Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma

Shah, Avanee A; WuDunn, Darrell; Cantor, Louis B.

doi:10.1016/s0002-9394(99)00410-9

Cited by 75 publications

(90 citation statements)

References 16 publications

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“…One study, comparing GDI bleb revision with an additional GDI procedure after failed GDI surgery found corneal edema to be a common complication, especially in the additional tube group. 4 Another study reported that progressive corneal decompensation occurred in 7 of 43 eyes (16.3%) following second tube implants. 5 However, in the latter study nearly 50% of the sequential GDI tubes were placed in the sulcus or vitreous cavity instead of the angle insertion.…”

Section: Discussionmentioning

confidence: 98%

“…6 Previous reports have found corneal decompensation to be the main complication following a second GDI procedure. [2][3][4][5] Another viable procedure option if extra drainage is needed is to add a second GDI piggybacked to the primary GDI bleb, that is, without actually entering the anterior chamber again. The sequential implant is rotated so that its tube is toward the primary device and is inserted into the bleb of the primary implant.…”

Section: Introductionmentioning

confidence: 99%

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Insertion of sequential glaucoma drainage implant in a piggyback manner

Välimäki

2015

Eye

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Purpose This pilot study, the first of its type, was conducted to determine the clinical outcome of a sequential glaucoma drainage implant (GDI) inserted in piggyback manner, that is into the bleb of a primary GDI. Methods This was a retrospective chart study with a minimum 1-year follow-up involving 16 eyes of 14 uncontrolled glaucoma patients who had previously undergone sequential GDI performed using a technique to convert a one-plate into a two-plate implant system. Surgical success was defined as intraocular pressure (IOP) o21 mm Hg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP 45 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception vision. Results The mean ± SD baseline IOP was 29.2 ± 5.2 mm Hg, and the mean postoperative IOP was 17.3 ± 3.4 mm Hg, with a mean pressure drop of 39.4 ± 10.4% (Po0.001). Life-table analysis showed an 88% success rate after 12 months of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 0.2 ± 0.2 logMAR (Snellen equivalent 6/9.5), compared with 0.3 ± 0.3 logMAR postoperatively (Snellen equivalent 6/12; P = 0.497). Postoperative complications included a flat anterior chamber and choroidal detachment (one eye), uveitis and cataract (one eye), diplopia (one eye), and worsening of pre-existing pseudophakic bullous keratopathy (one eye). Conclusions In glaucoma eyes with useful vision the piggyback GDI seems to provide a significant IOP lowering with minimal complications in patients in whom an initial GDI had failed to control the IOP.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Insertion of sequential glaucoma drainage implant in a piggyback manner

Välimäki

2015

Eye

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“…Needling or surgical revision of the bleb over the plate (capsule excision) may be attempted but published studies have shown the outcomes are inferior to additional GDD implantation. [113][114][115] Sequential tube surgery may, however, result in more corneal complications. In children, small series of sequential tube surgery in a different quadrant report reasonable success rates.…”

Section: Gddmentioning

confidence: 99%

Childhood glaucoma surgery in the 21st Century

Papadopoulos

Edmunds

Fenerty

et al. 2014

Eye

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“…Furthermore, injection of 5-fluorouracil seems to enhance the outcome after failed GDD surgery [7,8]. For shunt revision with excision of the capsule, a qualified success rate of 42% has been reported [9]. Another therapeutic approach, having a qualified success rate of 62% [9], is implantation of an additional GDD.…”

Section: Excision+ologen™mentioning

confidence: 99%

“…If bleb encapsulation has occurred in a primarily working glaucoma implant and IOP cannot be controlled any longer by topical or systemic medication or digital massage capsule needling [7], injection of 5-fluorouracil [7,8], additional implantation of a GDD or surgical excision of the capsule around the glaucoma implant has been proposed [9], although there is a lack of evidence that these "enhancing" secondary interventions have any longterm benefit.…”

Section: Introductionmentioning

confidence: 99%