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Surgical outcomes of inflammatory glaucoma: a comparison of trabeculectomy and glaucoma-drainage-device implantation

  • Clinical Investigation
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Abstract

Purpose

Our aim was to compare surgical outcomes of trabeculectomy and nonvalved glaucoma-drainage-device (GDD) implantation in eyes with chronic inflammatory glaucoma and uncontrolled intraocular pressure (IOP).

Methods

A retrospective chart review was conducted on patients with glaucomatous optic neuropathy, chronic anterior or posterior segment inflammation, and ≥6 months postoperative follow-up. All eyes underwent trabeculectomy with either antifibrotic therapy or implantation of a Baerveldt GDD (Abbott Laboratories Inc., Abbott Park, IL, USA). Failure was defined as IOP >21 mmHg, <20 % reduction below baseline or IOP <5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light-perception vision. Statistical methods consisted of Student’s t tests, χ2 test, and Kaplan–Meier time to failure analysis.

Results

Nineteen trabeculectomies of 42 patients were followed for a mean of 31 ± 23 and 23 GDD eyes for a mean of 39 ± 19 months (P = 0.22). At last follow-up, mean IOP (11.83 ± 4.59 and 13.15 ± 6.11 mmHg, P = 0.45) and number of glaucoma medications (1.28 ± 1.56 and 1.26 ± 1.25, P = 0.97) were similar between the trabeculectomy and GDD groups. The frequency and types of postoperative complications in both groups were similar. The cumulative probability of failure after 5 years of follow-up was significantly greater in trabeculectomy eyes (62 %) compared with GDD eyes (25 %) (P = 0.006).

Conclusions

Nonvalved tube-shunt surgery was more likely to maintain IOP control and avoid reoperation than trabeculectomy with antifibrotic therapy in eyes with chronic inflammatory glaucoma.

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Acknowledgments

This study received a University of Miami Core Grant (P30-EY014801), Bethesda, MD; an unrestricted grant from Research to Prevent Blindness, New York, NY; a grant from the Department of Defense (W81XWH-09-1-0675); The Maltz Family Endowment for Glaucoma Research, Cleveland, OH.

Conflicts of interest

S. M. Iverson, None; N. Bhardwaj, None; W. Shi, None; M. Sehi, None; D. S. Greenfield, None; D. L. Budenz, None; K. Kishor, None.

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Authors and Affiliations

  1. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 7101 Fairway Drive, Palm Beach Gardens, FL, 33418, USA

    Shawn M. Iverson, Namita Bhardwaj, Wei Shi, Mitra Sehi, David S. Greenfield & Krishna Kishor

  2. Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Donald L. Budenz

Authors
  1. Shawn M. Iverson
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  2. Namita Bhardwaj
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  3. Wei Shi
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  4. Mitra Sehi
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  5. David S. Greenfield
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  6. Donald L. Budenz
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  7. Krishna Kishor
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Correspondence to Krishna Kishor.

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Iverson, S.M., Bhardwaj, N., Shi, W. et al. Surgical outcomes of inflammatory glaucoma: a comparison of trabeculectomy and glaucoma-drainage-device implantation. Jpn J Ophthalmol 59, 179–186 (2015). https://doi.org/10.1007/s10384-015-0372-6

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  • DOI: https://doi.org/10.1007/s10384-015-0372-6

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