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B. E. Prum, Jr., C. M. Mertz, J. S. Tiedeman, L. A. Olsakovsky; The Long-Term Outcomes of Pars Plana Vitrectomy Combined With a Pars Plana Glaucoma Implant in Eyes With Complicated Glaucomas. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1245.
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To investigate long-term intraocular pressure (IOP) control and rates of complications in a large series of eyes undergoing combined pars plana vitrectomy (PPVtx) and pars plana Baerveldt glaucoma drainage implant (PPGDI).
Sixty-five eyes were identified with complicated glaucomas without penetrating keratoplasty that underwent PPVtx and PPGDI at a single center by two surgeons between 1996 and 2007. Fifty-five eyes (52 patients) with a minimum of 6 months follow-up were analyzed retrospectively. Preoperative demographic data including age, gender, ethnicity, eye, primary and secondary glaucoma diagnoses, other ocular diagnoses, lens status, prior ophthalmic surgeries, and glaucoma medications were recorded. IOP measurements, number of required glaucoma medications, complications, and visual acuity (VA) were recorded at each post-operative visit. Data analysis was performed on resulting IOP, change in IOP, survival time, VA, complications, and medication requirement changes with emphasis on Kaplan-Meier survival analysis.
Mean follow-up was 40 months (range 6-120). Successful IOP control (>5 and < 21 mmHg +/- medications) at 12, 24, 36, 48, and 60 months was achieved in 85, 81, 78, 78, and 78% of eyes respectively. Mean IOP reduction was 68%, from a preoperative mean of 32 mmHg (range 5-75) to a postoperative mean of 12 mmHg (range 1-36). Glaucoma medication requirement was reduced from a preoperative mean of 3 medications (range 0-6) to a postoperative mean of 1 medication (range 0-4). There was no significant difference in outcome based on preoperative demographic data or diagnostic group. Visual acuity was improved in 24 eyes (43.6%), unchanged in 17 eyes (30.9%), and worsened in 15 eyes (27.3%). Forty eyes (72.7%) experienced complications. The most common complication was re-operation for any reason (17 eyes; 30.9%), followed by chronic iritis (16 eyes; 29.1%), corneal edema (13 eyes; 23.6%), intraoperative corneal epithelial defect (10 eyes; 18.2%), and retinal detachment (8 eyes; 14.5%).
This study represents the largest reported series of eyes with complicated glaucomas undergoing combined PPVtx and PPGDI. Our study shows that this procedure provides excellent long-term IOP control compared to published studies with anterior chamber GDI placement. However, this procedure carries a high rate of morbidity that must be considered.
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