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
Objective:
To describe surgical outcomes of glaucoma drainage device (GDD) implantation performed by glaucoma fellows, and to identify factors influencing success.
Methods:
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.
Results:
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%).
Conclusion:
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