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Abstract #8052 Published in IGR 4-3
Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma
Budenz DL; Scott IU; Nguyen QH; Feuer WJ; Singh K; Nicolela MT; Bueche M; Palmberg PFJournal of Glaucoma 2002; 11: 439-445
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 mmHg, 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 mmHg at one year of follow-up and 11.9 ± 5.5 mmHg at the last follow-up visit (p < 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 the one-year follow-up and 0.6 ± 0.8 at the last follow-up visit (p < 0.001). LogMar visual acuity remained stable at mean of 1.15 ± 0.85 preoperatively, compared with 1.14 ± 1.05 at the one-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 (p = 0.004). Cumulative success was 91% at one year, 86% at two years, and 81% at three years. 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.
D.L. Budenz, MD, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA. dbudenz@med.miami.edu
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)