Risk Factors for Failure of Tube Shunt Surgery: A Pooled Data Analysis

Overview

Journal Am J Ophthalmol

Specialty Ophthalmology

Date 2022 Mar 15

PMID 35288073

Authors

Eileen C Bowden

Anjalee Choudhury

Steven J Gedde

William J Feuer

Panos G Christakis

Eleonore Savatovsky

Ying Han

Iqbal I K Ahmed

Donald L Budenz

Affiliations

Soon will be listed here.

Abstract

Purpose: To identify the risk factors associated with failure of tube shunt surgery.

Design: Pooled analysis of 3 prospective multicenter, randomized clinical trials.

Methods: A total of 621 patients with medically uncontrolled glaucoma were enrolled, including 276 from the Ahmed Baerveldt Comparison Study, 238 from the Ahmed Versus Baerveldt Study, and 107 from the tube group of the Tube Versus Trabeculectomy Study. Patients were randomized to treatment with an Ahmed glaucoma valve (model FP7) or Baerveldt glaucoma implant (model 101-350). The associations between baseline risk factors and tube shunt failure were assessed using a Cox proportional hazards regression model. The primary outcome measure was the rate of surgical failure defined as intraocular pressure (IOP) > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, loss of light perception vision, reoperation for glaucoma, or removal of implant.

Results: The cumulative probability of failure after tube shunt surgery was 38.3% after 5 years. In multivariable analyses, baseline factors that predicted tube shunt failure included preoperative IOP (≤ 21 mmHg compared to IOP > 21 and ≤ 25 mmHg; HR, 2.34; 95% CI, 1.52-3.61; P < .001), neovascular glaucoma (HR, 1.79; 95% CI, 1.28-2.52; P = .001), randomized treatment (for Ahmed glaucoma valve; HR, 1.36; 95% CI, 1.04-1.78; P = .025), and age (for 10 year decrease in age; HR, 1.19; 95% CI, 1.09-1.31; P < .001).

Conclusions: Lower preoperative IOP, neovascular glaucoma, Ahmed implantation, and younger age were predictors of tube shunt failure. This Study provides the largest prospectively collected dataset on tube shunt surgery.

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References

Liebmann J, Ritch R . Initial 5-fluorouracil trabeculectomy in young patients. Ophthalmology. 1992; 99(1):7-13. DOI: 10.1016/s0161-6420(92)32008-1. View

Li Z, Zhou M, Wang W, Huang W, Chen S, Li X . A prospective comparative study on neovascular glaucoma and non-neovascular refractory glaucoma following Ahmed glaucoma valve implantation. Chin Med J (Engl). 2014; 127(8):1417-22. View

Merritt J . Filtering procedures in American blacks. Ophthalmic Surg. 1980; 11(2):91-4. View

Minckler D, Francis B, Hodapp E, Jampel H, Lin S, Samples J . Aqueous shunts in glaucoma: a report by the American Academy of Ophthalmology. Ophthalmology. 2008; 115(6):1089-98. DOI: 10.1016/j.ophtha.2008.03.031. View

Gedde S, Feuer W, Chen P, Heuer D, Singh K, Wright M . Comparing Treatment Outcomes from the Tube Versus Trabeculectomy and Primary Tube Versus Trabeculectomy Studies. Ophthalmology. 2020; 128(2):324-326. PMC: 9400454. DOI: 10.1016/j.ophtha.2020.06.059. View

Landers J, Martin K, Sarkies N, Bourne R, Watson P . A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2011; 119(4):694-702. DOI: 10.1016/j.ophtha.2011.09.043. View

Gedde S, Schiffman J, Feuer W, Parrish 2nd R, Heuer D, Brandt J . The tube versus trabeculectomy study: design and baseline characteristics of study patients. Am J Ophthalmol. 2005; 140(2):275-87. DOI: 10.1016/j.ajo.2005.03.031. View

Arora K, Robin A, Corcoran K, Corcoran S, Ramulu P . Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012. Ophthalmology. 2015; 122(8):1615-24. DOI: 10.1016/j.ophtha.2015.04.015. View

Heuer D, Lloyd M, Abrams D, Baerveldt G, Minckler D, Lee M . Which is better? One or two? A randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia. Ophthalmology. 1992; 99(10):1512-9. DOI: 10.1016/s0161-6420(92)31772-5. View

10.

. Five-year follow-up of the Fluorouracil Filtering Surgery Study. The Fluorouracil Filtering Surgery Study Group. Am J Ophthalmol. 1996; 121(4):349-66. DOI: 10.1016/s0002-9394(14)70431-3. View

11.

Vinod K, Gedde S, Feuer W, Panarelli J, Chang T, Chen P . Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society. J Glaucoma. 2017; 26(8):687-693. PMC: 5726398. DOI: 10.1097/IJG.0000000000000720. View

12.

Freedman J, Iserovich P . Pro-inflammatory cytokines in glaucomatous aqueous and encysted Molteno implant blebs and their relationship to pressure. Invest Ophthalmol Vis Sci. 2013; 54(7):4851-5. DOI: 10.1167/iovs.13-12274. View

13.

Hinkle D, Zurakowski D, Ayyala R . A comparison of the polypropylene plate Ahmed glaucoma valve to the silicone plate Ahmed glaucoma flexible valve. Eur J Ophthalmol. 2007; 17(5):696-701. DOI: 10.1177/112067210701700502. View

14.

WuDunn D, Phan A, Cantor L, Lind J, Cortes A, Wu B . Clinical experience with the Baerveldt 250-mm2 Glaucoma Implant. Ophthalmology. 2006; 113(5):766-72. DOI: 10.1016/j.ophtha.2006.01.049. View

15.

Desai M, Gedde S, Feuer W, Shi W, Chen P, Parrish 2nd R . Practice preferences for glaucoma surgery: a survey of the American Glaucoma Society in 2008. Ophthalmic Surg Lasers Imaging. 2011; 42(3):202-8. DOI: 10.3928/15428877-20110224-04. View

16.

Chen P, Yamamoto T, Sawada A, Parrish 2nd R, Kitazawa Y . Use of antifibrosis agents and glaucoma drainage devices in the American and Japanese Glaucoma Societies. J Glaucoma. 1997; 6(3):192-6. View

17.

Uitto J . A method for studying collagen biosynthesis in human skin biopsies in vitro. Biochim Biophys Acta. 1970; 201(3):438-45. DOI: 10.1016/0304-4165(70)90163-7. View

18.

Christakis P, Kalenak J, Tsai J, Zurakowski D, Kammer J, Harasymowycz P . The Ahmed Versus Baerveldt Study: Five-Year Treatment Outcomes. Ophthalmology. 2016; 123(10):2093-102. DOI: 10.1016/j.ophtha.2016.06.035. View

19.

Broadway D, Iester M, Schulzer M, Douglas G . Survival analysis for success of Molteno tube implants. Br J Ophthalmol. 2001; 85(6):689-95. PMC: 1723991. DOI: 10.1136/bjo.85.6.689. View

20.

Lloyd M, Baerveldt G, Fellenbaum P, Sidoti P, Minckler D, Martone J . Intermediate-term results of a randomized clinical trial of the 350- versus the 500-mm2 Baerveldt implant. Ophthalmology. 1994; 101(8):1456-63; discussion 1463-4. DOI: 10.1016/s0161-6420(94)31152-3. View