Failed glaucoma drainage implant: long-term outcomes of a second glaucoma drainage device versus cyclophotocoagulation.

BACKGROUND/AIMS: To evaluate long-term efficacy of a second glaucoma drainage device (GDD) versus cyclophotocoagulation (CPC) after failure of primary drainage implant. METHODS: This is a non-randomised, retrospective cohort study. A chart review was conducted of patients who underwent GDD surgery between July 1986 and November 2012 requiring further glaucoma procedures for intraocular pressure (IOP) control. An additional GDD was placed in 15 eyes, while 32 eyes underwent CPC. The main outcome measurement was IOP control and/or time to failure of secondary intervention (IOP >18 mm Hg on two sequential measurements). RESULTS: Mean follow-up after the second procedure was 63±65.8 months (range 6-254 months) in the CPC group and 132±91.8 months (range 12-254 months) in the GDD group. Thirty-four per cent (11/32 eyes) undergoing CPC later required further treatment at a mean of 13.6±10.7 months with 10/11(91%) of additional interventions occurring within 2 years. Despite an initially high success rate for IOP control in the first 5 years, eventually 60% (9/15 eyes) that underwent a second tube required additional treatment at a mean of 73.4 months with only 2/9(22%) requiring this within the first 2 years. The risk of visual acuity worsening by 2 Snellen lines or more at 12 months was 5/14 for the GDD group (36%) and 4/23(17%) for the CPC group. CONCLUSIONS: After failure of an initial drainage implant to control IOP, a sequential tube had a high initial rate of success but a relatively high likelihood of long-term failure, generally after 6 years. Eyes that received CPC tended to fail earlier, often within the first year, but had relatively few late failures.

Selective laser trabeculoplasty in phakic and pseudophakic eyes.

BACKGROUND AND OBJECTIVE: To evaluate the effect of pseudophakia on the success of selective laser trabeculoplasty in lowering intraocular pressure (IOP). PATIENTS AND METHODS: In this retrospective, nonrandomized clinical trial, a chart review of all patients who underwent selective laser trabeculoplasty from September 2002 to June 2004 using a frequency-doubled Q-switched 532-nm Nd:YAG laser was performed. Changes in IOP and statistical significance were determined at each follow-up period. Average decrease in IOP and success rates for phakic and pseudophakic eyes were compared statistically at each time period. RESULTS: In the phakic group, mean IOP decreased from 18.1 to 15.5 mm Hg (P < .0005) and mean glaucoma medication use decreased from 2.1 to 1.6 medications after 24 months of follow-up. In the pseudophakic group, mean IOP decreased from 18.3 to 15.2 mm Hg (P < .005) and mean glaucoma medication use decreased from 2.2 to 1.6 medications. Success rates ranged from 54% to 67% in the phakic group and 52% to 65% in the pseudophakic group. No statistically significant difference between phakic and pseudophakic eyes in decreased IOP or success rates was seen at any time point (P > .05). No significant complications occurred in either group. CONCLUSIONS: Selective laser trabeculoplasty is effective in lowering IOP in both phakic and pseudophakic patients.

Visual loss due to central serous chorioretinopathy during corticosteroid treatment for giant cell arteritis.

Giant cell arteritis (GCA) can be a devastating disease resulting in blindness if not promptly diagnosed and treated. The only proven treatment for GCA is systemic corticosteroids; however, there are many side-effects associated with this therapy including ocular side-effects such as ocular hypertension, cataract formation and central serous chorioretinopathy. To raise physician awareness, a patient with biopsy-proven GCA is reported who lost vision during corticosteroid therapy because of central serous chorioretinopathy.

Glaucoma medical treatment--2002: does yearly cost now equal the year?

BACKGROUND: To review costs of the wide array of glaucoma medications available today as well as patient-assistance programs. METHODS: Potential yearly costs for current frequently used single and multiple drug therapies were determined, taking into account the actual (not labeled) volume of drops in the bottled medications. Alternative modes for obtaining medications, such as compassionate-use programs, were also surveyed. RESULTS: "Maximum" medical therapy may cost over $2000 per year. Allergan, Ciba, Merck, Pharmacia-Upjohn, and Alcon offer patient-assistance programs of variable simplicity of use. DISCUSSION: The cost of maximum glaucoma medical therapy can assume a significant proportion of an elderly patient's yearly income.

A comparison of glaucoma drainage implant tube coverage.

PURPOSE: Surgeons may use various materials, including donor sclera, dura, or pericardium grafts to cover glaucoma drainage implant tubes, prior to repositioning conjunctiva. We reviewed our experience with these materials. PATIENTS AND METHODS: Sixty-four eyes with at least 24 months follow-up status post glaucoma drainage implant surgery were evaluated for signs of tube erosion, as well as patch graft thinning, after initial placement of donor sclera (23), dura (18), or pericardium (23) patch grafts. RESULTS: Sixty-two eyes required no intervention for conjunctival and patch graft melting with subsequent tube erosion. Three cases (two eyes) of erosion requiring reoperation (1-dura at 6 months, 1-sclera at 15 months, and in the same eye 21 months later, 1-pericardium) were noted. Significant thinning of the donor patch graft such that the tube was visible beneath intact conjunctiva ocurred in 6 out of 23 donor sclera eyes, 4 out of 18 donor dura eyes, and 6 out of 23 donor pericardium eyes. CONCLUSION: No material was more prone to melting than another. Donor sclera may be slightly more cost-efficient, but gamma-irradiated pericardium has sterility advantages.