Combined Pars Plana Vitrectomy and Baerveldt Glaucoma Implant Placement for Refractory Glaucoma

Abstract

Purpose: : To evaluate outcome of combined pars plana vitrectomy and Baerveldt glaucoma implant placement (PPVBGI) for refractory glaucoma.

Methods: : Retrospective review of 97 PPVBGI cases included 46 neovascular glaucoma cases (NVG) and 51 cases of other indications (Non-NVG).

Results: : Cummulative success to maintain light perception of vision and normal range of intraocular pressure(6 to 21mmHg) of Non-NVG vs NVG were 79.1% vs. 49.3% at 1 year, and 79.1% vs. 39.4% at 2 year (p<0.001). No difference was found between pars plana and anterior chamber placement of BGI (p=0.14). Mean preoperative intraocular pressure was 35 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Sixty patients (61.8%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mmHg with or without antiglaucoma medications, and 25 patients (25.7%) showed vision improvement better than 2 lines postoperatively. Unclearing vitreous hemorrhage (17 eyes, 17.5%) was most common postoperative complication, and postoperative suprachoroidal hemorrhage secondary to ocular hypotony occurred in 4 eyes (4.1%).

Conclusions: : PPVBGI showed promising long-term outcomes in refractory glaucoma regardless of its placement of tube. Outcome may be limited because of severe underlying ocular disease and postoperative complications relating with neovascular glaucoma.

Keywords: vitreoretinal surgery • neovascularization • diabetic retinopathy