Endoscopic cyclophotocoagulation versus second glaucoma drainage device after prior aqueous tube shunt surgery

Background To evaluate the efficacy in controlling intraocular pressure (IOP) with endoscopic cyclophotocoagulation (ECP) versus implantation of a second glaucoma drainage device (GDD‐2) in the treatment of uncontrolled glaucoma with a prior aqueous tube shunt. Design A nonrandomized retrospective chart review. Participants Patients with refractory glaucoma following a failed initial tube shunt (Baerveldt Glaucoma Implant 350), who underwent ECP or GDD‐2 with Baerveldt Glaucoma Implant as a second surgery. Twenty‐five eyes underwent ECP, and 48 eyes received a GDD‐2. Methods ECP or second tube‐shunt surgery. Main Outcome Measures Reduction in IOP and antiglaucoma medications, and Kaplan–Meier survival with success defined as lOP ≥ 5 mmHg and ≤ 21 mmHg and ≥ 20% reduction from preoperative IOP. Secondary outcome measures were visual acuity and the presence of any postoperative complications. Results Both ECP and GDD‐2 significantly lowered IOP (Student's t test) and number of antiglaucoma medications (Wilcoxon paired signed rank test). There were no significant differences in postoperative IOP (Student's t test) or antiglaucoma medications (Mann Whitney test) between ECP and GDD‐2 at 6 and 12 months. There was also no difference in the Kaplan–Meier survival outcomes between the two groups. Conclusion Both ECP and GDD‐2 are both effective as second surgeries for refractory glaucoma that has failed a prior aqueous shunt.