Long-term Outcomes of Glaucoma Drainage Implants in Uveitic Eyes With Fluocinolone Acetonide Implants.

Precis: In eyes with uveitis and a history of fluocinolone acetonide (FA) implantation, glaucoma drainage implants (GDIs) provides excellent long-term control of intraocular pressure (IOP).

Purpose

The purpose of this study was to evaluate the long-term control of IOP achieved by GDIs in uveitic eyes with glaucoma and a FA implant.

Patients and methods: Retrospective case series of 56 eyes from 37 patients with a history of noninfectious posterior uveitis who underwent both FA implantation and GDI surgery at the Cleveland Clinic Cole Eye Institute between April 2001 and April 2017. Patients were excluded if they did not undergo FA implantation before, or concurrently with, a GDI. Data was collected up to 10 years after GDI surgery. Outcome measures included IOP, number of IOP-lowering medications, and surgical success rate at each timepoint. Success was defined as IOP between 6 and 21 mm Hg at the most recent follow-up visit, without need for GDI removal or additional IOP-lowering surgeries, or loss of light perception.

Results

The mean follow-up time was 71.0 months (median 72.0 mo). IOP was reduced by a mean of 52.9% (range: 43.1% to 62.3%) and the number of IOP-lowering medications decreased by a mean of 69.0% (range: 56.3% to 93.8%) between 1 and 10 years postoperatively. The percentage of eyes with IOP <21 mm Hg was 32.1% at baseline and ranged between 76.8% and 100% at follow-up. The percentage of eyes with IOP <18 mm Hg was 21.4% at baseline and ranged between 67.9% and 100% at follow-up. The surgical success rate was 71.4% at 10 years.

Conclusions

In eyes with uveitis that undergo FA implantation, concurrent or subsequent GDI surgery offers excellent long-term control of IOP. Postoperative IOP and number of IOP-lowering medications dropped considerably and remained stable.