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M. T. Witmer, J. Tiedeman, L. Olsakovsky, B. Prum; Long-Term Intraocular Pressure Control and Corneal Graft Survival in Eyes With a Pars Plana Glaucoma Drainage Implant and Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3956.
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To investigate long-term intraocular pressure (IOP) control and corneal graft survival in eyes with pars plana (PP) insertion of a valve-less, Baerveldt 350 mm2 glaucoma drainage implant (GDI) and a penetrating keratoplasty (PK).
We retrospectively reviewed the medical records of 52 consecutive patients (55 eyes) who underwent PP tube placement of a GDI in conjunction with or following a previous PP vitrectomy, concurrent with or after a PK. All patients underwent PK prior to or simultaneously with GDI and PP vitrectomy, performed by the same three glaucoma, retina and corneal specialists, at the University of Virginia, between July 19th, 1996 and September 8th, 2006. The main outcomes measured were post-operative IOP, number of anti-glaucoma medications, and the need for further glaucoma surgery. Corneal graft success was assessed by corneal clarity. Visual acuity was also evaluated during the review.
Fifty patients (53 eyes) were included in the final analysis. Mean follow-up was 35.7 months (median: 37 mos.; range 2-86 mos.). Mean pre-operative IOP was 26.3 + 10.7 mm Hg (range: 5 to 47 mm Hg ) on a mean of 3.2 + 1.3 anti-glaucoma medications. At last follow-up, mean IOP was 12.5 + 5.8 mmHg (range: 5 to 26 mmHg ) on an average of 1.1 + 1.2 anti-glaucoma medications. IOP was successfully controlled in 88%, 82%, 79%, and 79% of eyes at 12, 24, 36 and 60 months, respectively. Graft failure occurred in 17 eyes (32.1%), with 1 of these immediately following the abrupt withdrawal of topical steroids. Corneal grafts were clear in 89%, 82%, 68%, 65%, and 48% of eyes at 12, 18, 24, 36, and 48 months and following, respectively. Combined IOP control and corneal graft survival was seen in 78%, 73%, 62%, 55% and 50% of eyes at 12, 18, 24, 36, and 48 months, respectively. At the last follow-up visit, visual acuity was the same or better than the pre-operative level in 45 eyes (66%).
Pars plana insertion of a Baerveldt 350 mm2 glaucoma drainage implant is an effective way to control IOP in eyes with PKs and medically uncontrolled glaucoma. Although a larger percentage (58.8%) of grafts failed in patients whose PK was performed prior to, rather than simultaneously with the GDI insertion, this difference was minimal. This study provides further evidence that pars plana insertion of a GDI leads to very effective reduction of IOP in eyes not well-controlled on maximal medical therapy, and may lead to greater long-term survival of the PK than in eyes with the GDI tube in the anterior chamber.
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