Ahmed Versus Baerveldt Glaucoma Drainage Device in Uveitic Glaucoma: A Retrospective Comparative Study

Abstract

Precis: Baerveldt glaucoma drainage device demonstrated a greater reduction in intraocular pressure (IOP) than Ahmed in patients with uveitic glaucoma. The most common cause of failure was uncontrolled IOP in Ahmed and hypotony in the Baerveldt group. Purpose: To compare the efficacy and safety of Ahmed and Baerveldt glaucoma drainage devices in uveitic glaucoma. Materials and Methods: The retrospective comparative study included patients with uveitic glaucoma who underwent Ahmed or Baerveldt glaucoma drainage device implantation with a minimum follow-up of 3 months. Success was defined as IOP ≥6 and ≤21 mm Hg and >20% reduction on 2 consecutive visits after the third month with (qualified success) or without (complete success) medications and no further glaucoma surgery or loss of vision. IOP, number of medications, visual acuity, complications, and interventions were compared between groups. Results: In total, 137 eyes of 122 patients (67 Ahmed, 70 Baerveldt) were included. The preoperative IOP and number of medications in the Ahmed group (32.7±10.3 mm Hg; 4.1±1.3) were similar to Baerveldt (32.1±10.2 mm Hg; 4.3±1.3; P=0.73, 0.35). These at the last follow-up were (18.1±9.8 mm Hg; 2.1±1) in Ahmed and (12.7±6.9 mm Hg; 1.3±1.3) in Baerveldt groups (P=0.04, 0.01). The Baerveldt had greater IOP reduction (60.3% vs. 44.5%) and complete success rate (30% vs. 9%) with higher complication rate (51.4% vs. 20.9%) (all P≤0.05). The de novo glaucoma reoperation rate was 19% in the Ahmed group and 4% in the Baerveldt group (P=0.006). Hypotony resulted in failure in 7 eyes (10%) in the Baerveldt group and none in the Ahmed group (P=0.013). Conclusions: Higher complete success rate and significantly greater reduction in mean IOP and number of medications were observed in the Baerveldt group, but with a higher rate of complications including hypotony.

Outcomes of Kahook Dual Blade Goniotomy for Uveitis Associated Open Angle Glaucoma or Ocular Hypertension

“…The complications’ rates were high in this study, with cataract being the most common 18. Glaucoma drainage devices have been effective in patients with uveitis, but they are prone to complications such as hypotony and corneal decompensation 19–24. The surgical success rates of Baerveldt glaucoma drainage devices have been noted to be as high as 91.7% at 2 years,19 with another study reporting a success rate of 86.9% at 1 year 20.…”

“…However, rates of hypotony with failure were high in the Baerveldt group. Sixteen percent of patients in the Ahmed group required a second drainage device 24…”

Uveitis and glaucoma: a look at present day surgical options

“…The Baerveldt tube had a 51% total complication rate while the Ahmed tube had 21%. The Baerveldt tube had higher rates of tube obstructions, tube–cornea touch, tube retraction, corneal decompensation and choroidal effusions compared with the Ahmed implant, whereas the Ahmed implants had a higher rate of tube exposures [29].…”

Comparing Ahmed-FP7 to Baerveldt-250 and Baerveldt-350 surgical outcomes: 1-year results from a retrospective cohort study leveraging the electronic health record

“…While other studies have examined outcomes following tube shunt implantation, some do not differentiate between BGI-250 and BGI-350,24–26 or compare AGI-FP7 to BGI-350 only,27–29 or in one instance (Kilgore et al 23) do compare the AGI-FP7/BGI-250/BGI-350 implants separately but are limited by population homogeneity and inclusion of multiple eyes per patient without statistical correction, which may confound effects. These studies also vary in success/failure definitions.…”