Early Aqueous Suppressant Therapy on Hypertensive Phase Following Glaucoma Drainage Device Procedure: A Randomized Prospective Trial

• Published in: Journal of glaucoma Vol. 25; no. 3; pp. 248 - 257
• Main Authors: Law, Simon K, Kornmann, Helen L, Giaconi, JoAnn A, Kwong, Allen, Tran, Eric, Caprioli, Joseph
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-03-2016
• Subjects: Aged; Antihypertensive Agents - therapeutic use; Aqueous Humor - physiology; Female; Follow-Up Studies; Glaucoma - physiopathology; Glaucoma - surgery; Glaucoma Drainage Implants; Humans; Intraocular Pressure - drug effects; Male; Middle Aged; Prospective Studies; Tonometry, Ocular; Treatment Outcome
• ISSN: 1057-0829; 1536-481X
• DOI: 10.1097/IJG.0000000000000131

PURPOSE:To prospectively evaluate the effect of early aqueous suppression (therapy) on hypertensive phase (HP) and intraocular pressure (IOP) control after implantation of silicone Ahmed glaucoma valve (AGV).
MATERIALS AND METHODS:Patients who underwent AGV implantation were randomized to initiate therapy (including β-blockers, α-agonists, or carbonic anhydrase inhibitors) when postoperative IOP>10 mm Hg (low-IOP initiation group) or >17 mm Hg (moderate-IOP initiation group). HP was defined as an IOP>21 mm Hg during the first 6 postoperative months, after an initial IOP reduction to <22 mm Hg in the first postoperative week. Primary outcome measures included the occurrence of HP and IOP control.
RESULTS:Fifty-two eyes (50 patients) underwent AGV implantation. Average follow-up was 21.9±10.7 months. HP was observed in 21 eyes (40.4%) with average peak IOP of 30±8 mm Hg, onset at 32±30 days, and duration of 15±32 days. One year postoperatively, those eyes with HP had higher IOP than eyes that did not develop HP (15.1±5.2, 11.4±4.3, respectively; P=0.021) and required more additional glaucoma surgeries (28.6%, 3.2%, respectively; P=0.013). The peak IOP at week 3 postoperatively in the low-IOP initiation group (26 eyes) was significantly lower than in the moderate-IOP initiation group (26 eyes; 15.7±3.6, 20.6±8.9, respectively; P=0.012). Eyes with therapy started after HP onset had significantly higher postoperative IOP from 2 to 4 months. Therapy initiated before the development of HP was not associated with a higher complication rate.
CONCLUSIONS:Aqueous suppression initiated in the early postoperative period while IOPs were still in the low-teens and was able to reduce the incidence of IOP spike associated with the HP without an increased complication rate.