Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use

Sean Yonamine; Lauren Ton; Jennifer Rose-Nussbaumer; Gui-Shuang Ying; Iqbal Ike K Ahmed; Teresa C Chen; Asher Weiner; Steven J Gedde; Ying Han

doi:10.2147/OPTH.S369673

Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use

Clin Ophthalmol. 2022 Jul 21:16:2305-2310. doi: 10.2147/OPTH.S369673. eCollection 2022.

Authors

Affiliations

¹ Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
² School of Medicine, University of California San Francisco, San Francisco, CA, USA.
³ Stanford Byers Eye Institute, Palo Alto, CA, USA.
⁴ Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Prism Eye Institute, Mississauga, Ontario, Canada.
⁶ Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
⁷ University at Buffalo, State University of New York, Buffalo, NY, USA.
⁸ Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

^# Contributed equally.

Abstract

Purpose: 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; glaucoma drainage device; sulcus.