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Trabeculectomy Outcomes After Glaucoma Drainage Device Surgery.

Reza Alizadeh1, Handan Akil2, James Tan2

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Trabeculectomy with mitomycin C effectively lowers intraocular pressure (IOP) in patients with uncontrolled glaucoma drainage device (GDD) outcomes. This surgical option offers a viable solution for persistent high IOP after GDD implantation.

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Retinal Research

Background:

  • Glaucoma drainage device (GDD) implantation is a common procedure for managing refractory glaucoma.
  • Some patients continue to experience uncontrolled intraocular pressure (IOP) despite GDD implantation, necessitating further intervention.
  • Trabeculectomy with adjunctive mitomycin C is a potential surgical option for such cases.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of trabeculectomy combined with mitomycin C in patients with uncontrolled IOP after prior GDD implantation.
  • To assess the success rates based on defined IOP targets and reduction percentages.
  • To analyze secondary outcomes including medication use, complications, and the need for further glaucoma surgery.

Main Methods:

  • A retrospective review of consecutive patients who underwent trabeculectomy after GDD implantation was conducted.
  • Surgical success was defined by stratified IOP targets: (A) IOP < 18 mmHg and 20% reduction, (B) IOP < 15 mmHg and 25% reduction, (C) IOP < 12 mmHg and 30% reduction.
  • Secondary outcomes included medication usage, complication rates, and subsequent surgical interventions.

Main Results:

  • Twenty eyes from 19 patients were analyzed, with a median follow-up of 3.7 years.
  • Mean IOP significantly decreased from 19.3 mmHg preoperatively to 9.8 mmHg at 1 year, and remained low at 5 years (8.4 mmHg, P<0.001).
  • Cumulative success rates for criteria A and B were over 68% between years 1-5. Criterion C success was 49.1% at year 1 and 32.7% by year 5. Hypotony maculopathy occurred in 10% of patients.

Conclusions:

  • Trabeculectomy with mitomycin C is a viable surgical procedure for managing uncontrolled intraocular pressure (IOP) in patients who have previously undergone glaucoma drainage device (GDD) implantation.
  • The procedure demonstrates significant IOP reduction and achieves target success rates, particularly for less stringent criteria.
  • While effective, potential complications like hypotony maculopathy should be considered, with some cases requiring revision surgery.