Risk Factors for Glaucoma Drainage Device Exposure in a Middle-Eastern Population (original) (raw)
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Risk factors for exposure of glaucoma drainage devices: a retrospective observational study
BMJ open, 2014
The purpose of this study was to identify risk factors for exposure of glaucoma drainage devices (GDD). This retrospective, observational study was conducted in the eye clinic of an academic medical centre. Participants included 1073 consecutive adults who underwent GDD surgery between 1 January 2005 and 1 January 2011. Participants were included if chart review indicated GDD surgery during the study period and excluded if at least 12 months of clinical follow-up was not available in the medical record. The primary outcome measure was exposure of the GDD occurring at least 1 month after implant surgery. The characteristics of participants who experienced exposure of the implant were compared to the characteristics of participants who did not experience exposure. Of the 1073 participants having undergone GDD surgery, 67 experienced exposure of the device. Neither the type of GDD, type of patch graft (eye bank sclera, Tutoplast sclera and Tutoplast pericardium), surgeon, location of G...
Glaucoma drainage device exposure in Asian eyes
Clinical & Experimental Ophthalmology, 2014
pressure, the greater the drop in intraocular pressure that might occur with the active treatment. 4 Theoretically, with a greater drop in intraocular pressure, any differences between two actives might be exaggerated, and the study would more likely reach the 1.5 mmHg level, which is typically used in clinical trial design to determine a statistical difference in efficacy between treatment groups. However, no study has demonstrated that higher baseline intraocular pressures do indeed help differentiate the efficacy between two treatments with more validity. At the last active treatment visit, this study showed among prostaglandin treatment arms that a statistical difference among upper limit entry intraocular pressures continued to be observed for the morning and diurnal intraocular pressure measurements. This was not the case with beta-blockers, however. Further, the reductions from baseline were not statistically significant for either prostaglandins or beta-blockers for either the morning or diurnal intraocular pressure measurements among different upper limit entry intraocular pressures. Therefore, this difference between beta-blockers and prostaglandins in treatment intraocular pressures was not confirmed by the lack of difference in reduction of intraocular pressures. Accordingly, it is difficult to determine currently if the differences in treated intraocular pressures for prostaglandins based on the level of untreated baseline intraocular pressures is real or not. This study suggests that differences in the upper limit for entry of intraocular pressure at baseline in well-controlled clinical trials may influence the mean intraocular pressure at baseline.
The Choice of Drainage Device in Complicated Glaucomas: Comparing Ahmed and Baerveldt Implants
In Vivo
Background/Aim: Glaucoma is a chronic and progressive optic neuropathy which leads to deterioration of visual function. It is estimated to be the second leading cause of severe vision loss and blindness worldwide. Failure of antiglaucoma medication to sufficiently reduce intraocular pressure (IOP) and poor compliance with medication are indications for glaucoma surgery, for example using glaucoma drainage devices. Our aim was to compare the surgical outcomes following the implantation of Ahmed FP7 and Baerveldt 350 drainage devices. Patients and Methods: Five hundred and fiftytwo patients with primary or secondary glaucoma were enrolled in the study. All patients had a history of failed trabeculectomy or other intraocular surgery, and IOP ≥18 mm Hg. The implantation of Ahmed (266 patients) or Baerveldt (286 patients) devices was randomly performed in the patients, who were subsequently examined for a period of 5 years. Follow-up visits were scheduled 1 day; 1 week; 1, 3 and 6 months; and 1, 1.5, 2, 3, 4 and 5 years postoperatively. Results: Significant reduction of IOP was achieved in both groups. Ahmed valve (28.3±9.3, 13.4±6.9, 14.2±6 and 12.7±4.5 mmHg at baseline, 1, 3, and 5 years postoperatively, respectively) resulted in significantly greater IOP reduction compared to Baerveldt implant (29.6±10.1, 15.4±5.5, 14.5±5.5 and 14.7±4.4 mmHg at baseline, 1, 3, and 5 years postoperatively, respectively). A significantly lower number of medications was required in the Ahmed group in comparison to the Baerveldt one (Ahmed group: 1.5±1.4, 1.4±1.5 and 1.8±1.5; Baerveldt group: 1.9±1.3, 1.9±1.3 and 2.2±1.4, respectively). The incidence of treatment failure and the rate of glaucoma reoperation were significantly higher in the Baerveldt group (40%) compared to the Ahmed group (17%). Conclusion: Ahmed drainage implantation seemed to outclass that using the Baerveldt device in our study, in terms of efficacy and success rate.
The Impact of Glaucoma Drainage Devices on the Cornea
Current Ophthalmology Reports, 2020
Purpose of Review To discuss the relevant clinical associations between glaucoma drainage device (GDD) implantation and health of the cornea, focusing on corneal endothelial disease and success of viability of keratoplasty. Recent Findings Corneal endothelial injury and risk of graft failure continues to demonstrate association with GDD placement; however, newer studies demonstrate improved outcomes associated with Descemet membrane endothelial keratoplasty. Additionally, newer adverse effects associated with GDD placement have been described. Summary GDD implantation certainly carries risk of endothelial injury and keratoplasty viability, but newer keratoplasty techniques may improve visual outcomes. Furthermore, attention to placement and location of the GDD may affect the risk of progressive corneal injury.
Glaucoma drainage devices: a systematic literature review and current controversies
Survey of Ophthalmology, 2005
Glaucoma drainage devices create alternate aqueous pathways by channeling aqueous from the anterior chamber through a long tube to an equatorial plate that promotes bleb formation. Glaucoma drainage devices are being used more frequently in the treatment of glaucoma that does not respond to medications or trabeculectomy operations. In certain conditions, such as neovascular glaucoma, iridio-corneal syndrome, penetrating keratoplasty with glaucoma, glaucoma following retinal detachment surgery, and so on, it is becoming the primary operation. This review provides a systematic review of the literature and outlines the current controversies involving different glaucoma drainage devices and their design, overall surgical success, and complications following glaucoma drainage device insertion.
Revista Brasileira de Oftalmologia
Glaucoma drainage devices are important therapeutic options for cases of refractory glaucoma, in which trabeculectomy with antimetabolites has shown high risk of failure. There are devices with different sizes, designs and materials, and several studies have been conducted to test their safety and effectiveness. Despite known complications, their use has progressively increased in recent years, and they are the primary surgical option, in some situations. The aim of this review is to discuss the importance, mechanisms, biomaterials, results and complications of glaucoma drainage devices. RESUMO Os dispositivos de drenagem para glaucoma são importante opção terapêutica em casos de glaucomas refratários, nos quais a trabeculectomia com antimetabólitos tem alta chance de falência. Há dispositivos com diferentes tamanhos, desenhos e materiais, e muitos estudos foram realizados para testar sua segurança e eficácia. Apesar de suas conhecidas complicações, seu uso tem aumentado progressivamente nos últimos anos, inclusive como primeira opção cirúrgica, em algumas situações. O objetivo desta revisão foi discutir a importância, os mecanismos, os biomateriais, os resultados e as complicações dos dispositivos de drenagem para glaucoma.
Ophthalmology Glaucoma, 2019
Purpose: To report the outcomes of Aurolab Aqueous Drainage Implant (AADI) (Aurolab, Madurai, India) surgery in adults with refractory glaucoma. Design: Retrospective, noncomparative, interventional case series. Participants: Patients 18 years of age or older who underwent AADI surgery between January 2012 and December 2015 for refractory glaucoma with a minimum follow-up of 2 years. Methods: Case records of eligible patients were evaluated for demographics, best-corrected visual acuity (BCVA), and indication for AADI surgery. The intraocular pressure (IOP) and the number of antiglaucoma medications (AGMs) were recorded at baseline, at 1, 3, 6, 9, 12, 18, and 24 months, and at the last visit after 24 months if any from the case files. Complications during or at any time point after surgery were also recorded. Main Outcome Measures: Cumulative failure rate of the AADI was defined as IOP > 18 mmHg or not reduced by 30% below baseline on 2 consecutive follow-up visits after 3 months, IOP 6 mmHg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Results: A total of 158 eyes of 158 patients with a mean age of 45.4AE17.4 years and mean follow-up of 41.9AE14.7 months were included in the analysis. Secondary open-angle glaucoma (n ¼ 71, 45%) was the most common form of glaucoma. The mean preoperative IOP was 34.7AE9.9 mmHg with 3.2AE0.7 AGMs. At 1 year, the mean IOP decreased to 15.10AE6.7 mmHg with 1.5AE1.1 medications, and this was maintained at 2 years. KaplaneMeier estimates showed that the cumulative probability of failure was 9.5% (95% confidence interval [CI], 5.8e15.2) at 1 year, 27.8% (95% CI, 21.5e35.5) at 2 years, 38.9% (95% CI, 31.1e47.8) at 3 years, and 50.1% (95% CI, 40.5e60.6) at 4 years. Forty-seven complications were observed in 38 eyes (24%), most of which were transient and did not require surgical intervention. The AADI tube exposure (n ¼ 1), retraction (n ¼ 1), plate exposure (n ¼ 1), and plate displacement (n ¼ 1) were seen rarely. Conclusions: The AADI appears to have good efficacy and safety for managing eyes with refractory glaucoma. Longer follow-up studies are required to determine long-term cumulative failure rates.
Efficacy of glaucoma drainage devices in uveitic glaucoma and a meta-analysis of the literature
Graefes Archive for Clinical and Experimental Ophthalmology, 2018
Purpose To assess the efficacy of glaucoma drainage devices (GDD) in uveitic glaucoma and non-uveitic glaucoma, and to perform a meta-analysis of previously published results to compare with our data. Methods Retrospective case-control study, in which all eyes that underwent GDD surgery were included from 2015 onwards. Cases were defined as patients with uveitic glaucoma. Patients with non-uveitic glaucoma served as controls. To compare our results, a review of the literature was performed using PubMed database. Results A total of 99 eyes were included (38 with uveitic glaucoma). The preoperative IOP was 25.9 ± 7.7 mmHg and 27.9 ± 9.6 mmHg for patients with and without uveitis (p = 0.277). No significant differences were found between patients with and without uveitis in the final IOP or reduction in IOP (44.9% vs. 42.8%, respectively). Within the first year after surgery, 13.2% of cases developed macular edema (vs. 6.6%; p = 0.267) and 15.8% a transient hypotony (vs. 8.2%; p = 0.242). A meta-analysis of 24 studies showed a postoperative weighted mean difference of − 17.8 mmHg and 2.2 lower number of IOP-lowering medications in uveitic glaucoma (compared to − 13.2 mmHg and 3.5 in the current study, respectively). Conclusion GDD surgery in patients with uveitis has a similar effect on IOP as in patients without uveitis. The risks of developing macular edema and hypotony were slightly higher in patients with uveitis, but the results were not statistically significant. These findings are in line with previous reports, though data on the efficacy of GDD surgery and macular edema in uveitic glaucoma is scarce.