Comparison of Two Tube-Modification Techniques in Baerveldt Glaucoma Implantation in Refractory Glaucoma

Abstract

Purit Petpiroon,1 Thanyathorn Vijittrakarnrung,1 Wasu Supakontanasan,1 Apichat Tantraworasin,2,3 Yanin Suwan1 1Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Surgery and Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Yanin SuwanDepartment of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandTel [phone]Fax [phone]Email [email protected]: To compare treatment outcomes among a stent group, ligature group and combined group in eyes with refractory glaucoma.Background: Various techniques have been used intra-operatively to restrict the aqueous flow in Baerveldt glaucoma implantation.Design: Retrospective chart review.Participants: All glaucoma patients aged over 18-years old who had Baerveldt implantation in Ramathibodi Hospital, Bangkok, Thailand, between October 2011 and February 2018 were included for analysis.Methods: Retrospective interventional research was conducted. All glaucoma patients who underwent drainage device implantations were retrospectively reviewed from medical records and divided into three groups: stent group, ligature group, and combined group. The primary outcome was post-operative intraocular pressure (IOP) changes and BCVA (logMAR) change. The secondary outcome is treatment failure. Repeated measurements with mixed models and multi-level parametric survival model stratified by propensity score and eye side were used to compare the primary and secondary outcomes between stent group and ligature group.Main Outcome Measures: Treatment failure between two groups.Results: A total of 163 patients with a mean age of 57.11 ± 19.04 years, implanted with Baerveldt tube, were eligible. There were no significant differences between stent and ligature groups in terms of post-operative IOP changes [mean difference with 95% confidence interval = 0.53 (− 0.49, +1.55) vs − 0.02 (− 0.84, +0.81); P = 0.411] and post-operative BCVA (logMAR) change (0.02 (− 0.13, +0.18) vs – 0.05 (− 0.18, +0.07); P = 0.465). The hazard ratio and 95% confidence interval of treatment failure in ligature group were 2.57 (0.72– 9.19) compared with the stent group.Conclusion: This study suggests a trend toward a better result in the stent group compared with the ligature group. Further research with a larger sample size and randomized control trial is warranted.Keywords: glaucoma drainage device, tube shunt, glaucoma surgery, Baerveldt glaucoma implantation

Keywords

• glaucoma drainage device
• tube shunt
• glaucoma surgery
• baerveldt glaucoma implantation