Baerveldt Glaucoma Drainage Device Research Articles

Ahmed to Baerveldt glaucoma drainage device exchange in pediatric patients

BackgroundThere is no consensus and few reports as to the surgical management of encapsulated Ahmed glaucoma drainage devices (GDD) which no longer control intraocular pressure (IOP), especially within the pediatric population. The purpose of this study was to report outcomes of exchanging the Ahmed GDD for a Baerveldt GDD in children with refractory glaucoma.MethodsRetrospective review of children (< 18yrs) who underwent removal of Ahmed FP7 and placement of Baerveldt 350 (2016–2021) with ≥ 3-month follow-up. Surgical success was defined as IOP 5–20 mmHg without additional IOP-lowering surgeries or visually devastating complications. Outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications.ResultsTwelve eyes of 10 patients underwent superotemporal Ahmed FP7 to Baerveldt 350 GDD exchange at 8.8 ± 3.6 years. Time to Ahmed failure was 2.7 ± 1.9 years with 1-, 3-, and 5-year survival rates of 83% with a 95% CI[48,95], 33% with a 95% CI[10, 59], and 8% with a 95% CI[0, 30]. At final follow-up (2.5 ± 1.8 years), success rate for Baerveldt 350 GDDs was 75% (9 of 12 eyes) with 1 and 3-yr survival rates of 100% and 71% with 95% CI[25,92], respectively. IOP (24.1 ± 2.9 vs. 14.9 ± 3.1 mmHg) and number of glaucoma medications (3.7 ± 0.7 vs. 2.7 ± 1.1) were significantly decreased (p < 0.004). BCVA remained stable. Two eyes required cycloablation and 1 eye developed a retinal detachment.ConclusionsAhmed removal with Baerveldt placement can improve IOP control with fewer medications in cases of refractory pediatric glaucoma. However, more eyes with greater follow-up are required to determine long-term outcomes.

Risk factors for Baerveldt glaucoma drainage implantation for uveitic glaucoma

Uveitic glaucoma (UG) is sometimes intractable, including intricate interaction between intraocular pressure (IOP) elevation associated with inflammation and side effects of steroids. Based on the Tube Versus Trabeculectomy study in refractory glaucoma results in 2012, tube shunt surgeries have been performed for UG, but few reports have focused on UG. We retrospectively examined the surgical efficacy, complications, and risk factors in 62 eyes with UG that underwent Baerveldt glaucoma drainage device (BGD) implantation at Kumamoto University. The IOPs significantly dropped, and the mean number of glaucoma medications was reduced by more than two. Kaplan‒Meier survival curves were presented under 2 conditions: an IOP reduction of 20% and 6 ≤ IOP ≤ 18 mmHg (criterion A) or 6 ≤ IOP ≤ 15 mmHg (criterion B). In criterion A, the median survival times (MST) were 124 days (complete) and 997 days (qualified). In criterion B, the MST was 129 days (complete) and 867 days (qualified). The Cox hazard proportional model found that the hazard ratio was 0.170 for a history of cataract surgery (95% CI 0.0303–0.950) and 8.669 for systemic immunosuppressive therapy (95% CI 1.810–41.51). BGD implantation is effective for treating UG, but the presence of systemic treatment and the lens status should be considered.

The long-term postoperative effect of the Baerveldt glaucoma drainage device and of a trabeculectomy on the corneal endothelium.

To determine whether the postoperative corneal endothelial cell density (ECD) differs between glaucoma patients who underwent Baerveldt implant (BGI) surgery and patients who underwent a trabeculectomy (TE) over 5 years ago. Cross-sectional, observational study including 34 patients who underwent TE and 36 patients who underwent BGI surgery 5-11 years ago, as part of a randomized clinical trial. None of the patients had a history of intraocular surgery prior to their glaucoma surgery. Central and peripheral ECD was measured by using a non-contact specular microscope. Central and peripheral ECD in the TE group was 2285 ± 371 cells/mm2 (mean ± SD) and 2463 ± 476 cells/mm2 , respectively. Central and peripheral ECD in the BGI group was 1813 ± 745 cells/mm2 and 1876 ± 764 cells/mm2 , respectively. The central and peripheral ECD was statistically significantly higher in the TE group than in the BGI group (p = 0.001 for both). Additional intraocular surgical interventions were more prevalent in the BGI group (23) than in the TE group (5) (p < 0.001). In a subanalysis, without eyes that had undergone additional surgical interventions, only the peripheral ECD was statistically significantly higher in the TE group compared with the BGI group (p = 0.011). For the BGI group, a longer postoperative period resulted in a lower central ECD (r = -0.614, p = 0.004). Long-term ECD in eyes that underwent a BGI was considerably lower compared with eyes that underwent a TE, mainly in the peripheral cornea. This suggests that BGI causes a larger decrease of ECD than TE. Additionally, the decrease after BGI appears to continue for a longer period than after TE.

Ocular motility disturbances after glaucoma drainage device implantation for paediatric glaucoma: a cross-sectional study

AimTo grade extraocular motility in the field of action of each extraocular muscle following superotemporal glaucoma drainage device (GDD) implantation in a paediatric population and to investigate which drainage device...

&lt;p&gt;The Baerveldt Glaucoma Drainage Device: Efficacy, Safety, and Place in Therapy&lt;/p&gt;

ObjectiveThis review summarizes published findings concerning the Baerveldt-350 glaucoma drainage device (GDD). Most studies focus on the comparison between different treatments; in this review, the primary focus is efficacy, safety, and place in therapy for the Baerveldt implant.MethodsA systematic review was performed using the PubMed database for literature on March 13th, 2020. Efficacy was estimated by performing multiple meta-analyses to calculate the weighted mean difference in intraocular pressure (IOP) and IOP-lowering medication after surgery. In order to get an indication of the safety of the Baerveldt implant, all recorded peri- and postoperative complication were summarized.ResultsA total of 21 studies, including 12 randomized controlled trials, were included with a follow-up up to 5 years, covering a mix of glaucoma types. At the last follow-up point, at 5 years postoperative, the mean (95% confidence interval) reduction in IOP was 15.57 mmHg (14.43–16.71) and the mean (95% confidence interval) reduction in IOP-lowering medication after surgery was 1.81 (1.61–2.01). Most frequently observed postoperative complications were corneal edema (2–34%) and tube complications (4–33%). Rates of required re-intervention ranged from 0% to 51% across all included studies.ConclusionThe efficacy of the Baerveldt implant is a significant reduction in IOP in the long term. The safety profile of the Baerveldt implant in terms of complication incidence is similar to those reported for other GDD's. For treatment of secondary glaucoma, we suggest the Baerveldt (or any other similar GDD) as the choice of treatment in patients where highest IOP reduction is desired.

Quiescent Neovascular Age-Related Macular Degeneration After Endophthalmitis.

This article describes eyes that achieved extended remission of neovascular age-related macular degeneration (NVAMD) following acute endophthalmitis. Adults who presented to the Duke Eye Center with acute endophthalmitis over a 9-year period and had at least 3 months of follow-up were identified. A retrospective review of medical records was performed to collect clinical data including demographic information, examination findings, etiology, treatment, and outcomes. A total of 133 eyes of 130 patients with endophthalmitis were identified. Of these, 15 eyes of 14 patients (11.3%) were receiving intravitreal antivascular endothelial growth factor (anti-VEGF) injections for NVAMD. Six of these 15 eyes (40%) did not require an anti-VEGF injection after endophthalmitis for a mean of 36.2 months. Endophthalmitis was injection-related in 5 of 6 eyes (83%) and Baerveldt glaucoma drainage device-related in 1 of 6 eyes (17%). Two of the 6 (33%) had culture-proven infectious endophthalmitis, whereas 4 of 6 (67%) had culture-negative endophthalmitis. Five of 6 eyes have required no anti-VEGF therapy to date; the remaining eye restarted intravitreal aflibercept therapy 9.3 months after endophthalmitis. Acute endophthalmitis may be associated with reduced activity of choroidal neovascularization in a subset of eyes with NVAMD.

Outcomes of the Shunt Tube Exposure Prevention Study: A Randomized Clinical Trial

To compare the long-term safety and efficacy of amniotic membrane-umbilical cord (AM-UC) and pericardium patch grafts in reducing glaucoma shunt tube exposure. Multicenter, prospective, randomized clinical trial. Adults with uncontrolled glaucoma undergoing glaucoma drainage device (GDD) implantation. Patients were randomized to receive GDD with either AM-UC or pericardium patch grafts to cover GDD tubes. Patients were followed up clinically with anterior segment (AS) OCT to assess patch graft stability and host-tissue integration prospectively. Tube exposure, graft thinning, and graft-related complications. A total of 81 eyes of 81 patients (50 women, 31 men) with a mean age of 67±13 years underwent GGD implantation using Baerveldt (n= 72) or Ahmed valve (n= 9). Tubes were inserted in the anterior chamber (n= 71), sulcus (n= 6), or pars plana (n= 4). Tube ligation was performed with Baerveldt GDD along with fenestration (n= 51) or orphan trabeculectomy (n= 21). Tubes were covered with AM-UC (n= 41) or pericardium (n= 40). The mean follow-up time was 29±8 months (range, 13-40 months). Tube exposure occurred in 1 eye (2%) in the AM-UC group at 3 months and in 2 eyes (5%) in the pericardium group at 2 and 6 months (P= 0.54). Sequential AS OCT showed better host-tissue integration and significantly less graft thinning in the AM-UC group. Early graft thinning (≤3 months) occurred in 5 eyes (12%) in the AM-UC group and in 17 eyes (43%) in the pericardium group (P= 0.002). Late thinning occurred in 2 eyes (5%) and 11 eyes (28%) in the AM-UC and pericardium groups, respectively (P= 0.007). Graft translucency and cosmetic appearance of the AM-UC graft were superior to those of the pericardium graft. No evidence of graft rejection or infection was associated with the patch grafts in either group. Amniotic membrane-umbilical cord grafts are well tolerated and offer an alternative to pericardium for safe and stable tube shunt coverage. Its high-tensile strength, low immunogenicity, and excellent host-tissue integration significantly reduced graft thinning.

Primary Baerveldt versus trabeculectomy study after one-year follow-up.

To compare a Baerveldt implant and trabeculectomy with respect to intraocular pressure (IOP) and failure rate at 1year of follow-up. Secondary outcomes are pharmacological therapy and complications at 1year of follow-up. This was a randomized, comparative study. A total of 119 glaucoma patients without previous ocular surgery were included at the Rotterdam Eye Hospital, the Netherlands. One eye of each subject was randomized to either a Baerveldt glaucoma drainage device (BGI) or trabeculectomy (TE). Follow-up visits were conducted at 1day, 2weeks, 6weeks, 3months, 6months and 1year after surgery. After one year, the final IOP was equivalent for both treatment groups: 14±4mmHg (mean ± SD) for the Baerveldt group versus 13±4mmHg for the trabeculectomy group. Statistically, we found no significant difference in failure rate between the two groups. However, the Baerveldt group needed significantly more medication to decrease IOP. Overall, self-limiting complication rate was similar in both groups. Diplopia, a serious complication, was significantly more present in the BGI group. One year after surgery, TE shows better results than the BGI. The final IOP, IOP reduction and failure rate are similar, but the need for additional IOP lowering medication in the BGI group is higher as well as the complication rate. The increased risk of developing diplopia after placement of a BGI must be taken into consideration.

Double Layer of Processed Dry Amniotic Membrane for an Exposed Glaucoma Drainage Device Tube

To present a case of the use of a double layer of processed dry amniotic membrane to cover an exposed Baerveldt Glaucoma Drainage Device (GDD) tube where no more autologous conjunctiva was available for harvesting.

Baerveldt 250 mm2 Glaucoma Drainage Devices in Eyes With Preexisting Scleral Buckles.

To evaluate eyes with preexisting scleral buckles (SBs) that underwent placement of a 250 mm Baerveldt glaucoma drainage device (GDD). Records of all patients with a preexisting SB who underwent 250 mm Baerveldt GDD placement at the Kellogg Eye Center between January 1, 2005 and September 30, 2012 were reviewed. Outcome measures included visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications prescribed. Seventeen eyes of 17 patients were analyzed. Mean follow-up was 23.9 months. Twelve eyes (70.6%) achieved successful control of IOP (<22 mm Hg, not requiring additional IOP reduction procedures, and no devastating complications). Preoperatively, mean IOP was 25.5 mm Hg, mean number of glaucoma medications was 3.5, and mean logMAR VA was 1.1 (Snellen equivalent 20/200). At 1 and 2 years postoperatively, mean IOP was 9.2 and 8.8 mm Hg (P<0.001), and mean number of glaucoma medications was 0.9 and 0.3 (P<0.001), respectively. There were no statistically significant changes in logMAR VA at 1 and 2 years postoperatively (P=0.45 and 0.99, respectively). Complications included conjunctival dehiscence (4 eyes, 24%), wound leak (2 eyes, 12%), tube and plate exposure requiring removal of drainage device (2 eyes, 12%), phthisis (2 eyes, 12%), and hemorrhagic choroidal detachment (1 eye, 6%). In eyes with preexisting SBs, the Baerveldt 250 mm GDD effectively lowers IOP and reduces the number of glaucoma medications. Complications related to conjunctival dehiscence are not uncommon in these eyes with significantly scarred conjunctiva.

Retrospective Review of Pars Plana Versus Anterior Chamber Placement of Baerveldt Glaucoma Drainage Device

To evaluate outcomes of pars plana (PP) versus anterior chamber (AC) placement of Baerveldt glaucoma drainage device (GDD). This study is a nonrandomized, retrospective case series evaluating 63 eyes that underwent GDD insertion with Baerveldt 350 device under the supervision of 2 surgeons at 5 centers. The drainage tube was either inserted into the AC or through the PP into the vitreous cavity where eyes had been vitrectomized. Surgery was conducted between 2003 and 2010 with minimum patient follow-up of 6 months. Data on postoperative intraocular pressure (IOP), visual acuity, number of hypotensive medications, and surgical complications were recorded. Of the 63 drainage device surgeries, 34 tubes were placed in the AC and 29 were placed into the posterior segment through the PP. Preoperative mean IOP was 32.3±20.3 mm Hg in the AC group and 32.8±18.4 mm Hg in the PP group. Postoperative mean IOP was reduced at all follow-up time points in both the groups. Postoperative mean IOP in the anterior tube group was 14.0, 12.9, and 14.0 mm Hg and in the PP group was 14.2, 14.2, and 14.0 mm Hg, at the 1-, 2-, and 3-year follow-up, respectively. The qualified success rate at 2 years was 94% for the PP group and 91% for the AC group, whereas absolute success was 35% for the PP group and 27% for the AC group at 2-year follow-up. Insertion of the tube of the Baerveldt GDD into the PP is a safe and effective method for IOP control in aphakic, pseudophakic, and vitrectomized eyes where there is a need to avoid anterior tube placement such as coexisting corneal pathology. IOP control results appear comparable to conventional AC placement.

Infected Baerveldt Glaucoma Drainage Device by Aspergillus niger.

Fungal endophthalmitis is rare but may complicate glaucoma drainage device surgery. Management is challenging as the symptoms and signs may be subtle at initial presentation and the visual prognosis is usually poor due to its resistant nature to treatment. At present there is lesser experience with intravitreal injection of voriconazole as compared to Amphotericin B. We present a case of successfully treated Aspergillus endophthalmitis following Baerveldt glaucoma drainage device implantation with intravitreal and topical voriconazole.

Surgical Outcomes of Superior Versus Inferior Glaucoma Drainage Device Implantation

To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus. A retrospective chart review was conducted to identify patients with glaucoma who had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes of patients had a minimum of 6 months of postoperative follow-up. These eyes were frequency-matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus, within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of antiglaucoma medications were extracted. Failure was defined as IOP>21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student t tests, χ test, and Kaplan-Meier time to failure analysis. Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2±15.2 mo for inferior and 23.9±10.43 mo for superior, P=0.54). Trabeculectomy had been performed previously in 8/17 (47%) and 11/33 (33%) eyes (P=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mm Hg) in the superior group (26±11) was significantly higher (P=0.02) when compared with the inferior group (21±7). Success rates were similar (P>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2 years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (P=0.20, log-rank test). The mean postoperative IOP and number of antiglaucoma medications were similar (all P>0.05) in both groups during the first 2 years of postoperative follow-up. The frequency and types of postoperative complications in both the groups were similar. The 36-month cumulative reoperation rates for IOP control were 33.8% and 9.1%, respectively, in the inferior and superior GDD groups (P=0.04 log-rank test). No differences were observed in the overall success rates of initial GDD implantation performed at the superior and inferior limbus in this cohort. However, inferior GDD implantation was associated with a greater incidence of reoperation for IOP control.

Improvised 3-0 Polypropylene Plug for the Glaucoma Drainage Tube During Phacoemulsification

Overfiltration through a preexisting glaucoma drainage tube can make subsequent phacoemulsification surgery more challenging due to a dangerously shallow anterior chamber. The author improvised a 3-0 polypropylene plug to occlude the implant tube during phacoemulsification in two patients with uveitic glaucoma and a prior Baerveldt glaucoma drainage device. The improvised plug safely and effectively maintained the anterior chamber during phacoemulsification. A 3-0 polypropylene suture can be tied, trimmed, and inserted into a glaucoma drainage implant tube, in select cases, to maintain the anterior chamber during cataract surgery.

Transcorneal tube extrusion in a child with a Baerveldt glaucoma drainage device

We describe a clinical scenario in which a child was treated for glaucoma and aqueous misdirection with surgical placement of a tube shunt. The child then suffered extrusion of the tube through the cornea, a rare complication of such procedures. This complication has only been seen in children, and thus, young patients with tube shunts need careful and frequent monitoring, especially during the first year of the post tube shunt period to ensure that they have not developed this complication.

Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma

Objective To evaluate the efficacy and safety of Baerveldt glaucoma drainage devices in the management of uveitic glaucoma. Design Retrospective, noncomparative case series. Participants Twenty-four eyes of 24 patients who underwent implantation of Baerveldt glaucoma drainage devices between 1996 and 2000 for the treatment of uveitic glaucoma refractory to medical therapy. Intervention Implantation of Baerveldt glaucoma drainage device. Main outcome measures Control of intraocular pressure (IOP), number of glaucoma medications needed for adequate IOP control, visual acuity, complications associated with the surgery, and the effect of subsequent surgery on the ability of the device to control IOP. Success was defined as IOP ≥5 and ≤21 mmHg with or without antiglaucoma medications and without need for further glaucoma surgery, loss of light perception, or phthisis. Results Cumulative life-table success rates were 95.8% at 3 months and 91.7% at 6 months, 12 months, and 24 months. The mean postoperative follow-up was 20.8 months. The IOP was reduced from a preoperative mean of 30.5 ± 8.96 mmHg with 3.1 ± 0.99 antiglaucoma medications to a postoperative mean at 6 months or 1 year of 13.0 ± 4.6 mmHg ( P < 0.001) with 0.8 ± 0.8 antiglaucoma medications ( P < 0.001). At last follow-up 14 of 24 eyes (58.3%) required no antiglaucoma medications. Best-corrected visual acuity improved or remained within 2 lines of preoperative visual acuity in 19 (79.2%) eyes. The most common complications were choroidal effusions in four (16.7%), hypotony in three (12.5%) eyes, cystoid macular edema in three (12.5%) eyes, and failure of corneal grafts in two (8.3%). Seven of 22 eyes (31.8%) in which successful control of IOP with the Baerveldt implant was achieved underwent subsequent nonglaucoma-related incisional surgery. None of these eyes (0%) lost IOP control after the subsequent procedure. Conclusions The Baerveldt glaucoma drainage device offers reasonable safety and effectiveness for the control of IOP in eyes with uveitis and refractory glaucoma.