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J Glaucoma Volume 00, Number 00, ’’ 2016 Sequential GDD versus Cyclophotocoagulation
TABLE 3. Univariate Analysis of Risk Factors for Surgical Failure TABLE 5. Surgical Complications
Preoperative Variables Pw n (%)
Age 0.4042 Complications GDD CPC
Race 0.7176
Sex 0.4184 Shallow anterior chamber 4 (12.5) 1 (4.8)
Procedure choice 0.8673 Serous choroidal detachment 4 (12.5) 3 (14.3)
No. previous surgeries 0.8094 Hemorrhagic choroidal detachment 0 0
Phthisis 0 0
Preoperative IOP 0.0199*
Reoperation for glaucoma 5 (15.6) 3 (14.3)
Preoperative VA 0.4388
Loss of light perception 1 (3.1) 2 (9.5)
*indicates statistically significant at a P < 0.05. Endophthalmitis 2 (6.3) 0
wConducted with Wald w2 tests. Enucleation 1 (3.1) 0
IOP indicates intraocular pressure; VA, visual acuity. GDD tube occlusion 3 (9.4) N/A
GDD exposure 3 (9.4) N/A
16.5 mm Hg, P < 0.0001) in the GDD group and 56.3% CPC indicates cyclophotocoagulation; GDD, glaucoma drainage device.
(33.2 vs. 14.5 mm Hg, P < 0.0001) in the CPC group. CPC
led to a greater reduction in IOP than sequential GDD
include overfiltration with hypotony, corneal decom-
(P = 0.0172). Both groups required fewer ocular hypo-
pensation, exposure of the device through the conjunctiva,
tensive agents at the final follow-up visit compared with
endophthalmitis, and failure to adequately control IOP.15
preoperatively.
Semchyshyn and colleagues retrospectively studied the
Postoperative complications are listed in Table 5.
outcomes of CPC following failure of a primary GDD in
Special interest was paid to the development of corneal
adults and children. CPC significantly reduced IOP and
decompensation. Eyes with corneal grafts or preoperative
mean number of glaucoma medications.16 Later studies by
corneal decompensation were excluded from this analysis.
Panarelli et al17 and Ness et al18 also found transscleral
Corneal decompensation occurred in 19.2% (5/26) of the
CPC to be an effective treatment following shunt failure.
GDD group and 5.6% (1/18) of the CPC group. Kaplan-
Only 1 study could be identified that directly compared
Meier estimates of the probability of corneal failure at 3
the outcomes of sequential GDD and CPC following failure
years were 31.6% and 6.7% in the GDD and CPC groups,
of a primary drainage device. Sood and Beck4 retrospectively
respectively (P = 0.0828, Fig. 2). Also of note, there were 2
reviewed outcomes in a small case series with pediatric
cases of endophthalmitis (6.3%) in the GDD group and
glaucoma. Successful outcomes were achieved in 62.5% of
none in the CPC group.
patients who underwent implantation of a sequential GDD
and 66.7% of those receiving CPC at 24 months.
DISCUSSION The most serious complications with CPC are phthisis and
This study retrospectively reviewed the surgical out- loss of light perception. It is notable that no cases of phthisis
comes of sequential GDD versus transscleral CPC follow- occurred in either treatment group during the study period. Loss
ing failure of a primary drainage device. Both procedures of light perception occurred in 1 eye that underwent sequential
were found to be effective in lowering IOP and decreasing GDD and 2 eyes that underwent CPC. All 3 patients who lost
ocular hypotensive medications. No statistical difference light perception in this study had Count Fingers or worse vision
was found in surgical success rates between groups. CPC preoperatively, and no cases of loss of light perception occurred
resulted in a greater reduction in IOP, though this was in the immediate postoperative period.
influenced by a higher preoperative IOP in the CPC group. Exposure of a GDD through the conjunctiva has been
Published data regarding surgical outcomes for shown to be a risk factor for endophthalmitis.19 GDD
sequential GDD are limited to the results of small, retro- exposure was noted in 3 cases in our series, including 2
spective studies.11–14 These studies found sequential GDD to cases associated with endophthalmitis. No cases of
be a viable option for controlling IOP with surgical success endophthalmitis occurred in the CPC group, and no pri-
rates ranging from 37% to 83%. Complications of GDD mary GDD exposed following CPC. Another well-known
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Levinson et al J Glaucoma Volume 00, Number 00, ’’ 2016
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