Abstract
Purpose: :
To assess the long term outcomes of patients with complicated glaucomas and corneal opacities or fibrosed pupils that underwent tube shunt placement into the vitreous cavity with concurrent endoscopic-assisted pars plana vitrectomy.
Methods: :
The medical records of 25 eyes of 23 patients (19 adult, 6 pediatric) with complicated glaucomas and corneal opacities or fibrosed pupils that underwent insertion of a Baerveldt tube shunt into the vitreous cavity with concurrent vitrectomy using adjunctive endoscopy were reviewed. Surgeries were performed by a single glaucoma surgeon and a single vitreoretinal surgeon between 1997 and 2005. The reduction of intraocular pressure (IOP), reduction of glaucoma medications, and incidence of complications were analyzed.
Results: :
Mean follow-up duration was 62 months (range, 10-106 months). Mean preoperative IOP was 31.6 + 9.8 (SD) mmHg on 3.2 + 1.0 (SD) glaucoma medications. In the 22 eyes that did not develop phthisis, IOP was significantly reduced at the most recent follow-up exam to a mean of 12.2 + 4.6 (SD) mmHg (P<0.0001). The number of glaucoma medications required in these eyes at the most recent follow-up exam was significantly reduced to a mean of 1.4 + 1.2 (SD) (P<0.0001). Postoperative complications occurred in 9 of 19 adult patients. Complications included tube shunt revision in 4 eyes, supplemental cyclophotocoagulation for elevated IOP in 3 eyes, retinal detachment that required surgical repair in 1 eye, choroidal hemorrhage that required surgical drainage in 1 eye, and macular pucker that required repeat vitrectomy in one eye. Two adult eyes developed phthisis related to subsequent corneal surgeries. Postoperative complications occurred in all 6 pediatric eyes. These included rhegmatogenous retinal detachment with successful repair in one eye and vitreous membranes in 5 eyes, one of which developed severe PVR, traction retinal detachment, and eventual phthisis.
Keywords: intraocular pressure • clinical (human) or epidemiologic studies: outcomes/complications