Risk Factors for Failure in Double-Plate Tube Surgery for Refractory Glaucoma: 25 Years Surgical Experience

Abstract

Purpose: To investigate risk factors associated with success and failure in double-plate tube surgery. Methods: This retrospective case-series observational study included 243 consecutive eyes that underwent anterior-segment double-plate tube surgery from 1990 to 2015. Evaluation of the efficacy of the device was based on the final intraocular pressure (IOP) and the need for anti-glaucoma medication. We also assessed success and failure according to risk factors for trabeculectomy and an early hypertensive phase (HP). Results: Preoperative IOP was 37.3±13.1 mmHg (mean±SD) with 3.0±0.7 medications. After a median follow-up of 44.3 months, the mean IOP was 14.6±6.3 mmHg with 0.4±1.0 medications. The final IOPs ranged from 6 to 21 mmHg in 87.24% of eyes; however, 25.47% required medication. No risk factors studied were associated with surgical failure. Preoperative IOP, glaucoma type, previous surgery, previous anti-glaucoma drugs, implant type, and HP were associated with partial success (p<0.05). HP and preoperative use of brimonidine reduced the probability of complete success by 66.9% and 68.2%, respectively (p<0.05). HP was more likely when chronic preoperative prostaglandin analogues were administered (odds ratio [OR] 4.286; 95% confidence intervals [CI] 1.593-11.529; P=0.0039) and when the tube was located in the posterior chamber (OR 3.561; 95% CI 1.286-9.861; P=0.0145). Conclusion: Tube surgery is effective and seems to be independent of the major risk factors for glaucoma surgery. However, previous surgery and some chronic preoperative drugs are related to the need for glaucoma medication to achieve the target pressure.

Prevalence of hypertensive phase and outcomes in patients with Ahmed valve implantation at one year of follow-up and evaluation of associated risk factors

“…Regarding previous surgeries, particularly cataract surgery, we found that pseudophakic and aphakic eyes were less likely to develop HP. This finding contrasts with previous results, such as the studies by Chansangpetch et al ,[ 12 ] Duch et al ,[ 13 ] and Dubey et al . [ 5 ]…”

“…[ 10 - 12 ] However, this contrasts with the study by Duch et al . [ 13 ] who found higher preoperative IOP to be a protective factor against HP.…”

Surgical Repair of the Extrusion of the Body of a PAUL Implant for Glaucoma

“…The type of implant chosen depends on the priorities of the surgical technique and the objectives to be achieved. The greater safety and postoperative comfort of valved GDD contrasts with the greater hypotensive efficacy of nonvalved GDD [ 4 ], which requires perioperative maneuvers to regulate the intraocular pressure (IOP) during the immediate postoperative period or the introduction of flow pressure control devices like eyeWatch TM , which varies the diameter of the extraocular tube through a magnetic externally controlled device [ 5 ]. The preoperative plan must individually assess the pros and cons of each option to decide the type of implant, the specific access, the location of the plates, and the flow control measurements to be used.…”