title: A Comparison of Sequential Glaucoma Drainage Device Implantation Versus Cyclophotocoagulation Following Failure of a Primary Drainage Device.
abstract: OBJECTIVE
  To compare sequential glaucoma drainage device (GDD) implantation with transscleral diode cyclophotocoagulation (CPC) following failure of a primary GDD.
  
  
  METHODS
  A retrospective review of all patients who underwent GDD implantation at a single institution over 10 years. Patients who required an additional GDD and/or CPC were analyzed. Success was defined as absence of loss of light perception, reoperation for glaucoma, and intraocular pressure (IOP) >21 or <6 at 2 consecutive visits after an initial 3-month period.
  
  
  RESULTS
  Thirty-two patients received sequential GDD. Twenty-one underwent CPC. Cohorts were statistically similar in regards to age, sex, race, and number of previous surgeries. Preoperatively, the GDD cohort had a lower IOP and better visual acuity. The mean length of follow-up was 37.9 months for the GDD group and 46.3 months for CPC. Both procedures significantly reduced IOP; however, CPC led to a greater reduction (P=0.0172). Survival analysis found the 5-year probability of surgical success to be 65.3% for sequential GDD and 58.0% for CPC (P=0.8678). No cases of phthisis occurred in either group. There were 2 cases of endophthalmitis (6.3%) in the GDD group, and none in the CPC group. In eyes without preexisting corneal edema, estimated corneal decompensation probability at 3 years was 31.6% for GDD and 6.7% for CPC (P=0.0828).
  
  
  CONCLUSIONS
  Sequential GDD and CPC are both effective at reducing IOP following the failure of a primary GDD. CPC after GDD failure warrants further investigation as it led to a greater reduction in IOP with fewer serious adverse events.
authors: Departments of *Ophthalmology †Biostatistics and Bioinformatics, Emory University, Atlanta, GA.
authors: Joshua D
authors: JD
authors: Levinson
authors: Annette L
authors: AL
authors: Giangiacomo
authors: Allen D
authors: AD
authors: Beck
authors: Paul B
authors: PB
authors: Pruett
authors: Hillary M
authors: HM
authors: Superak
authors: Michael J
authors: MJ
authors: Lynn
authors: Anastasios P
authors: AP
authors: Costarides
mesh_terms: D000368:Aged; D002924:Ciliary Body / Q000601:surgery; D015715:Corneal Edema; D009877:Endophthalmitis; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000601:surgery; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology