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

Donald L. Budenz, Ingrid Scott, Quang H. Nguyen, William Feuer, Kuldev Singh, Marcelo T. Nicolela, Michael Bueche, Paul F. Palmberg

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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 (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 1-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 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 (P = 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.

Original languageEnglish (US)
Pages (from-to)439-445
Number of pages7
JournalJournal of Glaucoma
Volume11
Issue number5
DOIs
StatePublished - Jan 1 2002

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Glaucoma Drainage Implants
Trabeculectomy
Mitomycin
Glaucoma
Intraocular Pressure
Polypropylenes
Reoperation
Sutures
Visual Acuity
Eye Hemorrhage
Kaplan-Meier Estimate
Survival Analysis
Postoperative Period
Medical Records
Lasers

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Budenz, Donald L. ; Scott, Ingrid ; Nguyen, Quang H. ; Feuer, William ; Singh, Kuldev ; Nicolela, Marcelo T. ; Bueche, Michael ; Palmberg, Paul F. / Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma. In: Journal of Glaucoma. 2002 ; Vol. 11, No. 5. pp. 439-445.
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title = "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 (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 1-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 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 (P = 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.",
author = "Budenz, {Donald L.} and Ingrid Scott and Nguyen, {Quang H.} and William Feuer and Kuldev Singh and Nicolela, {Marcelo T.} and Michael Bueche and Palmberg, {Paul F.}",
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Budenz, DL, Scott, I, Nguyen, QH, Feuer, W, Singh, K, Nicolela, MT, Bueche, M & Palmberg, PF 2002, 'Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma', Journal of Glaucoma, vol. 11, no. 5, pp. 439-445. https://doi.org/10.1097/00061198-200210000-00013

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma. / Budenz, Donald L.; Scott, Ingrid; Nguyen, Quang H.; Feuer, William; Singh, Kuldev; Nicolela, Marcelo T.; Bueche, Michael; Palmberg, Paul F.

In: Journal of Glaucoma, Vol. 11, No. 5, 01.01.2002, p. 439-445.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma

AU - Budenz, Donald L.

AU - Scott, Ingrid

AU - Nguyen, Quang H.

AU - Feuer, William

AU - Singh, Kuldev

AU - Nicolela, Marcelo T.

AU - Bueche, Michael

AU - Palmberg, Paul F.

PY - 2002/1/1

Y1 - 2002/1/1

N2 - 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 (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 1-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 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 (P = 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.

AB - 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 (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 1-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 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 (P = 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.

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