Outcomes of glaucoma tube shunt implantation with vitrectomy in eyes with neovascular glaucoma.

PURPOSE: To evaluate the clinical outcomes of tube shunt surgery combined with pars plana vitrectomy (PPV) in eyes with neovascular glaucoma (NVG), using either the Ahmed Glaucoma Valve (AGV) or the Baerveldt Glaucoma Implant (BGI).

METHODS

This retrospective observational study included 41 eyes of 38 patients with NVG who underwent combined PPV and tube shunt surgery between 2015 and 2020. All tubes were inserted into the vitreous cavity. Intraocular pressure (IOP), number of glaucoma medications (ED score), best-corrected visual acuity (logMAR VA), and complications were analyzed over a follow-up period of up to 5 years. The primary outcome was surgical success, defined as IOP between 6 and 20 mmHg without the need for additional or replacement implants. Kaplan-Meier analysis was performed to evaluate success probability.

RESULTS

AGV was implanted in 33 eyes and BGI in 8 eyes. At the final visit, the mean IOP significantly decreased from 32.3 ± 10.1 to 15.5 ± 3.5 mmHg (p < 0.001), and the mean ED score decreased from 5.4 ± 1.5 to 1.5 ± 0.9 (p < 0.001). No significant change was observed in logMAR VA (p = 0.53). The final success rates were 75.0% in the BGI group and 72.7% in the AGV group (p = 0.880). The mean postoperative IOP was significantly lower in the BGI group compared to the AGV group (12.5 ± 4.1 mmHg vs. 16.2 ± 3.0 mmHg, p = 0.025). No severe complications such as endophthalmitis or hypotony were observed.

CONCLUSIONS

Tube shunt surgery with PPV and pars plana tube insertion is effective and well tolerated in eyes with NVG. While both AGV and BGI provide comparable success rates, BGI may offer better IOP control.