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Adam J. Weiner, Omar Faridi, Mamtha Balasubramaniam, Asher Weiner; Clinical Experience with Sulcus-Implanted Baerveldt Glaucoma Tube Shunts Fully Concealed Behind the Iris in Pseudophakic Eyes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2640.
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To describe our clinical experience with ciliary sulcus-implanted Baerveldt glaucoma tube shunts entirely concealed behind the iris, compared to similarly implanted tubes whose openings remain fully exposed in the pupil
A retrospective interventional non-randomized comparative chart review. Main outcome measures were postoperative tube incarceration by iris, and postoperative intraocular pressure (IOP) and number of glaucoma medications
Fifteen eyes of 15 patients were identified with sulcus-implanted fully concealed tubes (CT group) while 48 eyes of 43 patients had sulcus-implanted fully exposed tube openings (ET group) in the pupil. Follow-up period was 22.9±17.9 (mean ± SD, range, 1.0-72.0 months). Only 1 case (6.67%) of tube incarceration by iris has occurred in the CT group and none in the ET group. The blockage was treated by laser iridotomy with no recurrence. Preoperative IOP in the CT and ET groups was 27.2 ± 9.6 mmHg (range, 16-46 mmHg) and 25.2 ± 10.1 mmHg (range, 12-59 mmHg), respectively, with no significant difference between the groups. IOP was significantly reduced at final visit to 13.2 ± 4.2 mmHg (range, 6-22 mmHg, p=.0001) and 10.5 ± 4.2 mmHg (range, 4-25 mmHg, p=.0001), respectively. Final visit IOP was significantly lower in the ET group than in the CT group (p=.032). Preoperative number of glaucoma medications in the CT and ET groups was 3.87 ± 0.74 (range, 2.0-5.0) and 3.90 ± 1.04 (range, 1.0-6.0), respectively. It was significantly reduced to 1.87 ± 1.19 (range, 0.0-4.0, p=.0001) and 1.63 ± 1.38 (range, 0.0-5.0, p=.0001), respectively. There was no significant difference in the number of glaucoma medications between the groups before or after surgery. LogMAR visual acuity was similar in both groups and did not change significantly following surgery
These results suggest that the risk of iris occluding sulcus-implanted Baerveldt glaucoma tube shunts entirely concealed behind the iris is small, and is treatable by laser without the need for tube repositioning. However, it appears that sulcus-implanted tubes whose openings remain fully exposed in the pupil are more effective in IOP control than tube shunts entirely concealed behind the iris
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