SURGICAL OUTCOMES IN UVEITIC GLAUCOMA: LONG-TERM EVALUATION OF TRABECULECTOMY, NON-PENETRATING DEEP SCLERECTOMY, EX-PRESS SHUNT AND AHMED GLAUCOMA VALVE. A 3-YEAR FOLLOW-UP STUDY
Published 2024 - 28th ESCRS Winter Meeting
Reference: FP80 | Type: Submission | DOI: 10.82333/v0s5-0121
Authors: David Aragon Roca* 1 , David Oliver Gutierrez 2 , Sandra Banderas García 3 , Fernando Trejo Velasco 4 , Xavier Garrell Salat 5 , Marta Castany Aregall 2
1Glaucoma,Vall d'Hebrón University Hospital,Barcelona,Spain;Cornea,Hospital l'Esperança - Hospital del Mar,Barcelona,Spain, 2Glaucoma,Vall d'Hebrón University Hospital,Barcelona,Spain, 3Glaucoma,Vall d'Hebrón University Hospital,Barcelona,Spain;Vitreoretina,Manchester Royal Eye Hospital ,Manchester,United Kingdom, 4Glaucoma,Vall d'Hebrón University Hospital,Barcelona,Spain;Paediatrics Ophthalmology,Sant Joan de Deu Hospital,Barcelona,Spain, 5Glaucoma,Vall d'Hebrón University Hospital,Barcelona,Spain;Vitreoretina,Granollers Hospital,Barcelona,Spain
Purpose
Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is not a consensus of which is the best surgical approach in uveitic glaucoma due to limited data comparing various IOP-lowering surgeries. This retrospective cohort aims to assess clinical outcomes of trabeculectomy, non-penetrating deep sclerectomy, Ex-PRESS shunt and Ahmed glaucoma valve and offer additional insights to the long-term IOP control and safety of filtering surgeries in uveitic glaucoma.
Setting
Hospital Universitari Vall d’Hebron, Barcelona, Spain.
Methods
Filtering surgery was performed in 32 eyes of 27 uveitic glaucoma patients. Complete success was defined as IOP≤18mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment.
Results
Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both Ex-Press and NPDS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p=0.049; Ex-Press vs TBT: HR = 0.28, p=0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. Non-penetrating deep sclerectomy had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups.
Conclusion
Diverse filtering surgeries are safe and effective procedures lowering intraocular pressure and reducing the requirement of topical antihypertensives in uveitic glaucoma at 36 months. However, a third of the patients will require another IOP-lowering procedure.