July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Scheduled postoperative ripcord removal in Baerveldt 350 implants corresponds with increased complications: a prospective, randomized trial
Author Affiliations & Notes
  • Selena J. An
    Duke Eye Center, Durham, North Carolina, United States
  • Joanne C Wen
    University of Washington, Seattle, Washington, United States
  • Michael Quist
    Duke Eye Center, Durham, North Carolina, United States
  • Anita Vin
    Alamance Eye Center, Burlington, North Carolina, United States
  • Liz Mathenge
    Duke Eye Center, Durham, North Carolina, United States
  • Leon Herndon
    Duke Eye Center, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Selena An, None; Joanne Wen, None; Michael Quist, None; Anita Vin, None; Liz Mathenge, None; Leon Herndon, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2073. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Selena J. An, Joanne C Wen, Michael Quist, Anita Vin, Liz Mathenge, Leon Herndon; Scheduled postoperative ripcord removal in Baerveldt 350 implants corresponds with increased complications: a prospective, randomized trial. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2073.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
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.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×