A Retrospective Comparison of Primary Baerveldt Implantation versus Trabeculectomy with Mitomycin C

Abstract

Purpose To compare the safety and efficacy of Baerveldt implantation and trabeculectomy with mitomycin C (MMC) in patients who have not had prior incisional glaucoma surgery. Design Retrospective comparative case series Patients A total of 125 patients with low risk glaucoma undergoing primary glaucoma surgery, including 55 patients who received a 350-mm2 Baerveldt glaucoma implant and 70 patients who had a trabeculectomy with mitomycin C Methods Eligible patients were identified using current procedural terminology codes, and their medical records were retrospectively reviewed. Main Outcome Measures The primary outcome measure was surgical success (IOP ≤ 21 mm Hg and reduced ≥ 20% from baseline, IOP > 5 mm Hg, no reoperation for glaucoma, no loss of light perception vision). Secondary outcome measures included visual acuity, intraocular pressure (IOP), number of glaucoma medications, and complications. Results The cumulative probability of success at 3 years with or without medical therapy was 87% in the Baerveldt group and 76% in the trabeculectomy group (p = 0.23). Postoperative complications occurred in 11 (20%) patients in the Baerveldt group and 20 (29%) patients in the trabeculectomy group (p = 0.27). Follow-up (mean ± SD) was 27 ± 19 months in the Baerveldt group and 34 ± 20 in the trabeculectomy group (p = 0.053). Conclusions Similar rates of surgical success and postoperative complications were observed with trabeculectomy with mitomycin C and Baerveldt implantation during 3 years of follow-up. Both are viable primary glaucoma procedures in patients without prior ocular surgery.

Primary Baerveldt Shunt Implantation: Outcomes and Complications

“…At 6 months of follow-up, Baerveldt glaucoma implant surgery produced a 50% decrease in IOP whereas trabeculectomy with MMC produced a 62% reduction, a result similar to earlier reports in the literature [4, 19–21]. Those IOP reductions were stable at 5 years in both groups, suggesting that the IOP at 6 months may be a good predictor of long-term IOP reduction.…”

“…Recently, outcomes were reported comparing the safety and efficacy of Baerveldt glaucoma implant surgery and trabeculectomy with MMC in patients who had not undergone prior incisional surgery [4]. At 6 months of follow-up, Baerveldt glaucoma implant surgery produced a 50% decrease in IOP whereas trabeculectomy with MMC produced a 62% reduction, a result similar to earlier reports in the literature [4, 19–21].…”

“…Consistent with prior reports, we defined failure was defined as IOP >21 mmHg or less than 20% reduction below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision [1, 4]. All eyes that had not failed by the above criteria and were not on supplemental medical therapy were considered complete success.…”

“…The Tube Versus Trabeculectomy study demonstrated that Baerveldt glaucoma implant (BGI; Advanced Medical Optics, Santa Ana, CA, USA) surgery had a higher success rate compared to trabeculectomy, with fewer postoperative complications in patients with prior glaucoma or cataract surgery. In a recent retrospective study, Panarelli et al [4]. have shown similar rates of surgical success and post-operative complications in patients undergoing trabeculectomy with mitomycin C (MMC) and in those undergoing Baerveldt glaucoma implant surgery during a 3-year follow-up.…”

Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society

“…A retrospective study comparing the effectiveness of Baerveldt glaucoma implant surgery and trabeculectomy with MMC in eyes without prior incisional surgery suggested similar success and complication rates at 3 years. 31 This topic is currently under evaluation in the Primary Tube Versus Trabeculectomy (PTVT) Study, a multicenter randomized clinical trial. 32 …”