Previous cyclodestruction is a risk factor for late-onset hypotony and suprachoroidal haemorrhage after glaucoma drainage device surgery

摘要

Aim: To investigate whether previous cyclodestructive (eg, cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery. Methods: Retrospective analysis of 110 consecutive patients who had undergone GDD (Baerveldt 250 mm2 and 350 mm2 implant, AMO, USA) surgery with a minimum follow-up of 3 months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery (II; 63 patients). Intraocular pressure (IOP), medication score, best-corrected visual acuity and surgical treatments were recorded before and after drainage device implantation. Results: Patients of group I had a mean preoperative IOP of 32.1 mm Hg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.2 mm Hg (p=0.18) and a mean medication score of 4.9 ( p=0.84). All patients who developed suprachoroidal haemorrhage (six cases) belonged to group I (6/47=12.8%), no patient of group II (0/63=0%) developed suprachoroidal haemorrhage (Fisher 's test: p=0.01). Twelve patients developed late-onset (6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47=19.1%) and three of them to group II (3/63=4.8%) (Fisher 's test: p=0.03). Conclusions While taking potential bias arising from the retrospective nature of the study into consideration, a history of previous cyclodestructive procedures before GDD surgery seems to be a major risk factor for suprachoroidal haemorrhage and for late-onset postoperative hypotony.