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Anton M. Kolomeyer, Chris Seery, Chris Seery, Robert D. Fechtner, Marco A. Zarbin, Neelakshi Bhagat; Small Gauge Pars Plana Vitrectomy With Pars Plana Baerveldt Tube Placement For Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3710.
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To describe the functional outcomes and complications of combined small gauge pars plana vitrectomy and pars plana Baerveldt tube placement in eyes with glaucoma refractory to maximal medical therapy or prior surgical interventions.
Consecutive eyes undergoing a combined procedure at two tertiary care referral centers with ≥2 months of follow-up were identified and included. Outcome measures were visual acuity (VA), intraocular pressure (IOP), number of glaucoma medications, and complications preoperatively and at select time points. Changes in IOP and glaucoma medications were compared by a paired t-test. A Kaplan-Meier survival curve was constructed to evaluate surgical success as a function of time.
Seventy-five eyes of 75 patients (52% male) were identified. Mean ± SD age was 69.1 ± 14.6 years while mean ± SD follow-up was 16.0 ± 11.9 months. Forty-six (61%) eyes had neovascular glaucoma (NVG); 36 (78%) of these received Avastin and/or Kenalog for rubeosis, diabetic macular edema (DME), and/or cystoid macular edema (CME). Primary indication for combined procedure was shallow anterior chamber in 48 (64%) eyes (21 [44%] of which had rubeosis). Forty-nine (65%) underwent 23-gauge vitrectomy while 72 (96%) received a 250 mm2 Baerveldt tube. Mean ± SD preoperative IOP was reduced from 32.6 ± 10.5 mm Hg to a final mean ± SD IOP of 15.9 ± 5.5 mm Hg (p<0.05). Mean ± SD preoperative number of glaucoma medications was reduced from 2.9 ± 1.4 to a final mean ± SD number of glaucoma medications of 1.7 ± 1.6 (p<0.05). Final VA improved by ≥2 lines in 22 (29%) eyes. Six (8.0%) eyes with NVG ended up with NLP vision. In these eyes, mean preoperative VA was 2.2 logMAR and mean IOP was 37.3 mmHg. Fifteen of 46 (33%) eyes with NVG received Avastin and/or Kenalog after the combined procedure to control neovascularizaion, DME, and/or CME. Within 3 months of combined surgery, self-resolving complications included 57 (76%) eyes with transient ocular hypertension; 11 (15%) eyes with hypotony, six (8.0%) eyes with serous choroidal detachment (CD), and nine (12%) eyes with hypotony and serous CD (two [22%] of which developed decompression retinopathy); eight (11%) eyes with hyphema; six (8.0%) eyes with vitreous hemorrhage; and three (4.0%) eyes with CME. Five (6.7%) eyes underwent subsequent surgical procedures including tube/wound revision (n=4) and drainage of hemorrhagic choroidals (n=1). One (1.3%) eye developed endophthalmitis within 2 months of combined surgery and was enucleated.
A combined small gauge vitrectomy and pars plana Baerveldt tube insertion could be considered a useful procedure in reducing IOP and the number of glaucoma medications in eyes with refractory glaucoma.
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