Oman Journal of Ophthalmology (Jan 2012)

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

  • Anton M Kolomeyer,
  • H Jane Kim,
  • Albert S Khouri,
  • Paul J Lama,
  • Robert D Fechtner,
  • Marco A Zarbin,
  • Neelakshi Bhagat

DOI
https://doi.org/10.4103/0974-620X.94762
Journal volume & issue
Vol. 5, no. 1
pp. 19 – 27

Abstract

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Background: 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. Aims: 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. Settings and Design: 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. Materials and Methods: Main outcome measures were visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications. Statistical Analysis Used: 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. Results: 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<0.05). Thirty-five (90%) eyes maintained final IOP between 6 and 21 mmHg. Vision improved by ≥2 lines in 10 (26%) eyes, remained stable in 15 (38%) eyes, and decreased in 14 (36%) eyes. Two (5.1%) eyes developed no light perception vision, with one (2.6%) eye becoming phthisical. Twenty-four (62%) eyes developed complications managed with conservative measures. Five (13%) eyes required ≥1 surgeries within a year of the combined procedure. Conclusions: Pars plana Baerveldt tube implantation with PPV can preserve vision, reduce IOP, and decrease the number of glaucoma medications necessary to achieve target IOP in patients with recalcitrant glaucoma.

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