Comparison of surgical outcomes of gonioscopy-assisted transluminal trabeculotomy, Ahmed glaucoma valve implantation and Baerveldt glaucoma implant in uveitic glaucoma

Theme: Glaucoma
What: Glaucoma
Part of: Glaucoma II: Surgery / Glaucome II: Chirurgical
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 801

Abstract

Purpose : The purpose of this study is to compare the outcomes of three surgical interventions, namely Ahmed glaucoma valve implant, nonvalved Baerveldt glaucoma implant, and Gonioscopy-Assisted Transluminal Trabeculotomy, in patients diagnosed with uveitic glaucoma (UG).

Study Design: IRB-approved retrospective interventional case series.

Methods:  We reviewed the medical charts of patients with UG who underwent different initial surgical interventions: Ahmed glaucoma valve (AGV), nonvalved Baerveldt glaucoma implant (BGI), or gonioscopy-assisted transluminal trabeculotomy (GAAT) from September 2012 to December 2022, as a standalone procedure or concomitant with cataract extraction and intraocular lens implantation. Demographics, baseline and postoperative clinical data, were extracted from medical records before surgery, at day 1, week 1, and months 3, 6, and 12 postoperatively. The main outcome was surgical success which is defined as intraocular pressure (IOP) between 6 and 21 mmHg or IOP reduction ≥20% from baseline following the third postoperative month, no secondary glaucoma surgery, and no loss of light perception. Not achieving the aforementioned IOP criteria at 2 or more consecutive visits constituted a failure. Baseline group differences were assessed using the Analysis of Variance (ANOVA) and post-hoc tests with Bonferroni correction.Success rates as a function of time was assessed by survival analyzes using Kaplan–Meier curves.To our knowledge, this study is the first to compare the outcomes of these three surgical interventions for UG.

Results: A final sample of 77 eyes (15 GATT, 23 AGV, 39 BGI), with a median length of follow-up of 12 months were included. The mean age was 48±15.3 years. Baseline demographics and clinical characteristics were compatible between groups. The BGI group on average experienced an IOP decrease from 32.0 ± 5.8mmHG to 15 ± 1.0 mmHG over the 12 months, with a 53% reduction (p<0.001) and a 78% success rate. The AGV on average experienced an IOP decrease from 34.0 ± 1.6 mmHG to 14.8 ± 2.3 mmHG over the 12 months, with a 56 % reduction (p<0.001) and a 82% success rate. The GATT group on average experienced an IOP decrease from 40.2 ± 5.5 mmHG to 14.2 ± 3.3 mmHG over the 12 months, with a reduction of 65% (p<0.001) and a 86% success rate. The BGI, AGV and GATT complication rate was 24%, 19% and 12% ,respectively (p<0.731). 

Conclusion: As GDDs are currently the preferred first-line surgical intervention for UG, GATT offers a similar success rate and better safety profile. Considering the substantial risk these patients face of requiring multiple surgical interventions throughout their lifetime, GATT offers a hopeful prospect for improved long-term outcomes.

Presenter(s)

Presenting Author: Maya Alik

Additional Author(s):

Ali Salimi, McGill University

Hady Saheb, McGill University

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