Outcomes of Inferonasal Baerveldt Glaucoma Drainage Implant Surgery

Harbick, Kara Hoffman; Sidoti, Paul A.; Budenz, Donald L.; Venkatraman, Anna S.; Bruther, Megan; Grayson, Douglas; Ko, A. Chan Sui; Yi, Glara N

doi:10.1097/01.ijg.0000195597.30600.27

Cited by 50 publications

(26 citation statements)

References 22 publications

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“…1–7,15,16 The incidence of diplopia was 5% in our study, and ranged from 1.4% to 37% in other reports. 1,2,4–7,14–16 Previously published data and the TVT Study show that many patients with persistent disturbances do not report subjective diplopia. This likely reflects a high prevalence of advanced VF loss and/or monocularity among glaucoma populations that receive drainage implants.…”

Section: Discussionsupporting

confidence: 53%

“…The incidence of persistent postoperative strabismus associated with the Baerveldt implant has ranged from 2.1% to 77% in case series. 1–7 The TVT Study is the first prospective randomized clinical trial to rigorously evaluate the incidence of preoperative and postoperative motility disturbances in patients undergoing trabeculectomy or placement of a tube shunt.…”

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confidence: 99%

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Motility Disturbances in the Tube Versus Trabeculectomy Study During the First Year of Follow-up

Rauscher

Gedde

Schiffman

et al. 2009

American Journal of Ophthalmology

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PURPOSE To describe the preoperative and postoperative motility disturbances encountered in the Tube Versus Trabeculectomy (TVT) Study during the first year of follow-up. DESIGN Multicenter randomized clinical trial. METHODS SETTINGS: Seventeen clinical centers. POPULATION: Patients 18 to 85 years old who had previous trabeculectomy and/or cataract surgery and uncontrolled glaucoma with intraocular pressure ≥18 mm Hg and ≤40 mm Hg on maximum tolerated medical therapy. INTERVENTIONS: 350-mm2 Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). MAIN OUTCOME MEASURES: Preoperative and postoperative evaluation of ocular motility and diplopia. RESULTS Motility disturbances were detected in 55 patients (28%) at baseline. New-onset persistent diplopia was reported in 5 patients (5%) in the tube group and no patients in the trabeculectomy group at 1 year (P = .06). A new postoperative motility disturbance developed or worsened in 7 patients (9.9%) in the tube group and no patients in the trabeculectomy group during the first year of follow-up (P = .005). Postoperative motility disturbances were also associated with increasing age (P < .001) and right eye surgery (P = .044). CONCLUSIONS Preoperative motility disturbances were common among patients in the TVT Study. New postoperative motility disturbances were more frequent following tube shunt surgery than trabeculectomy with MMC after 1 year of follow-up.

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Section: Discussionsupporting

confidence: 53%

mentioning

confidence: 99%

Motility Disturbances in the Tube Versus Trabeculectomy Study During the First Year of Follow-up

Rauscher

Gedde

Schiffman

et al. 2009

American Journal of Ophthalmology

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“…Inferiorly placed Ahmed valves have been shown to carry a higher risk of complications including endophthalmitis, although this did not reach statistical significance (0.0% superior versus 2.1% inferior) 28. In contrast, the 0.5% rate of endophthalmitis in a series describing the inferonasal insertion of Baeveldt implants was well within the 0.3–5.0% range for GDD endophthalmitis 29. The issue of inferior positioning is perhaps not as relevant for NPGS as it is usually performed superiorly unless in exceptional situations.…”

Section: Discussionmentioning

confidence: 89%

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

Ang

Varga

Shaarawy

2009

British Journal of Ophthalmology

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The aim of glaucoma surgery is to lower the intraocular pressure in order to reduce the risk of further glaucomatous progression, particularly in cases refractory to topical therapy. Although effective in reducing intraocular pressure, these procedures are not without complications, with endophthalmitis being one of the most serious. A PubMed review of the literature was performed for trabeculectomy, glaucoma drainage device procedures (Ahmed, Baerveldt and Molteno implants) and non-penetrating glaucoma surgery (deep sclerectomy and viscocanalostomy) for reports of postoperative infection, including blebitis and endophthalmitis. The literature on infections relating to non-penetrating glaucoma surgery is sparse compared with penetrating surgery, but this may be a reflection of the relatively shorter follow-up duration and comparatively smaller body of data available on non-penetrating procedures. Overall, there is not enough evidence, in terms of well-constructed randomised clinical trials with sufficiently large sample sizes and long follow-up durations, to be able to make informed comparisons of the risk of postoperative endophthalmitis and infection between the various glaucoma operations. This review article summarises the incidences of endophthalmitis from the literature and discusses the major risk factors for postoperative infection.

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“…Inferonasal placement of the GDI is an effective alternative in these cases, particularly because the inferior oblique muscle does not interfere with placement of the plate at this location. Harbick et al [9] retrospectively investigated the outcomes of inferonasal GDI surgery with the BGI in 182 eyes of 182 patients after 19 ± 15 months of followup. In this study, IOP was reduced from 28.6 ± 11.5 mmHg preoperatively to 12.4 ± 5.7 mmHg at last follow-up.…”

Section: Quadrant Placementmentioning

confidence: 99%

Glaucoma Drainage Implant Surgery

2012

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Glaucoma drainage implant (GDI) surgery represents a significant advance in the treatment of refractory glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of implants are currently available and differ in surface area, shape, composition, and presence or absence of a flow-restricting valve. A prospective, randomized clinical trial comparing two types of GDIs is ongoing. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.

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Outcomes of Inferonasal Baerveldt Glaucoma Drainage Implant Surgery

Abstract: Inferonasal Baerveldt glaucoma implant placement appears to be a safe and effective surgical option that may be helpful in certain clinical situations.

Cited by 50 publications

References 22 publications

Motility Disturbances in the Tube Versus Trabeculectomy Study During the First Year of Follow-up

Motility Disturbances in the Tube Versus Trabeculectomy Study During the First Year of Follow-up

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

Glaucoma Drainage Implant Surgery

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