Abstract
Purpose :
Many surgeons remove the dissolvable ligature suture, also called a ripcord, in the Baerveldt (BVT) glaucoma drainage device to better control the timing of tube opening and intraocular pressure (IOP) lowering postoperatively. However, complications following BVT implant surgery with or without ripcord removal are not well-characterized. We performed a prospective, randomized clinical trial to test the hypothesis that scheduled ripcord removal decreases complications and final IOP.
Methods :
Eighty-one patients undergoing BVT implant surgery were enrolled and randomized to scheduled ripcord removal at the postoperative week 3 clinic visit or to observation. They were followed for 6 months, and outcomes such as complications, IOPs, and glaucoma medications were compared between the two groups. Data were analyzed using intent-to-treat principle.
Results :
Forty-four patients were randomized to scheduled ripcord removal and 37 were randomized to observation. The removal group was found have higher rates of total complications (66% versus 43%, p=0.04) and, specifically, higher rates of hyphema (10% versus 4%, p=0.0113) and tube migration (6% versus 0%, p=0.003). The removal group had a lower rate of fibrin and heme tube blockage (0.4% versus 6%, p=0.0003) as well as a larger decrease in the number of final glaucoma medications (1.3 versus 0.59 fewer medications, p=0.02). Mean IOP decrease of the removal group was 8.6mmHg and did not significantly differ from the mean IOP decrease of the control group. The removal group’s success rate was 52%, defined as a final IOP>5mmHg and ≤15mmHg without further surgical intervention, and did not differ significantly from the control group’s success rate.
Conclusions :
This study’s results suggest that scheduled ripcord removal is correlated with a more complicated recovery course in comparison to spontaneous tube opening, though the complications seen were largely self-limited and not sight-threatening. This technique leads to similar outcomes in terms of IOP decrease and BVT implant success rate. Scheduled ripcord removal is associated with a greater decrease in the number of glaucoma medications, which may improve quality of life for patients. Additional studies with more varied types of glaucoma could be useful in clarifying the role of this technique in the postoperative course among different patient populations.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.