Primary Baerveldt Shunt Implantation: Outcomes and Complications

Abstract

IntroductionThis study is a retrospective case series to evaluate the outcomes and complications of Baerveldt glaucoma implant surgery (BGI) in patients without prior cataract or incisional glaucoma surgery.MethodsPatients who underwent 350-mm2 BGI through the Glaucoma Service of the University of Illinois at Chicago between 2010 and 2015 were included in this study. Outcome measures included age, sex, ethnicity, operated eye, preoperative diagnosis, preoperative, and sequential postoperative intraocular pressure (IOP), visual acuity, glaucoma medications, and postoperative complication and interventions. Statistical analyses were performed using the two-sided Student t test for continuous variables.ResultsThirty-seven patients were studied. IOP was consistently and statistically significantly lower at 3 months (17.4 ± 6.4, p = 3 × 10−7), 6 months (13.9 ± 5.1, p = 2 × 10−11), 1 year (12.2 ± 4.0, p = 9 × 10−10), and 2 years (14.6 ± 3.3, p = 0.0004) postoperatively compared to IOP at baseline (27.5 ± 8.1). Fewer glaucoma medications were used at 3 months (2.8 ± 1.3, p = 0.04), 6 months (2.6 ± 1.2, p = 0.02), 1 year (2.7 ± 1.7, p = 0.04), and 2 years (2.0 ± 1.2, p = 0.03) postoperatively compared to baseline (3.4 ± 1.1). A total of six cases (16%) had failure. A total of five patients (15%) had postoperative complications. Mean Snellen visual acuity was not statistically different at 6 months (0.5 ± 0.6, p = 0.88) or 1 year (0.4 ± 0.4, p = 0.57) postoperatively from baseline (0.5 ± 0.6).ConclusionsPrimary BGI is effective at reducing IOP and the medication burden in patients suffering glaucomatous optic neuropathy. Further randomized prospective studies are needed to compare various procedures in the primary surgical management of patients with uncontrolled glaucoma.FundingThis study was funded by an unrestricted grant from Research to Prevent Blindness.

Influence of glaucoma surgery on visual function: a clinical cohort study and meta‐analysis

“…In the metaanalysis, based on eight studies, the overall effect size indicated that glaucoma surgery significantly reduces the progression velocity in glaucoma. Several studies reported an unchanged BCVA after glaucoma surgery, for both TE (Bevin et al 2008;Bhardwaj et al 2013;Balekudaru et al 2014;Bertrand et al 2014;Iverson et al 2016) and BGI (Namavari et al 2016), and in a recent randomized clinical trial (RCT) comparing primary BGI with TE (Islamaj et al 2018). This is in agreement with our results.…”

“…) and BGI (Namavari et al. ), and in a recent randomized clinical trial (RCT) comparing primary BGI with TE (Islamaj et al. ).…”

Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma

“…tubes as primary choice). 14 , 15 Considering the cost-effectiveness rationale, trabeculectomy remains the most frequent surgical procedure in glaucoma. 16 …”

“…tubes as primary choice). 14,15 Considering the cost-effectiveness rationale, trabeculectomy remains the most frequent surgical procedure in glaucoma. 16 After primary trabeculectomy performed in different types of glaucoma, multiple studies reported variable longterm success rates (between 48 -98%), depending on definition and time-to-failure calculations, 17 but fewer studies reported results after trabeculectomy in advanced glaucoma only.…”

Dealing with perimetric variability in clinical glaucoma care

“…Several studies reported an unchanged BCVA after glaucoma surgery, for both TE (Balekudaru et al 2014, Bertrand et al 2014, Bevin et al 2008, Bhardwaj et al 2013, Iverson et al 2016 and BGI, (Namavari et al 2016) and in a recent randomized clinical trial (RCT) comparing primary BGI with TE. (Islamaj et al 2018) -25.3[3.5] dB) who underwent a TE, that nine of 104 patients lost two lines of Snellen or more -deemed to be related to glaucoma -at the end of the follow-up (i.e., on average three years postoperatively).…”