Analysis of long-term outcomes for combined pars plana vitrectomy (PPV) and glaucoma tube shunt surgery in eyes with advanced glaucoma

• Published in: Eye (London) Vol. 28; no. 3; pp. 290 - 295
• Main Authors: Gandhi, A, Miller, D M, Zink, J M, Khatana, A K, Riemann, C D, Petersen, M R, Foster, R E, Sisk, R A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2014; Nature Publishing Group
• Subjects: 692/699/3161/3169/3170; 692/700/565/545; Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Clinical Study; Combined Modality Therapy; Female; Follow-Up Studies; Glaucoma; Glaucoma - physiopathology; Glaucoma - surgery; Glaucoma Drainage Implants; Humans; Intraocular Pressure - physiology; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Pharmaceutical Sciences/Technology; Retrospective Studies; Surgery; Surgical Oncology; Suture Techniques; Tonometry, Ocular; Visual Acuity - physiology; Vitrectomy; Young Adult; pars plana vitrectomy; glaucoma tube shunt; intraocular pressure; glaucoma
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2013.263

Purpose
To analyze 12- and 24-month visual acuity, intraocular pressure, and complications associated with combined pars plana vitrectomy (PPV) and glaucoma tube shunt placement in eyes with glaucoma.
Patients and methods
A retrospective chart review was performed of patients with advanced glaucoma who underwent combined PPV and tube shunt surgery from 2006 to 2010. A minimum of 12 months of follow-up was required for their inclusion in the study. Visual acuity, intraocular pressure, complications, and number of glaucoma medications at 1 and 2 years postoperatively were analyzed.
Results
Twenty-eight eyes met the inclusion and exclusion criteria. Baseline visual acuity was 20/200 or worse in 14/28 eyes (50.0%) and 20/40 or better in 2/28 eyes (7.1%). Visual acuity remained 20/200 or worse in 50.0% (
P
=0.921) and 44.4% (
P
=0.973) of eyes after 1 and 2 years postoperatively, respectively. At baseline, the mean intraocular pressure was 30.4 mm Hg. There was significant improvement in mean IOP at 1 year (14.7 mm Hg,
P
=0.001) and at 2 years (15.2 mm Hg,
P
=0.001) postoperatively. Baseline number of glaucoma medications averaged 3.0±1.09 (SD), and improved to 1.8±1.28 (SD) at 1 year (
P
=0.0002) and to 1.4±1.33 at 2 years (
P
<0.0001) postoperatively.
Conclusion
In this retrospective interventional case series, surgical management of advanced glaucoma with a combination of PPV and glaucoma tube shunt resulted in significantly reduced IOP and glaucoma medications at 1 and 2 years postoperatively.