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H.J. Kim, N. Patel, M.A. Zarbin, R. Fechtner, P.J. Lama, N. Bhagat; Pars Plana Tube Insertion Of Glaucoma Drainage Implants With Pars Plana Vitrectomy: Review Of Complications, Anatomic And Functional Outcomes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):29.
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To describe the anatomic and functional outcomes of pars plana tube insertion of glaucoma drainage implants with vitrectomy for the management of glaucoma refractory to medical therapy.
A retrospective review of 18 consecutive patients who underwent Baerveldt shunt implant with pars plana tube insertion and pars plana vitrectomy between January 1997 and June 2005. The main outcome measures included preoperative and postoperative visual acuity, intraocular pressure (IOP), number of glaucoma medications, and complications.
A total of 18 eyes from 18 patients were included in our evaluation. The mean patient age was 52 years (median 55, range 9–87 years). There were 8 Hispanics, 7 Caucasians, 2 Africans, and 1 Asian; 16 females and 2 males. The mean follow–up period was 12 months (median 12, range 2–36 months). Visual acuity remained the same or improved in12 eyes (67%). The mean preoperative IOP of 30.9 +/– 7.4 standard deviation mmHg (median 31, range 14–44mmHg) was reduced to a mean postoperative IOP of 15.0 +/– 4.3 standard deviation mmHg (median 15, range 6–21mmHg). The mean number of glaucoma medications before surgery was 2.8 (median 3, range 0–4) and after surgery was 0.8 (median 0.5, range 0–3). Two eyes required additional procedures to lower IOP to less than 21 mmHg. Ten eyes required medication(s) to maintain that IOP. Complications included choroidal effusions (3 eyes), corneal graft decompensation (3 eyes), transient hypotony (2 eyes), vitreous occlusion of the tube (1 eye), cystoid macular edema (1 eye), and corneal ulcer (1 eye). Seventy–three% (n=8) of the complications occurred within 6 months postoperatively and 91% (n=10) occurred within a year postoperatively. Only 2 complications (18%) required surgical intervention (repeat corneal transplant for graft failure; pars plana vitrectomy for vitreous occlusion of the tube). The rest were successfully managed with conservative measures.
Pars plana tube insertion of glaucoma drainage implants with vitrectomy can preserve vision, reduce IOP and number of glaucoma medications to achieve target IOP goals. Most complications were self–limited and treatable with conservative measures. Further prospective and comparative study is needed to determine the safety of this combined approach to manage glaucoma refractory to medical therapy in patients with high risk for anterior segment decompensation.
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