The Impact of Glaucoma Drainage Devices on the Cornea
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CORNEA (T YAMAGUCHI, SECTION EDITOR)
The Impact of Glaucoma Drainage Devices on the Cornea Eric Weinlander 1 & Tomas Meijome 1 & Manjool Shah 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To discuss the relevant clinical associations between glaucoma drainage device (GDD) implantation and health of the cornea, focusing on corneal endothelial disease and success of viability of keratoplasty. Recent Findings Corneal endothelial injury and risk of graft failure continues to demonstrate association with GDD placement; however, newer studies demonstrate improved outcomes associated with Descemet membrane endothelial keratoplasty. Additionally, newer adverse effects associated with GDD placement have been described. Summary GDD implantation certainly carries risk of endothelial injury and keratoplasty viability, but newer keratoplasty techniques may improve visual outcomes. Furthermore, attention to placement and location of the GDD may affect the risk of progressive corneal injury. Keywords Glaucoma surgery . Glaucoma drainage device . Endothelium . Keratoplasty . Graft survival
Introduction Glaucoma drainage devices (GDDs) are a mainstay of glaucoma surgery. Although other designs have been used in the past, the Ahmed valved implant (AGV, New World Medical), Baerveldt non-valved implant (BGI, Advanced Medical Optics), and Molteno non-valved implant (Molteno Ophthalmic Limited) are currently the most commonly utilized options for aqueous shunt surgery. GDD use has grown fourfold from 1994 to 2012, despite an overall stable number of glaucoma surgeries, matching the general shift in glaucoma providers’ surgical preferences towards increased use of GDDs [1, 2]. Each of these GDDs can have immediate and long-term effects on the cornea with corneal complications rates ranging between 8 and 29% [3]. In this review, we discuss the most common corneal complications of persistent This article is part of the Topical Collection on Cornea * Manjool Shah [email protected] Eric Weinlander [email protected] Tomas Meijome [email protected] 1
Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA
corneal edema and corneal endothelial cell loss and review the influence of GDDs on graft survival in eyes that have undergone keratoplasty.
Corneal Edema GDDs increase the risk of persistent corneal edema. In the landmark Trabeculectomy Versus Tube (TVT) Study, persistent corneal edema occurred in 16% of patients who underwent BGI implantation (17 of 107 over the 5-year follow-up period), and occurred less frequently in patients who underwent trabeculectomy (9 of 105, 9%) [4]. Similar rates of persistent corneal edema were observed in the Ahmed Versus Baerveldt (AVB) Study and Ahmed Baerveldt Comparison (ABC) Study for both AGV and BGI [5–7]. Although 1-year results of the AVB reported that more patients developed persistent corneal edema after BGI implantation (14 of 114, 12%) compared with AGV (3 of 124, 2%, p < 0.004), this difference d
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