Early aqueous suppressant therapy on hypertensive phase following glaucoma drainage device procedure: A randomized prospective trial

Simon K. Law, Helen L. Kornmann, Joann A. Giaconi, Allen Kwong, Eric Tran, Joseph Caprioli

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Purpose: To prospectively evaluate the effect of early aqueous suppression (therapy) on hypertensive phase (HP) and intraocular pressure (IOP) control after implantation of silicone Ahmed glaucoma valve (AGV). Materials and Methods: Patients who underwent AGV implantation were randomized to initiate therapy (including b-blockers, aagonists, or carbonic anhydrase inhibitors) when postoperative IOP>10mm Hg (low-IOP initiation group) or >17mm Hg (moderate-IOP initiation group). HP was defined as an IOP>21 mm Hg during the first 6 postoperative months, after an initial IOP reduction to <22mm Hg in the first postoperative week. Primary outcome measures included the occurrence of HP and IOP control. Results: Fifty-two eyes (50 patients) underwent AGV implantation. Average follow-up was 21.9±10.7 months. HP was observed in 21 eyes (40.4%) with average peak IOP of 30±8mm Hg, onset at 32±30 days, and duration of 15±32 days. One year postoperatively, those eyes with HP had higher IOP than eyes that did not develop HP (15.1±5.2, 11.4±4.3, respectively; P=0.021) and required more additional glaucoma surgeries (28.6%, 3.2%, respectively; P=0.013). The peak IOP at week 3 postoperatively in the low-IOP initiation group (26 eyes) was significantly lower than in the moderate-IOP initiation group (26 eyes; 15.7±3.6, 20.6±8.9, respectively; P=0.012). Eyes with therapy started after HP onset had significantly higher postoperative IOP from 2 to 4 months. Therapy initiated before the development of HP was not associated with a higher complication rate. Conclusions: Aqueous suppression initiated in the early postoperative period while IOPs were still in the low-teens and was able to reduce the incidence of IOP spike associated with the HP without an increased complication rate.

Original languageEnglish (US)
Pages (from-to)248-257
Number of pages10
JournalJournal of glaucoma
Volume25
Issue number3
DOIs
StatePublished - Mar 23 2016

Keywords

  • Glaucoma
  • Glaucoma drainage device
  • Hypertensive phase
  • Intraocular pressure

ASJC Scopus subject areas

  • Ophthalmology

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