Surgical outcomes of superior versus inferior glaucoma drainage device implantation

Amy Z. Martino, Shawn Iverson, William J Feuer, David Greenfield

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

PURPOSE: To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus.

METHODS: A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis.

RESULTS: Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47%) and 11/33 (33%) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8% and 9.1%, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test).

CONCLUSIONS: No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.

Original languageEnglish (US)
Pages (from-to)32-36
Number of pages5
JournalJournal of Glaucoma
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Glaucoma
Intraocular Pressure
Drainage
Equipment and Supplies
Reoperation
Trabeculectomy
Kaplan-Meier Estimate
Visual Acuity
Demography
Students
Safety
Light
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Surgical outcomes of superior versus inferior glaucoma drainage device implantation. / Martino, Amy Z.; Iverson, Shawn; Feuer, William J; Greenfield, David.

In: Journal of Glaucoma, Vol. 24, No. 1, 01.01.2015, p. 32-36.

Research output: Contribution to journalArticle

Martino, Amy Z. ; Iverson, Shawn ; Feuer, William J ; Greenfield, David. / Surgical outcomes of superior versus inferior glaucoma drainage device implantation. In: Journal of Glaucoma. 2015 ; Vol. 24, No. 1. pp. 32-36.
@article{f60b295d43484fa6a99cbeea57be5441,
title = "Surgical outcomes of superior versus inferior glaucoma drainage device implantation",
abstract = "PURPOSE: To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus.METHODS: A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20{\%} below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis.RESULTS: Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47{\%}) and 11/33 (33{\%}) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7{\%} and 75.8{\%} classified as successful at 1-year of follow-up and 43.1{\%} and 65.7{\%} at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8{\%} and 9.1{\%}, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test).CONCLUSIONS: No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.",
author = "Martino, {Amy Z.} and Shawn Iverson and Feuer, {William J} and David Greenfield",
year = "2015",
month = "1",
day = "1",
doi = "10.1097/IJG.0b013e318287ac8f",
language = "English (US)",
volume = "24",
pages = "32--36",
journal = "Journal of Glaucoma",
issn = "1057-0829",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Surgical outcomes of superior versus inferior glaucoma drainage device implantation

AU - Martino, Amy Z.

AU - Iverson, Shawn

AU - Feuer, William J

AU - Greenfield, David

PY - 2015/1/1

Y1 - 2015/1/1

N2 - PURPOSE: To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus.METHODS: A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis.RESULTS: Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47%) and 11/33 (33%) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8% and 9.1%, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test).CONCLUSIONS: No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.

AB - PURPOSE: To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus.METHODS: A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis.RESULTS: Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47%) and 11/33 (33%) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8% and 9.1%, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test).CONCLUSIONS: No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.

UR - http://www.scopus.com/inward/record.url?scp=84979860389&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979860389&partnerID=8YFLogxK

U2 - 10.1097/IJG.0b013e318287ac8f

DO - 10.1097/IJG.0b013e318287ac8f

M3 - Article

C2 - 23429626

AN - SCOPUS:84979860389

VL - 24

SP - 32

EP - 36

JO - Journal of Glaucoma

JF - Journal of Glaucoma

SN - 1057-0829

IS - 1

ER -