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P. Ceruti, R. Tosi, R. Morbio, M. Marraffa, G. Marchini; Outcome of Baerveldt Glaucoma Drainage Implant for the Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3955.
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To determine the effectiveness and safety of the Baerveldt glaucoma drainage implant (GDI) for the treatment of refractory glaucoma.
Thirty eyes from thirty consecutive Caucasian patients with different phenotypes of refractory glaucoma were enrolled in a prospective, non-comparative case series, single-centre study. All the eyes underwent superotemporal placement of a Baerveldt 350-mm2 GDI modified with an occlusive 7-0 external absorbable ligature and a 5-0 nylon intraluminal suture which was tucked under the conjunctiva. This technique was used to temporarily occlude the drainage tube and to prevent early postoperative hypotony. The main outcome measures included postoperative IOP values, time for IOP stabilization, complications and number of postoperative medications. Outcomes were compared for patients with primary and secondary glaucoma. Moreover, the relationship between type and number of previous surgical antiglaucoma treatments and IOP control at 12 months was assessed.
Over a mean postoperative follow-up of 16.1 ± 4.5 months (range 12-24 months), the IOP was reduced from a mean of 32.7 ± 7.2 mm Hg preoperatively to 11 ± 5.5 mm Hg at 12 months (P<0.0001, paired t test). A total of 27 eyes (90%) achieved adequate IOP control (IOP < 21 mm Hg) without adjunctive medications. The IOP stabilization was obtained after 33.8 ± 12.8 days when the 7-0 ligature was absorbed or the 5-0 intraluminal suture was removed (N=5, 16.6%). Postoperative complications (choroidal serous detachment [N=3, 10%], choroidal haemorrhagic detachment [N=2, 7%], retinal detachment [N=1, 3%] and conjunctival leakage [N=2, 7%]) occurred in 8 eyes (27%) and 4 eyes (13%) required further surgical intervention. There was no difference between primary (N=14) and secondary glaucoma (N=16) patients in terms of postoperative IOP values, time for IOP stabilization, complications and number of postoperative medications. The bivariate analysis failed to establish any relationship between type (P=0.23) and number (P=0.66) of previous surgical antiglaucoma treatments and IOP control at 12 months.
The Baerveldt GDI seems to be effective in lowering IOP without adjunctive medications in most patients with primary and secondary refractory glaucoma. Our experience shows a mean postoperative IOP reduction of 67% (range 54-79%) from the preoperative value after 12 months. Both the occlusive ligature and the intraluminal suture methods provide stable and satisfactory IOP reduction with low incidence of complications in the immediate postoperative period.
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