Clinical Experience with Baerveldt 250–mm2 Glaucoma Drainage Implant in Treating Neovascular Glaucoma

Abstract

Abstract: : Purpose: To report the short term results of the Baerveldt 250–mm² drainage implant in the treatment of neovascular glaucoma. Methods: Retrospective chart review of a consecutive series of 21 eyes undergoing Baerveldt 250–mm² drainage implantation between March 1996 and May 2002, for treatment of neovascular glaucoma refractory to medical therapy. Patients consisted of 16 Caucasians, 4 African–descendents, and 1 Asian. Pre–op age, sex, IOP, visual acuity, number of ocular surgeries, and number of anti–glaucoma medications were recorded. Post–op IOP, visual acuity, number of anti–glaucoma medications, and implant–related complications were recorded. Success was categorized into sets with IOP ≥ 6 mmHg and final IOP ≤ 21 mmHg, ≤ 24 mmHg, or ≤ 27 mmHg (with/without anti–glaucoma medications) and without further glaucoma surgery, devastating complication, or loss of light perception. Results: Mean pre–op IOP was 42.8 ± 10.5 mmHg, on 2.8 ± 0.8 anti–glaucoma medications. Average follow–up was 9.2 ± 5.3 months (range 3 – 24 months). The cumulative Kaplan–Meier success rates at 12 months for final IOP ≤ 21 mmHg, ≤ 24 mmHg, and ≤ 27 mmHg were 44%, 63%, and 68%, respectively. Mean post–op final IOP was 15.5 ± 6.3 mmHg (range 3 – 26 mmHg), with 52% patients requiring anti–glaucoma medication(s). Visual acuity improved or was unchanged in 70% patients. Implant–related complications included hyphema (9 patients), plugged tube (2 patients), persistent hypotony (IOP < 6 mmHg beyond 3 months, 1 patient), choroidal effusion (1 patient), retinal detachment (1 patient), corneal decompensation (1 patient), phthisis (1 patient), and loss of light perception (1 patient). Conclusions: Neovascular glaucoma remains difficult to manage and often results in poor outcomes. Results utilizing the Baerveldt 250–mm² drainage implant have not been emphasized in previous studies. The short term results of this study show the Baerveldt 250–mm² drainage implant is a reasonable candidate for the management of intractable neovascular glaucoma, in terms of IOP control, visual acuity stability, incidence of additional glaucoma surgery, and devastating complications.  

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • neovascularization