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Abstract #109602 Published in IGR 24-1
Five Year Outcomes of Graft Free Tube Shunts and Risk Factors for Tube Exposures in Glaucoma
Youn S; Yan DBJournal of Glaucoma 2023; 0:
PRCIS: Use of a scleral tunnel technique instead of a patch graft can be considered in most cases of tube shunt implantation. Grafts may still be considered in younger (<65 y old) East Asians. PURPOSE: 1) To assess the risk factors for tube exposure with a graft-free implantation technique; 2) To examine five-year outcomes of graft-free tube shunt insertion. METHODS: This was a retrospective case series of 204 consecutive eyes undergoing a glaucoma tube shunt implantation with a scleral tunnel technique in lieu of a graft. Pre and postoperative best corrected visual acuity, intraocular pressure, and number of glaucoma medications were compared. Failure was defined as the following: 1) Intraocular pressure >21 mmHg or ≤5 mmHg on 2 consecutive visits after 3 mo; 2) Required additional glaucoma surgery; 3) Loss of light perception. Univariable and multivariable regression analyses were conducted to identify risk factors of tube exposures. RESULTS: Intraocular pressure and the number of glaucoma medications were significantly decreased at all post-operative time points (P<0.001). Success rates were 91% at year 1, 75% at year 3, and 67% at year 5. The most common early (<3 mo) complication was tube malpositioning. The most common late (>3 mo to 5 y) complications were corneal complications and uncontrolled intraocular pressure. By year 5, 6.9% of tubes were exposed. Multivariable regression showed that age less than 65 years old (OR 3.66, P=0.04) and East Asian ethnicity (OR 3.36, P=0.04) were associated with significantly increased risk of tube exposure. CONCLUSIONS: Graft-free glaucoma tube implantation has comparable long-term outcomes and complication rates to shunts with a graft. Younger (<65 y old) East Asians are at greater risk of tube exposure without a graft.
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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