Purchase this article with an account.
K. Barton; A Modified Stenting Technique Without External Ligation for Early Flow Control With the Baerveldt Glaucoma Drainage Device . Invest. Ophthalmol. Vis. Sci. 2005;46(13):86.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:To investigate the safety and efficacy of a modified stenting technique for early postoperative flow restriction with the Baerveldt Glaucoma Drainage Device (GDD) Methods:Prospective, non–comparative, interventional study of Baerveldt GDD implanted for recalcitrant glaucoma and stented using a 3/0 braided nylon suture threaded through the full length of the tube with additional resistance provided by a constriction around the suture at a tight (25 gauge) anterior chamber scleral entry. Consecutive eyes implanted by one surgeon using the above technique from June 2003 to the present were identified from a prospective registry of GDD, and considered for inclusion. Pars plana Baerveldt GDD (unsuitable for the above technique), Baerveldt 250 GDD (small numbers), second eyes in patients implanted in both, and eyes with <3 months follow–up were excluded. 10 GDD that were ligated in addition to the stent suture during implantation, were also excluded. Results:62 eyes of 62 patients, aged 48.6 ± 20.8 years (mean±S.D.) were included and followed for 11.3 ± 7.1 months. The preoperative intraocular pressure (IOP) (average of last 3 attendances) was 26.6 ± 6.9 mmHg on 2.4 ± 0.89 (mean±S.D.) topical glaucoma medications. In addition, 47 (65%) were taking acetazolamide. Postoperative IOP’s (mean±S.E.M)(mmHg) at 1, 4, and 7 days, 2, 3, 4, and 6 weeks, 2, 3, 4 and 6 months were 17.6±1.2, 14.1±2.1, 14.1±2.14, 12.8±1.6, 9.9±1.5, 12.4±1.2, 12.3±1.0, 12.4±1.0, 15.4±1.1, 14.2±1.0, 13.4 ±0.9 respectively. On day 1, the IOP was <6mmHg in 4 eyes and >21mmHg in 15. 42 (77%) of eyes were controlled within the normal range at last follow–up without medication, 12 (19%) with topical medication, 1 was hypotonous and none were uncontrolled. The stent suture had been removed in 14 (23%) of eyes at last follow–up. Stents were removed 7.4 ± 4.3 months (mean ±S.D.) after implantation. Of 27 eyes followed for > 1 year, the stent suture was still in place in 19 (70%). Complications included 1 iris blockage, 1 resiting for corneal touch, 2 exposures, 3 ligations for hypotony, 2 vitrectomies for misdirection, and 1 retinal detachment. No eye sustained a suprachoroidal haemorrhage. Conclusions:The potential advantages of this technique over conventional external ligation are firstly, the absence of a precipitious IOP drop at 5–6 weeks and secondly, early IOP control within the normal range in most patients. The advantage over previous stenting techniques is that no ligature is required. In this study this technique compared favorably in terms of safety and efficacy with previous studies using external ligation.
This PDF is available to Subscribers Only