Combined 25-gauge vitrectomy and posterior tube shunt placement for advanced glaucoma.
OBJECTIVE
To report the initial clinical outcomes of a combined procedure utilizing 25-gauge vitrectomy and posterior tube shunt placement in eyes with refractory glaucoma not amenable to standard treatment.


METHODS
Retrospective chart review.


METHODS
We included 10 eyes (10 consecutive adult patients, mean age 61 years) with advanced glaucoma and anterior segment abnormalities precluding tube placement in the anterior chamber who were treated with combined 25-gauge vitrectomy and posterior tube shunt placement.


METHODS
Records of consecutive patients were reviewed for demographics, etiology of glaucoma, preoperative clinical data (visual acuity, intraocular pressure, number of ocular antihypertensive medications), and postoperative outcome measures at predetermined time points.


METHODS
(1) Intraocular pressure (IOP) at 1, 2, 6, and 12 months postoperatively; (2) number of ocular antihypertensive medications needed at 12 months postoperatively; (3) visual acuity (VA) at 12 months postoperatively; and (4) incidence of hypotony, retinal detachment, endophthalmitis, and corneal decompensation.


RESULTS
Preoperatively, mean IOP was 31 mmHg, and patients required a mean of 2.5 ocular antihypertensive medications. Mean IOP at 1, 2, 6, and 12 months postoperatively were 17.0, 16.1, 17.8, and 16.1 mmHg, respectively, and significantly lower than preoperative IOP (P < 0.005 at all time points). At 1 year postoperatively, 90% of patients had an IOP < 20 mmHg, and 50% of patients required ≤ 2 ocular antihypertensive medications. At 1 year postoperatively, VA was the same or improved in 70% of patients, and no worse than 1 Snellen line in any patient. Corneal edema developed in 2 patients. No patient developed hypotony or endophthalmitis.


CONCLUSIONS
Combined 25-gauge vitrectomy and posterior tube shunt placement can be successful in lowering IOP in eyes with advanced glaucoma not amenable to other therapies.
Reichstein
David
D
Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kammer
Jeffrey
J
Recchia
Franco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057972:Posterior Eye Segment / Q000601:surgery*; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*
D000959:Antihypertensive Agents