Implantation of a second glaucoma drainage device.
OBJECTIVE
To evaluate success rates in controlling intraocular pressure (IOP) after implantation of a second glaucoma drainage device (GDD) with a Baerveldt glaucoma implant in patients with refractory glaucoma, with a secondary aim of reducing the need for postoperative glaucoma medications.


METHODS
This retrospective, noncomparative, interventional study included patients undergoing a second GDD for uncontrolled glaucoma from a tertiary care glaucoma service. Data were obtained from the medical records for the preoperative period and after the 1st, 15th, and 30th day, 3, 6, and 12 months, and then yearly until the last postoperative visit. Visual acuity, IOP, and number of glaucoma medications (NGM) from the follow-up visits were compared to baseline. Success and failure criteria were analyzed based on IOP level or need of glaucoma medications.


RESULTS
Forty-nine patients were studied, with a mean follow-up time of 25 ± 21 months. The mean preoperative IOP was 23.7 ± 8.2 mmHg, and decreased to 14.8 ± 4.0 mmHg after 1 year, 14.4 ± 3.9 mmHg after 2 years, and 16.6 ± 8.5 mmHg after 3 years. The mean preoperative NGM was 3.4 ± 1.3, and decreased to 2.0 ± 1.8 after 1 year, 2.5 ± 1.6 after 2 years, and 2.8 ± 2.0 after 3 years. Absolute success was 9% after 1 year for a postoperative IOP between 5 and 18 mmHg, and 76% for a postoperative IOP between 5 and 21 mmHg. The qualified success was 88% at the first and second years and 83% at the third year.


CONCLUSIONS
With up to 3 years of follow-up, a second glaucoma drainage device was successful in reducing IOP to below 21 mmHg, but not as successful below 18 mmHg. The success rate is improved with the use of glaucoma medications with up to 3 years of follow-up.
Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. BFrancis@doheny.org.
Brian A
BA
Francis
Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Rodrigo A B
RAB
Fernandes
Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Handan
H
Akil
Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Vikas
V
Chopra
Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Bruno
B
Diniz
Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
James
J
Tan
Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Alex
A
Huang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; 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; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
Complications; Glaucoma implants; Outcome; Refractory glaucoma; Sequential