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Bryan K. Hong, Brian A. Francis, Vikas Chopra, Esther S. Lee; Vision Loss and Recovery After Baerveldt. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3706.
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To assess the risk of long-term vision loss after tube shunt placement and to determine the course of long-term vision loss versus transient loss and recovery.
The medical records of 116 eyes in 116 patients undergoing Baerveldt tube shunt implantation between January 1998 and December 2010 were retrospectively reviewed. Postoperative vision loss was categorized as mild or moderate (decrease in Snellen visual acuity of 3-5 lines) vs severe (decrease of >5 lines of Snellen visual acuity or semiquantitative categories of low vision, e.g., counting fingers, hand motion, light perception, and no light perception). Postoperative vision loss was considered permanent if visual acuity did not have a return of 3 lines within a 6-month follow-up period. Preoperative, intraoperative, and postoperative variables of patients with permanent vision loss were compared to those of patients with transient or no vision loss.
Permanent vision loss occurred in 40 of 116 eyes (34.5%): 18 (15.5%) had mild or moderate vision loss, and 22 (19.0%) had severe vision loss. Twelve eyes (10.3%) with permanent mild or moderate vision loss and 10 eyes (8.6%) with permanent severe vision loss had no identifiable cause. Except for the number of quadrants of split fixation, no significant relationship was observed between demographic data or preoperative glaucomatous parameters with permanent, severe loss of vision. Loss of four quadrants of fixation was associated with a significantly high risk (p=0.03), odds ratio (OR) 8.38, 95% CI [1.54 - 45.7]). Pseudophakic status seemed to be associated with a lower risk of permanent, severe vision loss compared to phakic status with OR = 0.34, but with p=0.06 failed to reach statistical significance. Similarly, lower preoperative IOP was associated with a lower risk of permanent, severe vision loss, OR 0.36, but this also did not reach statistical significance (p=0.1). Transient vision loss occurred in 32 of 116 eyes (27.6%): 12 (10.3%) had mild or moderate vision loss, and 20 (17.2%) had severe vision loss.
Permanent, severe vision loss is not uncommon after Baerveldt tube shunt implantation. A predictive risk factor for permanent vision loss is four quadrants of split fixation on preoperative HVF. Furthermore, transient vision loss occurs with equal frequency as permanent vision loss, and may take up to 6 months for full recovery to occur.
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