Sequential Glaucoma Implants in Refractory Glaucoma

Aashish Anand, Celso Tello, Paul A. Sidoti, Robert Ritch, Jeffrey M. Liebmann

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Purpose: To evaluate the efficacy of a second glaucoma implant in eyes with prior glaucoma implant surgery and inadequate intraocular pressure (IOP) control. Design: Retrospective observational cohort study. Methods: Patients undergoing a second glaucoma implant surgery from 1996 to 2008 were included. Outcome measures included visual acuity, IOP, glaucoma medication use, and complications. Success was defined as IOP < 21 mm Hg (criterion 1) and IOP < 17 mm Hg (criterion 2), with at least 25% reduction in IOP and no prolonged hypotony. Results: Forty-three eyes (43 patients) had a mean follow-up of 32.6 ± 21.6 months. Life-table analysis demonstrated success rates of 93%, 89%, and 83% using criterion 1 and 83%, 75%, and 75% using criterion 2 at 1, 2, and 3 years, respectively. At last follow-up, mean IOP (13.6 ± 4.6 vs 24.7 ± 7.5 mm Hg; P < .001) and mean number of medications (1.4 ± 1.2 vs 3.9 ± 1.2; P < .001) were lower following the second implant. There was no difference in preoperative and most recent logarithm of the minimal angle of resolution (logMAR) visual acuities (0.86 ± 0.13 vs 1.1 ± 0.13; P = .07). The most frequently used second implants were similar in percentage IOP reduction (Baerveldt implant, 45 ± 19%; Ahmed valve, 40 ± 18%; P = .4). Conclusions: A second glaucoma implant may effectively lower IOP in eyes with refractory glaucoma.

Original languageEnglish
Pages (from-to)95-101
Number of pages7
JournalAmerican Journal of Ophthalmology
Issue number1
StatePublished - Jan 2010
Externally publishedYes


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