Retinal detachment in patients with a preexisting glaucoma drainage device: Anatomic, visual acuity, and intraocular pressure outcomes

Purpose: To report anatomic, visual acuity, and intraocular pressure (IOP) outcomes after retinal detachment (RD) repair in patients with a preexisting glaucoma drainage device. Methods: Consecutive case series including patients with a preexisting glaucoma drainage device who underwent RD repair at Bascom Palmer Eye Institute between 1989 and 1999. Results: Ten patients were identified with a mean follow-up of 18 months. Initial RD repair included pars plana vitrectomy (PPV) and fluid-gas exchange in four patients, scleral buckling procedure (SBP) in two, PPV and SBP in three, and pneumatic retinopexy in one. Three patients initially treated with SBP or pneumatic retinopexy developed recurrent RD secondary to proliferative vitreoretinopathy. All patients eventually underwent PPV. At 6 months, the retina was attached in eight patients, and nine patients had an IOP no greater than 21 mmHg. Although postoperative vision was stable or improved compared to preoperative levels in seven patients, visual acuity at 6 months was worse than 2/200 in only four patients, largely because of preexisting advanced glaucoma. Conclusions: In eyes with RD and a preexisting glaucoma drainage device, PPV with fluid-gas exchange was the most successful approach in achieving retinal reattachment. Although anatomic success is usually achieved and IOP is usually controlled, visual acuity outcomes are often poor, largely because of preexisting advanced glaucoma.