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Eun Huh, Ahmad Aref, Thasarat Vajaranant, Jose De la Cruz, Felix Chau, Maria Cortina; Outcomes of Pars Plana Baerveldt Glaucoma Drainage Implant in Boston Type 1 Keratoprosthesis Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4754.
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Glaucoma drainage implantation (GDI) in conjunction with Boston Type 1 Keratoprosthesis (KPro) placement is a surgical option in controlling postoperative glaucoma. The Ahmed FP-7 glaucoma drainage device implant (AGI; New World Medical, Inc., Rancho Cucamonga, California, USA) has been used with highest frequency in this patient population, as reported in literature. We hypothesize that combined pars plana vitrectomy with placement of a Baerveldt glaucoma drainage device implant (BGI; Abbott Laboratories, Inc., Abbott Park, Illinois, USA) in KPro patients is similarly effective compared to a pars plana placed AGI.
A retrospective review of 106 patients who underwent KPro from April 2007 to September 2012 was performed. Preoperative and postoperative parameters collected and analyzed included: visual acuity, intraocular pressure (IOP), number of glaucoma medications to achieve IOP control, and postoperative complications.
Eleven and twelve eyes that underwent combined Kpro and pars plana placed BGI or AGI, respectively, were identified. Seventy-five percent of the BGI eyes and 100% of the AGI eyes had preoperative diagnosis of glaucoma. Table 1 shows the preoperative and postoperative parameters of the AGI and BGI eyes. Average follow-up was 9.6 months (±9.5, range, 1.8-35.8 months) for the BGI group and 34.2 (±15.9, range, 12.7-67.4 months) months for the AGI group. Two of the AGI eyes required subsequent BGI placement, with one also requiring cyclophotocoagulation (CPC), for better IOP control. Two eyes required AGI and KPro explantation, one due to fungal endophthalmitis from a corneal ulcer and the other due to hypotony from tractional retinal detachment. One of the BGI eyes required subsequent CPC for optimal IOP control. There were no erosions of the tube or plate in either AGI or BGI groups.
For the management of glaucoma in KPro patients, posteriorly placed pars plana BGI in conjunction with KPro has low rates of postoperative complications, including the need for additional glaucoma surgery.
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