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Shuri Kawamorita, Teruhiko Hamanaka, Tetsuro Sakurai; Baerveldt implant surgery combined with trabeculectomy versus Baerveldt surgery alone for the treatment of glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3196. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Tube implant surgery has been widely used for the treatment of refractory glaucoma. However, the ability of this procedure to lower intraocular pressure (IOP) in cases with very high IOP is limited, possibly caused by the severely impaired outflow pathway. Baerveldt implant surgery combined with trabeculectomy (TLE) was first used for the purpose of avoiding the hypertensive period before releasing tube ligation. Moreover, TLE may provide an additional IOP lowering effect for difficult cases involving very high IOP. Therefore, Baerveldt surgery combined with TLE may be effective for treating such eyes with refractory glaucoma. In this study, we retrospectively investigated the surgical outcomes of patients who received Baerveldt surgery alone (Group A) versus those who received Baerveldt combined with TLE (Group B) at the Japanese Red Cross Medical Center, Tokyo, Japan from April 2008 to July 2012 for the treatment of glaucoma.
Eyes with a history of vitrectomy, complication of plate or tube exposure, or which failed to follow-up for 1 year were excluded from the study. Preoperative and postoperative IOP at 6 months and 1 year, surgical success rate, the number of previous glaucoma surgeries, and the number of glaucoma medications were reviewed. A single surgeon (TH) performed all surgeries. Surgical success was defined as IOP ≧6mmHg and ≦ 21mmHg, and postoperative IOP reduction of at least 20% from preoperative IOP.
Groups A and B were composed of 45 eyes of 42 patients and 24 eyes of 23 patients, respectively. The mean preoperative IOP was 30.24mmHg in Group A and 37.54mmHg in Group B (p=0.006). The mean postoperative IOP at 1 year was 15.11mmHg in Group A and 16.17mmHg in Group B (p=0.492). No statistically significant difference in surgical success rate was found between the two groups (p=0.276). The percentage of eyes that had received previous glaucoma surgery was 37.8% in Group A and 79.2% in Group B (p=0.001).
The ability of Baerveldt implant surgery combined with TLE to lower IOP to a normal level was equal to that of Baerveldt surgery alone, even in cases of refractory glaucoma.
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