Intermediate-term outcomes of 350-mm2 Baerveldt glaucoma implants

doi:10.1016/S0161-6420(00)00537-6

Ophthalmology

Volume 108, Issue 3, March 2001, Pages 621-626

https://doi.org/10.1016/S0161-6420(00)00537-6 Get rights and content

Abstract

Objective

To determine the intermediate-term outcome of 350-mm² Baerveldt glaucoma implants.

Design

Retrospective, noncomparative case series.

Participants

Sixty-five patients (65 eyes).

Intervention

Implantation of 350-mm² Baerveldt glaucoma drainage device.

Main outcome measures

Intraocular pressure, number of glaucoma medications, best-corrected Snellen visual acuity, length of follow-up, risk factors for failure, and complications.

Results

Mean intraocular pressure was reduced from a preoperative value of 32 mmHg to a 2-year postoperative value of 14 mmHg (56% reduction, P < 0.001). Success rates at 2-year follow-up were 71%, 81%, 78%, 60%, and 47% for the overall group, primary open-angle glaucoma group, neovascular group, uveitic group, and other group, respectively. After accounting for the effect of diagnosis group, significant risk factors in the overall group for failure at 2 years included younger age, high preoperative intraocular pressure, and more prior incisional surgeries. Glaucoma medication use in our overall study population was reduced from 2.5 mean preoperative medications to 0.8 postoperative medications (68%). Median change in Snellen visual acuity between preoperative and 2-year postoperative visits was not significant in the overall group. Postoperative complications included choroidal effusion in 15 patients (23%), tube obstruction by blood or vitreous in five patients (8%), phthisis in four patients (6%), aqueous misdirection in two patients (3%), strabismus in two patients (3%), tube–cornea touch in two patients (3%), endophthalmitis in two patients (3%), and retinal detachment in two patients (3%). No patients had suprachoroidal hemorrhage.

Conclusions

The 350-mm² Baerveldt glaucoma implants are a safe and effective treatment for intermediate-term intraocular pressure control in patients with refractory glaucoma.

Section snippets

Patients and methods

A computerized search of all patients who underwent surgery at the Bascom Palmer Eye Institute between January 1989 and August 1998 was performed to identify all patients who underwent glaucoma drainage device surgery. After approval by the Human Subjects Committee of the University of Miami School of Medicine, medical records of all of these patients were reviewed to identify patients who had received a BGI. Eyes that underwent concurrent trabeculectomy or revision of trabeculectomy were

Results

A total of 410 patients had GDD placement at the Bascom Palmer Eye Institute during the study period. A total of 167 patients had GDDs before February 1997 and were eligible for 2-year follow-up. Eighty of these patients had BGI placement and met inclusion criteria. Sixty-five patients (81%) either had 2 years of follow-up (n = 61) or had documented failure before 2 years (n = 4) and were included in the statistical analysis. Fifteen patients (19%) did not have 2 years of follow-up and were

Discussion

Glaucoma drainage devices have been shown to lower intraocular pressure effectively in refractory glaucomas. Two-year life table success rates range from 46% to 68% for single-plate Molteno implants,4, 10, 11 53% to 85% for double-plate Molteno implants,4, 5, 10, 11 68% to 75% for Ahmed implants,2, 9 and 60% for Baerveldt glaucoma drainage device implantation.7 The overall success rate at 2 years in our study population was 71%.

Difficulty often exists in comparison of intermediate-term and

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^☆: Supported in part by a grant from the Heed Ophthalmic Foundation, Cleveland, Ohio (RK), and an unrestricted grant from Research to Prevent Blindness, New York, New York.

³: The authors have no proprietary interest in any device or technique described in this paper.

¹: Dr. Krishna is currently affiliated with the Department of Ophthalmology/Eye Foundation, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri.

²: Dr. Godfrey is currently associated with the Glaucoma Associates of Texas, Dallas, Texas.

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Intermediate-term outcomes of 350-mm2 Baerveldt glaucoma implants3☆,

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Intermediate-term outcomes of 350-mm² Baerveldt glaucoma implants³☆,