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Anhtuan Hoang Nguyen, Alexander Nugent, Vikas Chopra, Brian A Francis, James C H Tan; Novel Venting Stitch Technique in Controlling Postoperative Intraocular Pressure in Baerveldt Glaucoma Implants. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3187.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize early postoperative intraocular pressure (IOP) after Baerveldt 350 (BGI) aqueous shunt modified with a novel venting stitch (VS) technique.
Retrospective chart review of 67 eyes of 64 patients receiving BGI 350 with VS (VS group) or BGI 350 without fenestration (control group). In the VS group, a 10-0 nylon suture is passed through the BGI tube lumen and sutured through superficial clear cornea. Data on IOP, number of medications and hypotony (IOP<5mmHg) was collected for the following periods: immediate preoperative (preop), postoperative day 1 (POD1), postoperative but pre-functioning bleb (postop pre-bleb), and immediate post-tube opening (post-tube opening). Fisher’s Exact and Mann-Whitney U tests were used for statistical analysis.
For patients with preoperative 15mmHg<IOP≤30mmHg, mean preop IOP in the VS group was 21.2±4.7mmHg (15 eyes) and control group was 24.1±3.8mmHg (18 eyes; p=.057). Mean POD1 IOP in the VS group was 13.6±6.4mmHg and control group was 24.3±11.1mmHg (p=.003). Mean postop pre-bleb IOP in the VS group was 16.1±5.6mmHg and control group was 22.3±6.1mmHg (p=.002). Mean number of postoperative IOP-lowering medications in the VS group was 0.6±0.9 and control group was 3.1±1.5 (p<.001). Mean post-tube opening IOP in the VS group was 13.1±6.1mmHg and control group was 12.9±6.0mmHg (p=.837). For patients with preoperative IOP>30mmHg, mean preop IOP in the VS group was 40.9±5.4mmHg (9 eyes) and control group was 40.1±7.0mmHg (25 eyes; p=.596). Mean POD1 IOP in the VS group was 14.6±11.6mmHg and control group was 25.4±16.7 (p=.099). Mean postop pre-bleb IOP in the VS group was 14.2±6.5mmHg and control group was 23.5±11.9mmHg (p=.029). Mean number of postoperative IOP-lowering medications in the VS group was 1.2±1.6 and control group was 2.2±1.9 (p=.149). Mean post-tube opening IOP in the VS group was 15.0±7.0mmHg and control group was 14.6±8.3mmHg (p=.781). Of the 67 eyes, hypotony occurred in 3 (12.5%) eyes in the VS group and 6 (14.0%) eyes in control group (p=1.000). 1 hypotonous eye had the venting stitch pulled after choroidals developed leading to resolution of the choroidals.
This novel venting stitch modification provides better IOP control in the early postoperative period before the BGI becomes functional, reducing the number of IOP-lowering medications required. Venting stitch modification did not increase the frequency of postoperative hypotony.
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