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Abstract #5866 Published in IGR 2-1
Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma
Shah AA; WuDunn D; Cantor LBAmerican Journal of Ophthalmology 2000; 129: 455-460
PURPOSE: To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. METHODS: The authors identified 281 patients who underwent a primary tube shunt procedure from 1985-1998 at Indiana University and reviewed 33 eyes of 33 patients that had failed and required further surgery. Shunt revision was performed in 12, whereas an additional shunt was placed in 21 eyes. Intraocular pressure, antiglaucoma medications, visual acuity, and complications were noted. Success was defined as at least a 25% reduction in intraocular pressure that was deemed clinically adequate. Qualified success was defined as a 25% intraocular pressure reduction but with additional medications or a significant reduction in medications with stable intraocular pressure for preoperative intraocular pressure less than 21 mmHg. RESULTS: Preoperative intraocular pressures (mean ±95% confidence interval) for the revision and additional tube groups were 28.8±5.8 mmHg and 29.8±2.7 mmHg (p=0.73), with an average follow-up period of 25.2 months (range, 3-108 months) and 34.8 months (range, 6-84 months), respectively. Final mean intraocular pressure was 25.3±6.7 mmHg for the revision group and 17.7±3.4 mmHg for the additional tube group (p=0.037). Forty-two percent in the revision group versus 62% in the additional tube group achieved at least a qualified success (p=0.30, Fisher exact test). Corneal edema was a common complication, especially in the additional tube group. Limitations of this study include the small sample sizes and the uneven distribution of neovascular glaucoma between the two groups (six of 12 in the revision group versus two of 21 in the additional tube group; p=0.015, Fisher exact test). CONCLUSIONS: This series showed that, after failed tube shunt surgery, an additional tube shunt offers better intraocular pressure control than revision by excision of an encapsulated bleb.
Dr. L.B. Cantor, Department of Ophthalmology, Indiana University, School of Medicine, 702 Rotary Circle, Indianapolis, IN 46202, USA
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
