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Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study
  1. Mohamad El Wardani,
  2. Ciara Bergin,
  3. Kenza Bradly,
  4. Eamon Sharkawi
  1. Department of Ophthalmology, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Dr Eamon Sharkawi, Department of Ophthalmology, Jules Gonin Eye Hospital, University of Lausanne, Lausanne 1004, Switzerland; eamon.sharkawi{at}fa2.ch

Abstract

Aim To examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.

Methods Seventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).

Results There was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).

Conclusions Failure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

  • baerveldt tube
  • aqueous shunt
  • glaucoma surgery
  • cataract
  • intraocular pressure
  • phacoemulsification

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Footnotes

  • Contributors ES: conception, design, drafting the article. MEW: collecting data, drafting the article, analysis and interpretation of data. CB: design, collecting data, drafting the article, analysis and interpretation of data. KB: collecting data, drafting the article, revising the article. ES, MEW and CB were involved in revising the article critically for important intellectual content. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical commitee of Vaud, Switzerland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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