Purpose
To identify risk factors for device exposure and intraocular infection following implantation of a glaucoma drainage device.
Design
Retrospective case series.
Methods
The medical records of adult patients undergoing glaucoma drainage device implantation at an academic medical center between 2000–2010 were reviewed. Main outcome measures included device exposure and intraocular infection.
Results
Seven hundred and sixty-three cases were identified. These included 702 primary implants (ie. the first drainage device implanted into an eye) and 61 sequential implants. Among 702 primary implants, there were 41 (5.8%) cases of exposure. None of the potential risk factors were statistically significant. Implant location was found to be a marginally-significant risk factor. The exposure rates for inferior and superior implants were 12.8% (5 of 39) and 5.4% (36 of 663), respectively (P=0.056). The highest rate of exposure for primary implants occurred in the inferior-nasal quadrant (17.2%, 5 of 29). The rate of exposure for sequential devices was 13.1% (8 of 61) with the highest rate also found in the inferior-nasal quadrant (20%, 5 of 25). Of 49 total exposures, eight were associated with intraocular infection (16.3%). Exposures over inferior implants were more likely to be associated with infection than exposures over superior implants (41.7% vs 8.1%; P=0.0151).
Conclusion
Implant location approached, but did not reach, statistical significance as a risk factor for exposure. Exposures over inferior implants place patients at a higher risk of infection than superior exposures. More studies are needed to identify modifiable risk factors for device exposure.
Purpose
To compare sequential glaucoma drainage device (GDD) implantation with transscleral diode cyclophotocoagulation (CPC) following failure of a primary GDD.
Materials and Methods
Retrospective review of all patients who underwent GDD implantation at a single institution over ten years. Patients who required an additional GDD and/or CPC were analyzed. Success was defined as absence of: loss of light perception, reoperation for glaucoma, and IOP >21 or < 6 at two consecutive visits after an initial 3-month period.
Results
Thirty-two patients received sequential GDD. Twenty-one underwent CPC. Cohorts were statistically similar in regards to age, sex, race, and number of previous surgeries. Preoperatively, the GDD cohort had a lower IOP and better visual acuity. The mean length of follow-up was 37.9 months for the GDD group and 46.3 months for CPC. Both procedures significantly reduced IOP, however CPC led to a greater reduction (p=0.0172). Survival analysis found the 5-year probability of surgical success to be 65.3% for sequential GDD and 58.0% for CPC (p=0.8678). No cases of phthisis occurred in either group. There were 2 cases of endophthalmitis (6.3%) in the GDD group, and none in the CPC group. In eyes without pre-existing corneal edema, estimated corneal decompensation probability at 3-years was 31.6% for GDD and 6.7% for CPC (p=0.0828).
Conclusion
Sequential GDD and CPC are both effective at reducing IOP following the failure of a primary GDD. CPC after GDD failure warrants further investigation as it led to a greater reduction in IOP with fewer serious adverse events.
An 11-year-old boy was struck in the left eye with a mechanical pencil in a projectile manner. Initial examination under the operating microscope revealed a presumed partial-thickness corneal injury with a retained 8-mm long segment of graphite lead. After removal of the graphite segment, a full-thickness hole in the cornea was revealed under the lead shaft. The proposed mechanism of injury and unique presentation was initial full-thickness penetration followed by lead shaft retraction (likely due to eye rubbing) and then corneal stromal reentry with stromal lamellar dissection and fixation. Prompt removal of the foreign body, corneal laceration repair, and early cataract extraction resulted in postoperative 20/40 uncorrected visual acuity. Mechanical lead pencil injuries represent a unique mechanism of penetrating trauma.
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