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E. Rietveld, N. M. Jansonius, R. P. H. M. Muskens; Immediate Pressure Reduction With Baerveldt Glaucoma Implants. Invest. Ophthalmol. Vis. Sci. 2009;50(13):445.
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© ARVO (1962-2015); The Authors (2016-present)
To present the method and efficacy of a surgical technique aimed at immediate reduction of the intraocular pressure (IOP) after implantation of the Baerveldt glaucoma drainage device.
41 eyes of 36 patients with refractory glaucoma with very high pre-operative IOPs received a standard implantation of a Baerveldt glaucoma drainage device. In 24 eyes of 22 patients the tube was perforated with a nylon 9-0 suture wich was left in place, while the remaining end of the suture was looped through the cornea. 17 eyes of 14 randomly chosen patients served as controls.The slits created by the spatula needle are kept open by the wire of the suture, allowing aqueous to leak through, providing immediate drainage and reduction of intraocular pressure. In case of inadvertent hypotony the suture is easily removed behind a slitlamp by pulling the corneal loop, after wich the slits in the wall of the tube will close spontaneously due to the elasticity of the silicon.
Mean preoperative IOP with maximum tolerated IOP lowering medication was 45 mmHg (SD 9 mmHg; range 32 - 62 mmHg) in the suture group and 26 mmHg (SD 7; range 16 - 35 mmHg) in the controls. Postoperatively, with the same IOP lowering medication, the mean IOP was 12 mmHg (SD 7 mmHg; range 2-26 mmHg) in the suture group and 23 mmHg (SD 7; range 14-45 mmHg) in the controls after one day, and 11 mmHg (SD 6 mmHG; range 2-26 mmHg) in the suture group and 23 mmHg (SD 8; 12-40 mmHg) in the controls after one week. Differences in IOP between the suture group and controls were significant for all postoperative visits until the Baerveldt tube opened. In two cases the suture failed within four weeks resulting in an IOP increase to pre-operative values. No serious adverse events were recorded.
The method described is an effective and safe option for immediate IOP reduction after implantation of a non-valved glaucoma drainage device.
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