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Results of Baerveldt Glaucoma Implants for Severe Refractory Glaucoma
1Marek J., 2Cotter F., 1Oficjalska-Mlynczak J.,
1Department of Ophthalmology and Eye Clinic, Wroclaw Medical University (Wroclaw)
2 (Roanoke)
Artificial drainage devices are therapeutic option for refractory glaucoma, especially when conventional surgery with antyfibrotic agents has failed. The purpose is presentation of our results of ten Baerveldt dranaige devices implanted with temporary occlusion and ligation technique.
Method: Implantation procedure was performed in secondary glaucoma with IOP 35-55 mmHg in 3 eyes after chemical burns, treated previously by penetrating keratoplasty and limbal autograft, in 2 aphakic eyes with posttraumatic aniridia, in 2 eyes with congenital glaucoma, in 2 eyes with uveitis and in 1 eye with diabetic neovascular glaucoma. Follow-up time was over 12 months.
Results: Opening of the Baerveldt implant after 4-6 weeks resulted in permanent decrease of IOP beneath 21 mmHg without any medication in 5 eyes. In other 5 eyes additional therapy with Timolol allowed proper control of IOP. The complications were noticed in two eyes with posttraumatic aniridia. Both of them were ineffectivly treated previously by cyclocryotherapy. In one eye appeared signs of pars planitis, that resolved after topical steroid therapy. In second eye, with cerclage for retinal detachment, appeared cystoid macular edema. In one eye with neovascular glaucoma 6 months after implantation, the tube of drenaige device dislocated out of anterior chamber. This tube was successfully implanted again in proper position. We did not observe postoperative hypotony or flat anterior chamber in any case.
Conclusions: Baervedt Glaucoma Implants are valuable method to decrease intraocular pressure in refractory glaucoma. The ligation and temporary occlusion technique prevents postoperative hypotony and minimizes risk of chorioidal hemorrhage. In eyes after chemical burns, Baerveldt Glaucoma Implant could be prefered as primary surgical treatment. Cyclocryotherapy, performed before implantation of drainage device, causes more postoperative complications.