Occurrence of motility disorders in patients undergoing tube surgery-consecutive, retrospective follow-up case series analysis.
Scherrer Elena, Bachmann Lucas M, Job Oliver, Müller Luzia, Thiel Michael A, Bochmann Frank
AI Summary
Glaucoma tube surgery commonly causes eye movement disorders, often affecting downgaze/adduction, irrespective of device type. Though not always causing diplopia, it's frequent and requires informed consent discussion.
Abstract
Background
The two glaucoma drainage devices (GDD) Ahmed and Baerveldt tubes are most commonly used for the treatment of refractory glaucoma. We noticed a significant number of patients with postoperative motility disorders resulting in diplopia. We investigated the occurrence and patterns of postoperative motility disorders overall and between the two GDD tubes using the Hess Screen Test.
Methods
Retrospective single-center matched case series of 20 patients undergoing Ahmed and 20 patients undergoing Baerveldt tube implantation with a follow-up of at least 1 year. In order to investigate the dynamic of GDD-induced motility disorder over time, from 25 patients, a follow-up examination from two different time periods (3 to 6 months and 12 to 24 months postoperatively) was available. From these 25 patients, 12 had received an Ahmed and 13 a Baerveldt GDD. To compare the different Hess Screen Tests, we developed nine categories of possible emerging motility disorder in the operated eye as a primary endpoint: Motility restriction in up-gaze, in down-gaze, in abduction, in adduction; combined motility disorders in up-gaze and adduction, up-gaze and abduction, down-gaze and adduction, down-gaze and abduction. If there was no motility disorder, this was also separately classified.
Results
Regardless of the used device, Ahmed or Baerveldt, most patients experienced motility disorders to some extent; mainly down-gaze and adduction were affected. However not every motility disorder resulted in diplopia. Although over time a decrease in ocular misalignment was seen, the incidence of diplopia was stable. Nevertheless, only few required therapy. We noted no difference between Ahmed and Baerveldt tube implant devices.
Conclusion
Ocular misalignment and restriction of motility is a common finding after GDD. Although not every motility disorder results in diplopia, it is frequent. Therefore, it needs to be taken into consideration in informed consent.
MeSH Terms
Shields Classification
Key Concepts5
Most patients undergoing glaucoma drainage device (GDD) implantation, regardless of whether an Ahmed or Baerveldt device was used, experienced motility disorders to some extent, primarily affecting down-gaze and adduction.
Not every motility disorder observed after glaucoma drainage device (GDD) implantation, regardless of whether an Ahmed or Baerveldt device was used, resulted in diplopia.
Although a decrease in ocular misalignment was observed over time after glaucoma drainage device (GDD) implantation, the incidence of diplopia remained stable.
There was no difference in the occurrence of motility disorders between Ahmed and Baerveldt tube implant devices in patients undergoing tube surgery for refractory glaucoma.
Ocular misalignment and restriction of motility are common findings after glaucoma drainage device (GDD) implantation and should be considered in informed consent.
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