Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma.

Abstract

PURPOSE:

To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C.

MATERIALS AND METHODS:

Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision.

RESULTS:

The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control.

CONCLUSIONS:

Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.

• Authors: Donald L Budenz, Ingrid U Scott, Quang H Nguyen, William Feuer, Kuldev Singh, Marcelo T Nicolela, Michael Bueche, Paul F Palmberg
• Journal: Journal of glaucoma (J Glaucoma) Vol. 11 Issue 5 Pg. 439-45 (Oct 2002) ISSN: 1057-0829 [Print] United States
• PMID: 12362086 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibiotics, Antineoplastic
• Mitomycin

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibiotics, Antineoplastic (therapeutic use)
• Combined Modality Therapy
• Female
• Glaucoma (surgery)
• Glaucoma Drainage Implants
• Humans
• Intraocular Pressure
• Intraoperative Complications
• Male
• Middle Aged
• Mitomycin (therapeutic use)
• Postoperative Complications
• Prosthesis Implantation (methods)
• Retrospective Studies
• Trabeculectomy (methods)
• Treatment Outcome
• Visual Acuity