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A. D. Cohn, A. J. Weiner, M. Balasubramaniam, A. Weiner; Glaucoma Tube Shunt Implantation Through the Ciliary Sulcus in Pseudophakic Eyes With High Risk of Corneal Decompensation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1247.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the safety and efficacy of implanting glaucoma Baerveldt-350 tube shunts through the ciliary sulcus, in between the iris and the intraocular lens, in pseudophakic eyes with high risk of postoperative corneal decompensation.
We retrospectively reviewed the charts of all patients in whom a Baerveldt-350 tube shunt was implanted by one surgeon (AW) over a 5-year period, to identify all eyes with preoperative shallow anterior chambers, corneal transplants or corneal edema, in which the tubes were implanted through the ciliary sulcus rather than through the irido-corneal angle or the pars plana. Primary outcome was the rate of postoperative corneal decompensation. Secondary outcomes were the postoperative control of intraocular pressure (IOP) and change in the number of IOP-lowering medications.
Twenty-five eyes of 22 patients were identified. Follow-up period was 25.4±15.3 months (mean±SD, range: 4-51 months). At final visit, all 15 preoperatively normal corneas in eyes with shallow anterior chambers, and 4 of 5 corneal transplants remained clear. That is, only one of 20 preoperatively clear corneas decompensated. Of the 5 preoperatively edematous corneas, 1 cleared, 1 decompensated, and 3 remained stable. Preoperative IOP was 27.5±11.5 mmHg (mean±SD, range: 12-59 mmHg). Final IOP was of 10.7±4.0 mmHg (mean±SD, range: 3-19 mmHg, p = 0.0001). Target IOP (Tg), as set by one glaucoma specialist (AW), was 12.8±3.0 mmHg (mean±SD, range: 9-18 mmHg). Final IOP was between 5 mmHg and Tg in 21 of 25 eyes (84%), and between 5 and 21 mmHg in 24 of 25 eyes (96%). The number of IOP-lowering medications was significantly reduced from 4.1±1.2 (mean±SD, range: 2-6 medications) to 1.8±1.5 (mean±SD, range: 0-5 medications, p = 0.0001) postoperatively. There were no long-term posterior segment complications.
Implantation of Baerveldt-350 tube shunts through the ciliary sulcus in eyes with high risk of corneal complications appears safe and effective, with a low rate of postoperative corneal decompensation or posterior segment complications.
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