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Editors Selection IGR 15-4

Surgical Treatment: Drainage Device Placement

Comment by Robert Feldman & Ruchi Shah on:

104780 Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use, Yonamine S; Ton L; Rose-Nussbaumer J et al., Clinical Ophthalmology, 2022; 16: 2305-2310

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This paper by Yonamine and colleagues aims to better understand practice patterns among glaucoma specialists regarding anterior chamber tube shunt placement and postoperative corticosteriod use, particularly in relation to endothelial cell damage. An online survey was sent to the members of the American Glaucoma Society and 128 responses were included. It found that 90% of respondents place tubes in the anterior chamber, however, 61% believe that sulcus tube placement is better than anterior chamber placement for endothelial cell protection. Of respondents, 49% believe that sulcus tube placement was not superior to anterior chamber placement for pressure control and 49% thought there was not enough evidence in the current literature. When asked about post-operative use of diflueprednate 0.05% over prednisolone 1% to prevent endothelial cell loss and for intraocular pressure control, over 40% were unfamiliar with the literature and over 45% felt here was not evidence to support the superiority of difluprednate. The majority of respondents felt there would be a benefit to randomized control trials comparing outcomes of anterior chamber vs sulcus tube placement and post-operative corticosteroid usage for preventing endothelial cell loss and pressure control after surgery and the majority also indicated that this evidence would change their practice patterns. This study is important as it highlights a perceived gap in the current literature and a need for more randomized control trials. However, this study has potential inherent bias in the questions that were asked. Respondents were not asked about potential long term complications from sulcus tubes including iris chafing and anterior tube migration overtime. Additional limitations of this study include the low response rate and recall bias that is inherent to survey-based research. Only a small population of glaucoma specialists were surveyed and this may not represent the overall practice patterns of the world-wide glaucoma community.

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