title: Sequential glaucoma implants in refractory glaucoma.
abstract: OBJECTIVE
  To evaluate the efficacy of a second glaucoma implant in eyes with prior glaucoma implant surgery and inadequate intraocular pressure (IOP) control.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Patients undergoing a second glaucoma implant surgery from 1996 to 2008 were included. Outcome measures included visual acuity, IOP, glaucoma medication use, and complications. Success was defined as IOP < 21 mm Hg (criterion 1) and IOP < 17 mm Hg (criterion 2), with at least 25% reduction in IOP and no prolonged hypotony.
  
  
  RESULTS
  Forty-three eyes (43 patients) had a mean follow-up of 32.6 +/- 21.6 months. Life-table analysis demonstrated success rates of 93%, 89%, and 83% using criterion 1 and 83%, 75%, and 75% using criterion 2 at 1, 2, and 3 years, respectively. At last follow-up, mean IOP (13.6 +/- 4.6 vs 24.7 +/- 7.5 mm Hg; P < .001) and mean number of medications (1.4 +/- 1.2 vs 3.9 +/- 1.2; P < .001) were lower following the second implant. There was no difference in preoperative and most recent logarithm of the minimal angle of resolution (logMAR) visual acuities (0.86 +/- 0.13 vs 1.1 +/- 0.13; P = .07). The most frequently used second implants were similar in percentage IOP reduction (Baerveldt implant, 45 +/- 19%; Ahmed valve, 40 +/- 18%; P = .4).
  
  
  CONCLUSIONS
  A second glaucoma implant may effectively lower IOP in eyes with refractory glaucoma.
authors.affiliation: New York Eye and Ear Infirmary, New York, New York, USA.
authors.forename: Aashish
authors.initials: A
authors.lastname: Anand
authors.forename: Celso
authors.initials: C
authors.lastname: Tello
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sidoti
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology