Abstract
Purpose: :
To evaluate the outcomes and complications of Baerveldt Glaucoma Implant (BGI) with ancillary trabeculectomy/express shunt surgery compared to BGI surgery alone.Study
Methods: :
Medical records of all patients treated by two surgeons (MM/GS) with BGI with concurrent trabeculectomy/express shunt (primary or revision) (BGI/trab) or BGI alone in the last 2 years were reviewed. Data collected for each group included age, gender, baseline intraocular pressure (IOP), postoperative IOP at various time intervals (one day, one week, one month, two months, three months, six months, and final follow up), corresponding number of hypotensive medications, need for early tube opening, and success rate. Success was defined as IOP ≥5 mmHg and ≤ 21 mmHg, and a reduction in IOP by 20%, without further glaucoma surgery.
Results: :
Twenty-seven patients had BGI/trab and fifty patients BGI alone. The mean IOP (in mmHg) at baseline was 36.3 ± 12.7 and 30.9 ± 10.7 in the BGI/trab and BGI groups, respectively (p=0.053). The IOP at last follow up was 14.7 ± 5.8 and 17.7 ± 10.8 in these groups respectively (p=0.42), giving a success rate of 73% for BGI/trab and 59% for BGI (p=0.22). There was no significant difference in IOP between the two groups at any time interval. The mean number of hypotensive medications at week one and month one was 0.08 ± 0.4 and 0.04 ± 0.2 for BGI/trab and 0.52 ± 1.1 and 0.9 ± 1.5 for BGI alone, respectively (p=0.058 and 0.017). The incidence of hypotony in the first postoperative month was 33% for BGI/trab and 22% for BGI (p=0.28). The incidence of pressure spikes(5mmHg greater than baseline IOP) during the same time frame was 11% for BGI/trab and 16% for BGI (p=0.56). Early tube opening was required in 30% of BGI/trab and in 34% of BGI cases (p=0.70). Other complications included (BGI/trab v. BGI): hyphema 19% v. 22%, shallow chamber 30% v. 28%, choroidal effusion 37% v. 16%, and choroidal hemorrhage 0% v. 8%. There were no cases of endophthalmitis in either group.
Conclusions: :
In this retrospective series, Baerveldt Glaucoma Implant surgery with ancillary filtering surgery was associated with similar outcomes other than a reduced need for hypotensive medications in the first month after surgery as compared to BGI surgery alone. The ancillary filtering surgery did not result in a significant decrease in hypotony, pressure spikes, or need for early tube opening in the first postoperative month.
Keywords: intraocular pressure • sclera • wound healing