Clinical Ophthalmology (Jul 2022)
Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use
Abstract
Sean Yonamine,1,* Lauren Ton,2,* Jennifer Rose-Nussbaumer,3 Gui-Shuang Ying,4 Iqbal Ike K Ahmed,5 Teresa C Chen,6 Asher Weiner,7 Steven J Gedde,8 Ying Han1 1Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 2School of Medicine, University of California San Francisco, San Francisco, CA, USA; 3Stanford Byers Eye Institute, Palo Alto, CA, USA; 4Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA; 5Prism Eye Institute, Mississauga, Ontario, Canada; 6Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; 7University at Buffalo, State University of New York, Buffalo, NY, USA; 8Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA*These authors contributed equally to this workCorrespondence: Ying Han, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, Tel +1 415 514 6920, Fax +1 415 353 4250, Email [email protected]: To assess practice patterns and opinions of glaucoma specialists regarding glaucoma drainage device tube shunt placement and post-operative anti-inflammatory medication use. We also assess the perceived need for a randomized control trial to compare them.Patients and Methods: An online survey was distributed to a group of glaucoma specialists from the American Glaucoma Society via the American Glaucoma Society forum from April to August 2021.Results: One hundred and twenty-eight responses were included. Ninety percent placed tubes in the anterior chamber. Sixty-one percent reported that evidence suggested the superiority of sulcus tube placement over the anterior chamber, whereas 34% reported there was not enough evidence to suggest superiority of either in preventing endothelial cell loss. Comparing these techniques for intraocular pressure control, 49% reported evidence suggested sulcus tube placement superiority whereas 46% reported there was not enough evidence. Over 40% of respondents reported that they were either unfamiliar with literature or that there was not enough evidence to support the superiority of difluprednate 0.05% over prednisolone 1% for post-operative use in preventing endothelial cell loss and for intraocular pressure control. Ninety percent and 81% of respondents respectively would benefit from randomized control trials comparing outcomes of anterior chamber vs sulcus tube placement and post-operative corticosteroid usage.Conclusion: Most glaucoma specialists surveyed place glaucoma drainage device tube in the anterior chamber over the sulcus. A randomized control trial to determine optimal tube placement and post-operative anti-inflammatory medication use for preventing endothelial cell loss would change current glaucoma drainage device practice patterns.Keywords: endothelial cell loss, sulcus, glaucoma drainage device
