Postoperative Complications in the Ahmed Baerveldt Comparison Study During Five Years of Follow-up

Abstract

PURPOSE To compare the late complications in the Ahmed Baerveldt Comparison Study during 5 years of follow-up. DESIGN Multicenter, prospective, randomized clinical trial. METHODS SETTINGS Sixteen international clinical centers. STUDY POPULATION Two hundred seventy six subjects aged 18 to 85 years with previous intraocular surgery or refractory glaucoma with intraocular pressure of > 18 mmHg. INTERVENTIONS Ahmed Glaucoma Valve FP7 or Baerveldt Glaucoma Implant BG 101-350. MAIN OUTCOME MEASURES Late postoperative complications (beyond 3 months), reoperations for complications, and decreased vision from complications. RESULTS Late complications developed in 56 subjects (46.8 ± 4.8 5 year cumulative % ± SE) in the Ahmed Glaucoma Valve group and 67 (56.3 ± 4.7 5 year cumulative % ± SE) in the Baerveldt Glaucoma Implant group (P = 0.082). The cumulative rates of serious complications were 15.9% and 24.7% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups respectively (P = 0.034) although this was largely driven by subjects who had tube occlusions in the two groups (0.8% in the Ahmed Glaucoma Valve group and 5.7% in the Baerveldt Glaucoma Implant group, P = 0.037). Both groups had a relatively high incidence of persistent diplopia (12%) and corneal edema (20%), although half of the corneal edema cases were likely due to pre-existing causes other than the aqueous shunt. The incidence of tube erosion was 1% and 3% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups, respectively (P = 0.04). CONCLUSIONS Long term rates of vision threatening complications and complications resulting in reoperation were higher in the Baerveldt Glaucoma Implant than the Ahmed Glaucoma Valve group over 5 years of follow-up.

Primary Baerveldt Shunt Implantation: Outcomes and Complications

“…While that study included persistent corneal edema, bleb leak, and persistent diplopia as postoperative complications in the BGI group, in this study there were no patients with those complications. Although variability among practitioners may account for this difference, the current study was also not adequately powered to detect relatively rare complications of BGI surgery [15, 24]. Interestingly, in both the current study and that by Panarelli et al [4].…”

Aqueous shunts for glaucoma

“…Three studies included only participants with neovascular glaucoma (Arcieri 2015; Mahdy 2013; Teixeira 2012), while the remainder of studies included a combination of glaucoma subtypes. The smallest trial enrolled 11 participants (Desai 2013), and the largest trial enrolled 276 participants (ABC 2011). …”

A Review of the Ahmed Glaucoma Valve Implant and Comparison with Other Surgical Operations

“…The existing evidence seems to suggest that AGV might have a more favorable safety profile when compared to nonvalved GDIs [20,51,52,54,55,60,61,64]. On the other hand, non-valved GDIs seem to achieve lower pressures than the AGV [54,55,[57][58][59][62][63][64].…”