June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
The effect of scheduled ripcord removal on the outcomes of Baerveldt 350 implants
Author Affiliations & Notes
  • Anita Vin
    Ophthalmology, Duke Eye Center, Durham, NC
  • Joanne C Wen
    Ophthalmology, Duke Eye Center, Durham, NC
  • Sandra Stinnett
    Ophthalmology, Duke Eye Center, Durham, NC
  • Leon W Herndon
    Ophthalmology, Duke Eye Center, Durham, NC
  • Footnotes
    Commercial Relationships Anita Vin, None; Joanne Wen, None; Sandra Stinnett, None; Leon Herndon, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2011. doi:
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      Anita Vin, Joanne C Wen, Sandra Stinnett, Leon W Herndon; The effect of scheduled ripcord removal on the outcomes of Baerveldt 350 implants. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2011.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Spontaneous opening of a Baerveldt glaucoma implant with dissolution of the ligating suture at 6 weeks can lead to a sudden decrease in intraocular pressure (IOP), which can be associated with visually debilitating complications. Many surgeons place a suture, called a ripcord, in the lumen of the implant at the time of surgery. It is unknown how complication rates of placement of a Baerveldt implant are affected by spontaneous tube opening versus scheduled opening by ripcord removal in clinic. We hypothesized that the scheduled removal of the ripcord at post-operative week 3 would allow for a more controlled reduction in intraocular pressure and be associated with fewer complications as compared to spontaneous opening of the tube.

Methods: In this randomized prospective study, 20 consecutive patients with medically uncontrolled glaucoma were consented to receive a superotemporal Baerveldt 350 implant. Subjects were randomized to scheduled ripcord removal with viscoelastic placement in the anterior chamber at week 3 following surgery versus no ripcord removal. Follow-up was done on a standardized schedule; each visit, visual acuity, IOP, and slit lamp biomicroscopy were performed. Complications of hypotony such as shallowing of the anterior chamber, choroidal effusion, or suprachoroidal hemorrhage were reported.

Results: Of the 20 study subjects, 10 were randomized to observation, 10 to ripcord removal. Complications of hypotony were not noted in the observation group; in the ripcord removal group 2 patients experienced hypotony (IOP ≤ 5), and 1 developed choroidal effusions. IOP was not statistically different between the two groups following ripcord removal at most visits although surprisingly at 3 months the ripcord removal group was found to have statistically higher IOP as compared to the removal group (p = 0.031, Wilcoxon rank sum test). This difference did not remain at the 6 month follow-up mark. Visual acuity was also not found to be statistically significantly different between the two groups.

Conclusions: Our results do not support our original hypothesis. We found no statistically significant improvement in IOP or visual acuity at 6 months with scheduled ripcord removal. Additionally, there were complications of hypotony within the ripcord removal group while there were no such complications in the observation group. A larger sample size and longer follow-up would help to corroborate these findings.

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