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Unplanned Return to the Operating Room After Tube Shunt Surgery

  • Nur Cardakli
    Affiliations
    From the Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • David S. Friedman
    Affiliations
    From the Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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  • Michael V. Boland
    Correspondence
    Inquiries to: Michael V. Boland, Massachusetts Eye and Ear, 243 Charles St, Boston, Massachusetts 02114.
    Affiliations
    From the Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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      HIGHLIGHTS

      • Approximately 10% of patients who underwent tube surgery required further operations within 6 months.
      • Many patients who underwent tube shunt surgery required further operation.
      • Valved and non-valved tube shunts had similar rates of reoperation.
      • Reoperation and control eyes fared similarly in terms of interocular pressure and visual acuity endpoints.
      • Unplanned reoperation needs further study prior to widespread use in ophthalmology.

      Purpose

      The purpose of this study was to determine the rate of unplanned returns to the operating room (OR) within 180 days and at any time postoperatively after valved and non-valved tube shunt surgery.

      Design

      Retrospective case-control study.

      Methods

      A review of 357 eyes that underwent tube shunt surgery (151 valved, 206 non-valved) was conducted at an academic glaucoma service between January 2014 and December 2016. A control eye was time matched for each eye that underwent reoperation.

      Results

      The reoperation rate within 180 days was 16 of 151 (10.6%) for valved and 25 of 206 (12.1%) for non-valved tube shunts and at any time postoperatively was 31 of 151 (20.5%) for valved, and 47 of 206 (22.8%) for non-valved tube shunts. Mean postoperative follow-up was 2.8 ± 1.1 years. The most common reoperations within 180 days and at any time postoperatively after valved tube shunt surgery were tube revisions (43.8% within 180 days, 38.7% any time) and external cyclophotocoagulation (CPC) (31.3% within 180 days, 38.7% anytime). The most common reoperations within 180 days after non-valved tube shunt surgery were tube revisions (32.0%), external CPC (12.0%), and vitrectomy with anterior chamber washout (12.0%) and at any time postoperatively were tube revision (34.0%), external CPC (31.9%), and tube explant (12.8%). At last follow-up, eyes that returned to the OR and controls were similar in terms of mean intraocular pressure (IOP), proportion of eyes meeting target IOP, and change in visual acuity.

      Conclusions

      More than 20% of eyes undergoing tube shunt surgery returned to the OR at any time postoperatively with a mean follow-up of nearly 3 years, with more than 10% of eyes undergoing reoperation within the first 180 days. Rates of reoperation were similar between valved and non-valved tube shunts.

      Graphical Abstract

      This retrospective case-controlled study examined the rate of unplanned return to the operating room after attending-performed and attending supervised tube shunt surgery at a single academic center. A considerable number of patients who underwent tube shunt implants required additional surgery; reoperation rates were similar between eyes that received valved versus those that received non-valved tube shunts. These findings provide information for the postoperative course after tube shunt surgery, which may be important in setting appropriate surgeon and patient expectations.
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