Ophthalmology. Glaucoma · 2025
Long-Term Outcomes of Nonvalved Glaucoma Drainage Devices in Uveitic Glaucoma.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Aluzri Hussain, Swampillai Andrew J, Hussain Sami, Masood Imran, Sung Velota C T
Аннотация
PURPOSE: To evaluate the long-term efficacy and safety profile of nonvalved glaucoma drainage devices (GDDs) in the management of refractory uveitic glaucoma.
DESIGN: Retrospective interventional case series.
PARTICIPANTS: Sixty-five eyes of 51 patients.
METHODS: Patients underwent Baerveldt (78.5%) or Molteno (21.5%) GDD implantation at a single tertiary center between 2000 and 2021. The mean follow-up period was 12.05 ± 4.9 years.
MAIN OUTCOME MEASURES: Primary outcome was surgical success defined by World Glaucoma Association criteria. Secondary outcomes included intraocular pressure (IOP) control, medication burden, and complications.
RESULTS: Mean IOP decreased from 32.6 ± 8.4 mmHg preoperatively to 12.2 ± 5.2 mmHg at the last follow-up (P < 0.0001), with concurrent glaucoma medications reduction from 3.8 ± 0.8 to 0.9 ± 1.1 (P < 0.0001). At the final visit, qualified and complete success rates were 58.5% (38/65) and 33.8% (22/65), respectively. The mean survival time was 12.8 years for qualified success and 8.1 years for complete success. Failure occurred in 41.5% (27/65) of eyes, most commonly due to hypotony (13 eyes) or inadequate IOP reduction (10 eyes). Mean best-corrected visual acuity was unchanged (0.49 ± 0.53 vs 0.59 ± 0.72 logarithm of the minimum angle of resolution, P = 0.34). On multivariate analysis, Baerveldt implantation (hazard ratio [HR], 5.56; 95% confidence interval [CI], 2.20-14.09; P < 0.001) and concurrent systemic biologic therapy (HR, 28.57; 95% CI, 6.90-111.11; P < 0.001) were strong independent predictors of qualified success.
CONCLUSIONS: Nonvalved GDDs offer durable IOP control and preserved vision in uveitic glaucoma, for over a decade, with 58.5% qualified success and 41.5% failure at final follow-up (12.05 ± 4.9 years). These findings represent the longest reported outcomes for this cohort.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
DESIGN: Retrospective interventional case series.
PARTICIPANTS: Sixty-five eyes of 51 patients.
METHODS: Patients underwent Baerveldt (78.5%) or Molteno (21.5%) GDD implantation at a single tertiary center between 2000 and 2021. The mean follow-up period was 12.05 ± 4.9 years.
MAIN OUTCOME MEASURES: Primary outcome was surgical success defined by World Glaucoma Association criteria. Secondary outcomes included intraocular pressure (IOP) control, medication burden, and complications.
RESULTS: Mean IOP decreased from 32.6 ± 8.4 mmHg preoperatively to 12.2 ± 5.2 mmHg at the last follow-up (P < 0.0001), with concurrent glaucoma medications reduction from 3.8 ± 0.8 to 0.9 ± 1.1 (P < 0.0001). At the final visit, qualified and complete success rates were 58.5% (38/65) and 33.8% (22/65), respectively. The mean survival time was 12.8 years for qualified success and 8.1 years for complete success. Failure occurred in 41.5% (27/65) of eyes, most commonly due to hypotony (13 eyes) or inadequate IOP reduction (10 eyes). Mean best-corrected visual acuity was unchanged (0.49 ± 0.53 vs 0.59 ± 0.72 logarithm of the minimum angle of resolution, P = 0.34). On multivariate analysis, Baerveldt implantation (hazard ratio [HR], 5.56; 95% confidence interval [CI], 2.20-14.09; P < 0.001) and concurrent systemic biologic therapy (HR, 28.57; 95% CI, 6.90-111.11; P < 0.001) were strong independent predictors of qualified success.
CONCLUSIONS: Nonvalved GDDs offer durable IOP control and preserved vision in uveitic glaucoma, for over a decade, with 58.5% qualified success and 41.5% failure at final follow-up (12.05 ± 4.9 years). These findings represent the longest reported outcomes for this cohort.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.