Abstract
Purpose :
A commonly reported complication after Baerveldt glaucoma drainage device (BGI) implantation is diplopia. We speculated that a reduction of the incidence and severity of diplopia might be achieved by refraining from standard suturing the plate to the globe, positioned behind the insertions of, and in close contact with the rectus muscles. Instead, the plate is put farther behind the insertions without sutures allowing the plate to settle where it is least in the way (‘free plate technique’). We performed a prospective observational clinical study to compare eye motility and diplopia development between the two surgical techniques, the sutured and the free plate technique.
Methods :
We studied 101 glaucoma patients (mean age 66 ± 9 years) (mean ± SD) who underwent a BGI implantation at the Rotterdam Eye Hospital, the Netherlands. In 51 patients the BGI plate was sutured to the sclera, while in 50 patients the free plate technique was applied. None of the patients had a history of strabismus. The main outcomes were the incidence of diplopia and ocular motility changes. Patients were measured shortly before and 1 year after surgery. We asked patients about the presence of diplopia. An orthoptist quantified the ductions in 8 gaze directions (Table 1) and the horizontal and vertical ocular alignment at near fixation and at distance. Chi-square tests (diplopia) and Mann Whitney tests (motility measurements) were used for statistical analysis.
Results :
The incidence of diplopia did not differ between the two groups, 1 year after surgery (28% in the sutured group versus 29% in the free plate group; p=0.84). At 1 year after surgery, significantly more free plate patients (60%) showed reduced ductions than in the sutured group (35%) (p=0.013). The ductions in the two groups were mostly restricted in abduction, elevation, elevation in 25°abduction and elevation in 25°adduction (Table 1). The horizontal change in ocular alignment at distance was greater in the sutured group than in the free plate group (0.12 ± 3.07° vs. -0.34 ± 1.56°; p=0.03).
Conclusions :
The free plate technique did not reduce the incidence of diplopia compared to the sutured technique. However, the free plate technique resulted in less change in the ocular alignment, and more changes in the ductions compared to the sutured technique. Further examination with MRI is planned to understand the development of diplopia after BGI implantation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.