Glaucoma drainage device implantation yields 65% success rate in uveitic glaucoma meta-analysis
Photo by Ferhat Deniz Fors / Unsplash
Key Takeaway
Consider GDD implantation as effective for uveitic glaucoma, with device-specific differences in IOP reduction and medication needs.
This systematic review and meta-analysis of 38 studies (1083 eyes) evaluated the efficacy of glaucoma drainage device (GDD) implantation in patients with uveitic glaucoma (UG). The devices included Ahmed, Baerveldt, Molteno, and PAUL Glaucoma Implants. The overall surgical success rate was 65.40% (95% CI: 54.90%-74.60%), with complete success at 36.40% (95% CI: 25.40%-49.00%) and qualified success at 40.30% (95% CI: 25.60%-56.90%).
Among the devices, Ahmed valves (AGV) showed the greatest intraocular pressure (IOP) reduction (mean difference -28.87, 95% CI: -38.38 to -19.36), while Baerveldt implants (BGI) led to the most pronounced reduction in postoperative IOP-lowering medications (mean difference -5.28, 95% CI: -8.40 to -2.15). In direct comparison, BGI required fewer postoperative medications than AGV.
Safety analysis revealed that in AGV-implanted eyes, elevated IOP occurred in 22.70% and hypotony in 18.40%. The authors note that current evidence remains scarce for novel devices, and the meta-analysis is based on observational studies, so causality cannot be established. Certainty is moderate due to potential heterogeneity.
Clinically, Ahmed, Baerveldt, Molteno, and PAUL Glaucoma Implants are effective surgical options for UG management. Differences in efficacy and complication profiles among devices warrant consideration in individualized treatment planning.
View Original Abstract ↓
PRCIS: In this meta-analysis of 1083 eyes with UG, GDDs achieved the overall surgical success rate of 65.40%, with AGVs demonstrating the greatest IOP reduction and BGIs requiring fewer postoperative medications.
PURPOSE: This study aimed to compare the effectiveness and complication profiles of different types of glaucoma drainage devices (GDDs) in patients with uveitic glaucoma (UG).
METHODS: A comprehensive literature search across PubMed, Web of Science, Cochrane Library, and Embase identified relevant GDD implantation studies in UG through October 12, 2025. Literature screening, data extraction, and quality assessment were implemented using EndNote, followed by meta-analyses through "meta" package in R software (version 4.3.0).
RESULTS: Thirty-eight studies (1083 eyes) were analyzed. The meta-analysis indicated a remarkable drop in intraocular pressure (IOP) across all GDD types postoperatively. Among these, the Ahmed glaucoma valves (AGVs) presented the greatest IOP reduction than other devices [MD = -28.87, 95% CI: (-38.38, -19.36)]. Postoperative use of topical IOP-lowering medications declined universally across all devices, with the Baerveldt Glaucoma Implants (BGIs) again showing the most pronounced reduction [MD=-5.28, 95% CI (-8.40, -2.15)]. In the comparative analysis between AGVs and BGIs, the BGIs group required fewer postoperative IOP-lowering medications than the AGVs group. The overall surgical success rate post-GDD implantation was 65.40% (95% CI: 54.90%-74.60%), with complete success and qualified success rates of 36.40% (95% CI: 25.40%-49.00%) and 40.30% (95% CI: 25.60%-56.90%). Postoperative complications included elevated IOP in 22.70% and hypotony in 18.40% of AGV-implanted eyes.
CONCLUSION: Ahmed, Baerveldt, Molteno, and PAUL Glaucoma Implant are effective surgical options for UG management. However, current evidence remains scarce for novel devices, and the differences in efficacy and complication profiles among devices warrant consideration in individualized treatment planning.
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