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Bingjie Ling, Jingjing Cui, James T Patrie, Bruce E Prum; Assessment of Long-Term Serious Corneal Complications from a Retrospective Review of 401 Baerveldt 350mm2 Glaucoma Implants With Scleral Patch Graft Performed from 1995 to 2011. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3195.
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To evaluate the long-term major and minor corneal complications of Baerveldt glaucoma implants.
In this retrospective, non-comparative case series, we reviewed 510 Baerveldt implants placed by a single surgeon (BEP). There were 401 surgeries that qualified (age ≥18 and ≥6 months follow-up). Five-year data collected in 6-month intervals included corneal status; date of onset and resolution, and type of surgical intervention for each major (e.g. ≥3+ edema, ulcer) or minor (e.g. ≤2+ edema, filament) corneal event. Kaplan Meier survival analysis of time to first major corneal event was performed.
The mean follow-up time was 5.4 years. Forty-eight (12%) eyes underwent previous corneal surgery and 44 (11%) eyes had previous graft (penetrating keratoplasty (PK) or Descemet stripping automated endothelial keratoplasty (DSAEK)). Pre-operatively, 296 (74%) had normal native corneas, 75 (19%) had any corneal abnormality (59 (15%) were native and 16 (4%) were grafted), and 28 (7%) had clear grafts. The mean number of all corneal events was 1.8. There were 156 eyes with any corneal event: 53 (34%) had only minor events, 103 (66%) had at least one major event, and 21 (14%) had more than one major event. There were 140 minor events: 73 (52%) were persistent (>90 days), 87 (62%) resolved without surgery, and 26 (19%) progressed to a major event. There were 132 major events: 119 (90%) were persistent, 14 (11%) resolved without surgery, 64 (49%) never resolved before the end of follow-up, and 54 (41%) underwent surgery. There were 32 PKs, 7 repeat PKs, 9 DSAEKs, 5 enucleations, and 1 anterior chamber reformation. The median time to first major complication was compared between groups: graft vs. normal native corneas and abnormal native vs. normal native corneas were significantly different (p<0.01 and p<0.05, respectively).
The probability of developing corneal edema post-operatively increased over time, and occurred more quickly in eyes with grafted or abnormal corneas. Eyes with abnormal native corneas or grafted corneas were significantly more likely than eyes with normal native corneas to develop major corneal edema. Compared to eyes with native corneas, ones with grafted corneas have almost a 3-fold increase in receiving a graft post-operatively. Complete statistical analysis will be presented.
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