Pars plana Baerveldt tube insertion with pars plana vitrectomy for refractory glaucoma

• Published in: Oman journal of ophthalmology 2012-01, Vol.5 (1), p.19-27
• Main Authors: Kolomeyer, Anton M, Kim, H Jane, Khouri, Albert S, Lama, Paul J, Fechtner, Robert D, Zarbin, Marco A, Bhagat, Neelakshi
• Format: Article
• Language: English
• Subjects: Baerveldt drainage device; Care and treatment; Diagnosis; Equipment and supplies; Glaucoma; Methods; Original; pars plana vitrectomy; refractory glaucoma; Surgery; Surgical techniques; Transplants & implants; Vitrectomy
• ISSN: 0974-620X; 0974-7842
• DOI: 10.4103/0974-620X.94762

Glaucoma drainage implants (GDIs) are used for managing recalcitrant glaucoma and are usually placed in the anterior chamber. This approach may lead to complications such as corneal decompensation, and so a pars plana approach is used in at risk eyes. To compare functional outcomes and complications of 250 mm(2) and 350 mm(2) pars plana Baerveldt tube insertion with pars plana vitrectomy (PPV) (both 20- and 23-gauge) for managing refractory glaucoma. A retrospective chart review of 38 patients (39 eyes) undergoing combined PPV-Baerveldt procedure for glaucoma recalcitrant to maximal medical treatment or previous filtering procedures with >6 weeks of follow-up. Main outcome measures were visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications. A paired 't' test was used to evaluate changes in IOP and glaucoma medications, Fisher's exact test was used to compare complication rates, and Kaplan-Meier survival curves were constructed for comparison of overall outcomes. Mean patient age was 62.2 years. Mean follow-up period was 33.7 months, with 36 (92%) eyes followed for ≥6 months. Mean±SD preoperative IOP and number of glaucoma medications were significantly reduced by the combined procedure (P