Long-term results of refractory glaucoma surgical treatment with the use of an original metallic glaucoma drainage device

PURPOSE: To study long-term results of refractory glaucoma surgical treatment carried out with the use of an original metallic glaucoma drainage device. METHODS: Between 2007 and 2012, we observed 21 patients with refractive glaucoma who underwent an operation with an implantation of a metallic glaucoma drainage device into the anterior chamber angle. In 9 of these cases (43%), the surgery was performed as an organ-saving procedure. There were 11 cases of glaucoma with ocular pain (52%). Intraocular pressure (IOP) was considered a primary outcome measure. Secondary outcome measures were the following: need for additional hypotensive therapy, second surgical intervention, complications, relief from ocular pain, successful organ-preserving operation, filtration bleb characteristics and the position of drainage device in the anterior chamber angle. Complete success was considered when IOP after surgery ranged between 14 to 25 mm Hg as measured by Maklakov’s method without any hypotensive therapy, partial success - with additional hypotensive therapy. IOP>5 mm Hg or <14 mm Hg and second surgery were considered a failure. Follow-up period was up to 3 years. RESULTS: Complete success after surgery was achieved in 57% of cases (12/21), partial - in 24% (5/21), failure - in 19% (4/21) cases. Mean IOP decreased from 34±5.8 to 20.7±3.9 mm Hg (p=0.0000001), which accounted for a 67.5% IOP drop from baseline. Use of mean number of hypotensive medications decreased from 2.6±0.5 to 1.1±0.3 (p=0.0002). Main reason for surgery failure was tissue fibrosis at the operation site. A repeated surgery with an implantation of another drainage device at another site was required to lower IOP to the desirable level in all failure cases. Postoperatively, hyphema was observed in 1/21 case (5%) only. 82% of patients (9/11) received relief from pain. Preservation of the eye as an anatomic organ was achieved in all planned cases. Diffuse blebs were observed in 48% of cases (10/21), cystic- in 24% (5/21), low - in 28% (6/21). Throughout postoperative follow-up period the device remained in position in all but one case, where device eroded through conjunctiva after 2.5 years of follow-up. The device was explanted and a penetrating glaucoma procedure was performed in this case. CONCLUSION: Implantation of an original metallic glaucoma drainage device into the anterior chamber angle in long terms effectively decreases IOP in patients with refractory glaucoma, relieves patients of pain and can serve as an alternative to enucleation or evisceration of the eye ball.

рефрактерная глаукома, металлический дренаж, внутриглазное давление, дренажная хирургия глаукомы, refractory glaucoma, metallic drainage, intraocular pressure, drainage surgery of glaucoma

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