed. Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed. To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.

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.

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.

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.

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. 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. 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). Conclusion: GDD implantation especially valved type appears to be safe and effective surgical option in treating refractory glaucoma patients 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.

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. To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. 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. 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 <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 <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). Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.