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Factors related to hypertensive phase after glaucoma drainage device implantation

Orathai Pitukcheewanont¹, Visanee Tantisevi¹, Sunee Chansangpetch²

¹Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, tvisanee@gmail.com.

Clinical Ophthalmology (Auckland, N.Z.)

|August 30, 2018

Insights

Hypertensive phase (HP) after glaucoma drainage device (GDD) implantation is common. Pre-operative visual acuity predicts HP risk, while heart disease offers protection, with no impact on surgical outcomes.

Area of Science:

Ophthalmology
Glaucoma Research
Surgical Innovation

Background:

Glaucoma drainage device (GDD) implantation is a surgical option for managing refractory glaucoma.
Hypertensive phase (HP) is a potential complication following GDD implantation, impacting intraocular pressure (IOP) control.
Understanding factors associated with HP is crucial for optimizing patient outcomes.

Purpose of the Study:

To identify risk and protective factors associated with the occurrence of hypertensive phase (HP) after glaucoma drainage device (GDD) implantation.
To evaluate the impact of HP on various surgical outcomes, including IOP, visual acuity, and surgical success.

Main Methods:

Retrospective chart review of glaucoma patients who underwent GDD implantation and completed 12 months of follow-up.
Patients were categorized into two groups: those who experienced HP and those who did not.
Statistical analysis was performed to identify factors associated with HP and compare surgical outcomes between groups.

Main Results:

Hypertensive phase (HP) occurred in 52.8% of patients following glaucoma drainage device (GDD) implantation.
Pre-operative visual acuity (VA) of 20/70 or better was a significant risk factor for HP (OR 7.5).
Pre-existing heart disease, often treated with anti-platelets, was a protective factor against HP (OR 0.06).

Conclusions:

Hypertensive phase (HP) is a frequent complication after glaucoma drainage device (GDD) implantation.
Pre-operative visual acuity is a key risk factor, while underlying heart disease serves as a protective factor for HP.
The occurrence of HP did not significantly affect overall surgical outcomes or failure rates at 12 months.

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Abstract

Background:

The aim of the study was to evaluate factors related to hypertensive phase (HP) after glaucoma drainage device (GDD) implantation.

Patients And Methods:

Retrospective charts review of glaucoma patients who underwent GDD implantation and completed 12 months of follow-up at King Chulalongkorn Memorial Hospital since 2004 was performed. Patients were divided into two groups according to the presence or absence of HP. The data were analyzed for factors associated with HP. The surgical outcomes including surgical failure, post-operative visual acuity (VA), post-operative number of medications, post-operative intraocular pressure (IOP), and post-operative complication were compared between the two groups.

Results:

Seventy-two patients were included. Most were diagnosed with secondary glaucoma (N=51, 70.8%), and Baerveldt was the most implanted GDD (N=49, 68.1%). Mean ± SD of IOP was significantly lower: 27.1±9.6 mmHg at pre-operation and 13.7±59 mmHg at 12-month follow-up (p<0.001). HP was identified in 38/72 patients (52.8%, 95% CI 40.7-64.7). Risk factor of HP was pre-operative VA equal or better than 20/70 (p=0.021, OR 7.5; 95% CI 1.4-41.4). Presence of underlying heart disease (patients in this group had taken anti-platelets) was found as a protective factor for HP (p=0.027, OR 0.06; 95% CI 0.00-0.72). It was speculated that the anti-inflammatory effect of the anti-platelets, particularly aspirin, may be responsible for controlling inflammation and retarding fibrosis formation around drainage implants. Failure rate at 12 months was 24/72 (33%). There was no difference in all surgical outcomes between the two groups. Survival analysis also showed no significant difference between HP and non-HP group.

Conclusion:

HP commonly occurred after GDD implantation. Pre-operative VA was a risk factor for the development of HP, whereas presence of underlying heart disease was a protective factor. No association between HP and surgical outcomes was identified.

Keywords:

glaucoma implant post-operative intraocular pressure risk factors surgical outcomes

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