Five-year outcomes of eyes with glaucoma drainage device and penetrating keratoplasty.

PURPOSE: To investigate intraocular pressure (IOP) control and corneal graft survival rates in eyes with glaucoma drainage device (GDD) implantation and penetrating keratoplasty (PK) and 5 years of follow-up data. DESIGN: Retrospective review. METHODS: We performed a review of records of all patients who underwent both GDD placement and PK at our institution between January 1, 1988 and December 31, 2003. Twenty-eight eyes of 27 patients were studied. Glaucoma outcome was assessed by postoperative IOP, number of glaucoma medications, and need for further glaucoma surgery. Corneal grafts were assessed for clarity. RESULTS: All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ± 10.3 mm Hg on a mean of 2.6 ± 0.8 glaucoma medications. At 5-year follow-up, the mean IOP was 13.0 ± 5.9 mm Hg on a mean of 0.9 ± 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 96%, 86%, 79%, 75%, and 71% of eyes at 1, 2, 3, 4, and 5 years, respectively. Grafts remained clear in 96%, 82%, 75%, 57%, and 54% of eyes at 1, 2, 3, 4, and 5 years, respectively. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries. CONCLUSIONS: Our data suggests that GDD placement can provide glaucoma control in a high percentage (71%) of eyes with PK even at 5 years. Furthermore, the success of PK in eyes with GDD remains reasonable (54%) at 5 years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity.

Trainee glaucoma surgery: experience with trabeculectomy and glaucoma drainage devices.

BACKGROUND AND OBJECTIVE: To examine outcomes of trabeculectomy with mitomycin C and glaucoma drainage device placement for uncontrolled glaucoma when performed by resident surgeons. PATIENTS AND METHODS: This study included any patient who underwent a trabeculectomy with mitomycin C (n = 93) or a glaucoma drainage device (n = 60) by a resident surgeon between 2001 and 2006. Outcome measures at 3, 6, and 12 months included failure of treatment, number of follow-up appointments, complications, number of medications, and need for further surgery. RESULTS: One year postoperatively, intraocular pressure averaged 12.1 ± 5.1 mm Hg in the trabeculectomy group and 13.0 ± 5.1 mm Hg in the glaucoma drainage device group (P = .31). Complications occurred in 30% of eyes with trabeculectomy and 10% of eyes with a glaucoma drainage device. CONCLUSION: During the first postoperative year, glaucoma drainage device surgery may have fewer complications and less morbidity than a trabeculectomy with mitomycin C when these surgeries are performed by resident surgeons. Final intraocular pressures were similar between the two groups.

Anterior chamber blood reflux during trabeculectomy in an eye with previous trabectome surgery.

INTRODUCTION: The Trabectome is a novel surgical device used in the treatment of open angle glaucoma that removes trabecular meshwork tissue to improve aqueous access to drainage channels. Little is known about the long-term consequences of permanently unroofing Schlemm canal. Eyes that have had previous surgery in the iridocorneal angle, specifically permanent removal of trabecular meshwork tissue, may have an increased propensity for blood reflux. CASE PRESENTATION: We present a case of a patient who had intraoperative blood reflux onto peripheral iris during trabeculectomy 11 months after Trabectome surgery. DISCUSSION: Intraoperative blood reflux and resultant hyphema is strongly correlated with Trabectome surgery, but the literature does not reveal any cases of late postoperative blood reflux. In our patient, the absence of overlying angle structures, including the roof of Schlemm canal, may have allowed blood to reflux into the angle and onto peripheral iris during a sudden decrease in intraocular pressure in trabeculectomy surgery. Further studies to assess the consequences of permanent trabecular meshwork tissue removal may be warranted.