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Kenza Bradly, Mohamad El Wardani, Ciara Bergin, Farid Achache, Eamon Sharkawi; Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2704. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the efficacy and safety of Baerveldt tube (BT) implantation compared to combined phacoemulsification and Baerveldt tube implantation (PBT) in refractory glaucoma at two years.
Seventy six patients with medically uncontrolled glaucoma underwent either BT Implantation with Phacoemulsification (Group PBT; n=38) or BT Implantation alone (group BT; n=38, pseudophakic eyes only). Groups were matched for glaucoma subtype and pre-operative IOP. Pre and post-operative measures recorded included patient demographics, visual acuity, IOP, number of anti-glaucoma medications prescribed and all complications. Where possible all patients were followed up for a minimum of 24 months.
There was a significant difference in failure rates between groups at 24 months (PBT 29% vs BT 9%, p=0.02). The PBT group had fewer previous glaucoma surgeries (excluding phacoemulsification; 23 eyes vs 30 eyes) and included significantly younger patients (61 vs 69 yrs, p=0.03). There was no significant difference for PBT vs BT in preoperative baseline ocular characteristics: median IOP =23mmHg vs 23mmHg, p=0.86; mean number of anti-glaucomatous =3.1 vs 2.7, p=0.21; and median VA=0.5 logMAR vs 0.3 logMAR, p=0.07. At year two: median IOP =14mmHg vs 11 mmHg, p=0.07; mean number of anti-glaucomatous medications=0.9 vs 1.0 p=0.73; median VA=0.3 vs 0.5, p=0.28. Complication rates were similar between the two groups (8% vs 10%).
There were statistically significant differences in failure rates at 24 months. Median IOP was higher in the PBT group at 24 months but this did not reach significance. This suggests that simultaneous phacoemulsification does have a marked effect on tube function.
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