Long-Term Outcomes of Nonvalved Glaucoma Drainage Devices in Uveitic Glaucoma.

PURPOSE

To evaluate the long-term efficacy and safety profile of nonvalved glaucoma drainage devices (GDDs) in the management of refractory uveitic glaucoma.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Sixty-five eyes of 51 patients.

METHODS

Patients underwent Baerveldt (78.5%) or Molteno (21.5%) GDD implantation at a single tertiary center between 2000 and 2021. The mean follow-up period was 12.05 ± 4.9 years.

MAIN OUTCOME MEASURES

Primary outcome was surgical success defined by World Glaucoma Association criteria. Secondary outcomes included intraocular pressure (IOP) control, medication burden, and complications.

RESULTS

Mean IOP decreased from 32.6 ± 8.4 mmHg preoperatively to 12.2 ± 5.2 mmHg at the last follow-up (P < 0.0001), with concurrent glaucoma medications reduction from 3.8 ± 0.8 to 0.9 ± 1.1 (P < 0.0001). At the final visit, qualified and complete success rates were 58.5% (38/65) and 33.8% (22/65), respectively. The mean survival time was 12.8 years for qualified success and 8.1 years for complete success. Failure occurred in 41.5% (27/65) of eyes, most commonly due to hypotony (13 eyes) or inadequate IOP reduction (10 eyes). Mean best-corrected visual acuity was unchanged (0.49 ± 0.53 vs 0.59 ± 0.72 logarithm of the minimum angle of resolution, P = 0.34). On multivariate analysis, Baerveldt implantation (hazard ratio [HR], 5.56; 95% confidence interval [CI], 2.20-14.09; P < 0.001) and concurrent systemic biologic therapy (HR, 28.57; 95% CI, 6.90-111.11; P < 0.001) were strong independent predictors of qualified success.

CONCLUSIONS

Nonvalved GDDs offer durable IOP control and preserved vision in uveitic glaucoma, for over a decade, with 58.5% qualified success and 41.5% failure at final follow-up (12.05 ± 4.9 years). These findings represent the longest reported outcomes for this cohort. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.