Intermediate and Long-Term Outcomes of Glaucoma Drainage Device Implantation by Glaucoma Fellows at a Tertiary Eye Center
Cris Martin P. Jacoba, MD and John Mark S. de Leon, MD, DPBO
To describe surgical outcomes of glaucoma drainage device (GDD) implantation performed by glaucoma fellows, and to identify factors influencing success.
This is a retrospective case series of eyes with GDDs implanted by glaucoma fellows at a tertiary eye center in the Philippines from February 2015 to March 2017. Records with at least 6 months post-operative follow-up were included. The primary outcome variables were intraocular pressure (IOP), number of anti-glaucoma medications, and visual acuity (VA). Surgical outcomes were classified as a complete success, a qualified success, or a failure. A complete success was defined as IOP ≥6 mmHg and ≤21 mmHg at last follow-up, without any glaucoma medication or additional glaucoma surgery. A qualified success was defined as IOP ≥6 mmHg and ≤21 mmHg at last follow-up, and on at least one topical anti-glaucoma medication. Failure was defined as IOP >21 mmHg or <6 mmHg at last follow-up, or the need for additional glaucoma surgery or a cyclodestructive procedure.
Seventeen eyes (16 subjects) were included in the study. Twelve (12) eyes were implanted with Ahmed® GDDs while 5 eyes received Baerveldt® GDDs. Mean follow-up time was 11.18 ± 6.74 months. There were significant decreases in the mean IOP (P <0.0001) and mean number of anti-glaucoma medications (P <0.0001) at final visit (16.29 ± 3.50 mmHg and 0.88 ± 0.39, respectively, from 28.16 mmHg ± 10.69 mmHg and 3.39 ± 1.05 prior to GDD implantation). VA was stable (P =0.22). GDD surgeries were classified as successful in 6/17 (35%) eyes, a qualified success in 8/17 (47%) eyes and as failures in 3/17 (18%) eyes. The complication rate was 10/17 (59%).
GDD implantations by glaucoma fellows in a single institution in the Philippines resulted to significant IOP decrease, reduction in number of anti-glaucoma medications, with good preservation of vision, however, complication rate was high.
Keywords: glaucoma drainage device, GDD, glaucoma, valve surgery