Efficacy of early aqueous suppression after glaucoma drainage device surgery in uveitis patients

Project: Research project

Project Details

Description

Surgical implantation of a glaucoma drainage device (GDD) is one of the most common incisional glaucoma surgical procedures performed in the US. Although GDD is effective in reducing intraocular pressures (IOP), a hypertensive phase (HP) commonly occurs 2-6 weeks after surgery due to inflammation and excessive fibrosis around the GDD endplate. Patients who experience a HP have increased IOP, need more medication and additional surgeries months after, and have an increased risk of optic nerve damage. To prevent this, studies have shown that early administration of aqueous suppressant medication leads to reduced HP frequency in patients who have undergone GDD implantation. This new practice has dramatically improved outcomes in patients undergoing GDD implantation and is now widely adopted by glaucoma specialists.

While administration of early aqueous suppressants has been shown to reduce the risk of glaucoma damage through reduction of HP frequency post-GDD, there has been limited research published focusing on the effects of early aqueous suppression in uveitic glaucoma patients. Although uveitic inflammation may lead to IOP elevation due to obstruction of the trabecular meshwork outflow pathway, inflammation of the ciliary body may also result in aqueous hyposecretion. Thus, uveitic glaucoma patients are at reported increased risk of hypotony (IOP ≤5 mmHg). Hypotony can lead to a host of harmful ocular effects, including visual impairment. A study by Daniel et al. found that 84.1% of uveitic eyes with hypotony had a visual acuity of 20/200 or worse. Hypotony is also associated with accelerated cataract development, retinal detachment, and hypotony maculopathy, which includes optic nerve edema, vascular tortuosity, choroidal folds, and macula striae that lead to vision loss. Several studies have demonstrated the increased risk of hypotony in uveitic patients, the associated significant ocular damage that follows, and the occurrence of these adverse events in uveitic eyes after different types of GDD procedures. However, there is a lack of research in the effect of early aqueous suppression on uveitic eyes after GDD, a practice that further reduces IOP in a higher risk population.

Previous clinical trials have demonstrated the therapeutic effectiveness of early aqueous suppressants in reducing frequency of HP after GDD surgery. However, there are limited data on early initiation of aqueous suppressants after GDD surgery in uveitic patients, a population at high risk of hypotony. We aim to study the surgical outcomes associated with the use of early aqueous suppressants in uveitic patients, including incidences of HP, hypotony and other adverse effects, and long-term success rates at a tertiary medical center. The findings of this study will allow ophthalmologists to make evidence-based decisions to optimize the post-operative care of these patients.
StatusActive
Effective start/end date7/1/216/30/22

Funding

  • Illinois Society for the Prevention of Blindness (Tanna AGMT 6/18/21)

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