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AIM: To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). METHODS: We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). RESULTS: Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. CONCLUSION: BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.

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PURPOSE: To compare the efficacy and safety of 2 nonvalved glaucoma drainage devices (GDDs): Ahmed ClearPath (ACP) vs. Baerveldt glaucoma implant (BGI). DESIGN: Single-center, retrospective, comparative study. PARTICIPANTS: Consecutive patients who underwent ACP or BGI surgery for glaucoma (250 mm2 or 350 mm2 models), had ≥ 6 months of follow-up, and no prior GDD implantation. METHODS: Chart review of ACP or BGI surgery in patients with glaucoma at Wills Eye Hospital (2020-2023). MAIN OUTCOME MEASURES: The primary outcome measure was surgical failure at the end of follow-up, defined as intraocular pressure (IOP) > 21 or < 6 mmHg at 2 consecutive visits, progression to no light perception (NLP) vision, glaucoma reoperation, or implant removal. Secondary outcome measures included the rate of postoperative complications and changes in best corrected visual acuity (BCVA), IOP, and glaucoma medications. RESULTS: A total of 128 eyes of 113 patients (63 ACP, 65 BGI) with similar baseline characteristics and a mean follow-up duration of 19.6 ± 10.8 (median 20.5) months were included. Surgical failure occurred in 12 eyes (9.4%) with no significant difference between ACP and BGI eyes (9.5% vs. 9.2%, respectively; P = 0.810). Reasons for failure included IOP > 21 mmHg (3/12, 25.0%), glaucoma reoperation (5/12, 41.7%), and tube removal (4/12, 33.3%). No eyes progressed to NLP vision. Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure in both groups (P = 0.871). Both groups achieved significant IOP and medication reduction compared to their baseline. Final IOP, BCVA, and complication rates were similar in both groups, but medication number was significantly lower in the ACP group (P = 0.012). Both the 250 mm2 and 350 mm2 models had similar outcomes, but diplopia was significantly associated with the 350 mm2 model of either implant (P = 0.012). Univariate logistic regression analysis did not identify either tube type or plate size as predictors of surgical failure. CONCLUSIONS: This study compares the recently approved ACP vs. BGI. Both implants had similar surgical failures and complication rates. Final IOP was similar in both groups, but ACP achieved lower medication number. Diplopia was significantly associated with the use of 350 mm2 model of either implant. Neither tube type nor plate size were significant predictors of surgical failure. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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Purpose: To describe two surgical techniques for removing Baerveldt-350 Glaucoma Implants (BGI-350). Observations and plan: A 91-year-old female with history of bilateral BGI-350s and prior history of tube associated endophthalmitis in the left eye requiring tube removal and resultant phthisis was referred for tube erosion and hypopyon in the right only-seeing eye, and we recommended tube removal. On exam, the left phthisical eye still had a BGI-350 plate attached under the lateral rectus muscle by one anchoring stalk, as it had not been fully removed previously, and the patient recalled severe pain during attempted tube removal in the left eye. We performed concurrent removal of both BGI-350s under general anesthesia. We describe a surgical technique for removing a BGI-350 when the conjunctiva does not need to be spared for future surgery. We also present a second case of BGI-350 removal with a different technique that aims to spare the conjunctiva for future surgery. Conclusions and importance: BGI-350s can develop complications requiring repositioning, revision, or removal. Improper removal of BGI-350s can lead to patient discomfort and future complications. We highlight two different techniques to remove a BGI-350, depending on whether the conjunctiva is intended to be spared for future surgery or not. With either technique, we advocate for general anesthesia and a posterior scleral traction suture to provide patient comfort and optimal exposure of the surgical field.

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PURPOSE: This study aimed to introduce a new technique for lowering intraocular pressure (IOP) using a multi-stent system after the implantation of a Baerveldt glaucoma implant (BGI) and evaluate its clinical effectiveness. STUDY DESIGN: Prospective case series. METHODS: Six patients with uncontrolled refractory glaucoma were enrolled between December 2021 and May 2022. Six 6-0 nylon sutures were preoperatively inserted into the tube of a BGI. These sutures were named "comet stents" (CSs). BGI implantation was performed, and the CSs were removed one-by-one whenever the IOP rose during the follow-up period. IOP was measured 30-60 min after the removal of each CS, and the reduction in IOP was recorded to assess the effect of CS removal. IOP reduction and the effect of CS removal on IOP reduction were evaluated for 6 months. The cut and trimmed stented tubes were examined with scanning electron microscopy, and the ratio of the patent cross-sectional area to the total luminal area (PCSA, %) and the luminal area occupation rate per stent (%) were calculated. RESULTS: The mean (±standard deviation) IOP decreased from 31.5 ± 2.8 mmHg at the baseline to 14.8 ± 8.3 mmHg at 1 month, 8.8 ± 4.7 mmHg at 3 months, and 9.2 ± 3.4 mmHg at 6 months. The IOP reduction induced by CS removal ranged from 0 to 19 mmHg. The mean PCSA was 52.7 ± 1.7%, and the mean luminal area occupation rate per stent was 7.9 ± 0.3%. CONCLUSION: The use of CSs is an effective technique for controlling IOP in a step-by-step manner after BGI surgery.

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PURPOSE: It has been reported that corneal endothelial cells (CEC) decrease faster when the tip of the Baerveldt glaucoma implant (BGI) tube is inserted into the anterior chamber than into the vitreous cavity. We investigated whether surgically relocating the tip of the BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss. PATIENTS AND METHODS: This was a single facility retrospective cohort study. The inclusion criteria were the CEC density less than 1500 cells/mm2 and the CEC reduction ratio was greater than 10%/year. The subjects were 11 consecutive patients that could be followed > 12 months after relocation surgery. All patients were undergone vitrectomy, and the tip of tube was inserted into the vitreous cavity from the anterior chamber. We compared the intraocular pressure (IOP), reduction slope of CEC density and annual reduction rate of CEC density before and after relocation surgery. We calculated the annual reduction ratio in comparison with the preoperative CEC density (%/year). RESULTS: The mean of period between the Baeveldt with anterior chamber insertion surgery and the relocation surgery was 33.8 ± 15.0 months. The mean of follow-up after relocation surgery was 21.8 ± 9.8 months. The relocation surgery did not significantly change IOP (p = 0.974). The mean preoperative and postoperative IOP were 13.1 ± 4.5 and 13.6 ± 4.3 mmHg. The reduction ratio of the CEC density was 15.4 ± 6.7 (%/year) before relocation surgery and significantly slower at 8.3 ± 6.5 (%/year) after relocation surgery (p = 0.024). Two patients resulted in bullous keratopathy after relocation surgery. CONCLUSIONS: Relocating the tip of BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss.

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Glaucoma drainage devices (GDD) are increasingly utilized in the management of childhood glaucoma. This systematic review and meta-analysis assesses the efficacy of first-time Ahmed or Baerveldt implantation in children. PubMed, Embase, and Cochrane Library were searched for relevant English-language, peer-reviewed literature. Postoperative outcomes were pooled using random effects regression models with restricted maximum likelihood estimation. Thirty-two studies (1,221 eyes, 885 children) were included. Mean ± standard deviation preoperative IOP was 31.8 ± 3.4 mm Hg. Pooled mean IOP at 12 and 24 months postoperatively were 16.5 mm Hg (95% CI, 15.5-17.6) and 17.6 mm Hg (95% CI, 16.4-18.7), respectively. Pooled proportions of success were 0.87 (95% CI, 0.83-0.91) at 12 months, 0.77 (95% CI, 0.71-0.83) at 24 months, 0.54 (95% CI, 0.44-0.65) at 48 months, 0.60 (95% CI, 0.48-0.71) at 60 months, and 0.37 (95% CI, 0.32-0.42) at 120 months. There were no differences in proportion of success at 12 and 24 months among eyes that received Ahmed and Baerveldt tube shunts, nor between eyes with primary glaucoma, glaucoma following cataract surgery, or other secondary glaucoma. Our findings show that Ahmed and Baerveldt shunts substantially reduced IOP for at least 24 months in childhood glaucoma, with similar findings among device types and glaucoma etiologies.

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Toxic anterior segment syndrome (TASS) is a rapid-onset inflammation of the eye following uneventful ocular surgery. We report a case of TASS following Baerveldt glaucoma implant (BGI) surgery. Inductively coupled plasma-mass spectrometry (ICP-MS) identified barium in the eye and in the eluate from the bleb of the BGI. We attribute TASS in our patient to the dissolution of barium from the BGI and its entry into the eye, where it causes severe inflammation.

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OBJECTIVE: To compare the surgical outcomes between Baerveldt glaucoma implant (BGI) surgery and trabeculectomy with mitomycin C for patients with neovascular glaucoma (NVG). DESIGN: Retrospective clinical cohort study at 5 clinical centers in Japan. PARTICIPANTS: Patients treated with trabeculectomy or BGI for NVG between April 1, 2012, and December 31, 2019, at 5 clinical centers were recruited. METHODS: The inclusion criteria were age ≥ 20 years and having NVG. The exclusion criteria were eyes with no light perception vision and with previous tube-shunt surgery. If both eyes in the same patient satisfied the inclusion criteria, the eye that was treated first was investigated. We included 100 eyes undergoing BGI surgery and 204 eyes undergoing trabeculectomy. MAIN OUTCOME MEASURES: The primary outcome was surgical success or failure, with failure being defined according to 3 criteria: < 20% reduction of the preoperative intraocular pressure (IOP) or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Cases of reoperation, a loss of light perception vision, or hypotony were also considered failures. RESULTS: The probability of success was significantly higher in patients undergoing BGI surgery than in those receiving trabeculectomy for criteria A (P < 0.01) and B (P = 0.01). Trabeculectomy was significantly associated with surgical failure in the multivariable analysis for criterion A (hazard ratio, 1.70) and criterion B (hazard ratio, 1.50). The overall incidence of postoperative complications was similar between the 2 groups. Reoperations for glaucoma were required significantly more frequently in the trabeculectomy group than in the BGI surgery group (20.1 % vs. 5.0%; P < 0.01). CONCLUSIONS: Baerveldt glaucoma implant surgery had a higher success rate compared with trabeculectomy in patients with NVG for a target IOP < 21 mmHg or < 17 mmHg. The rates of postoperative complications were similar between both surgical procedures. Additional glaucoma surgery was required more frequently after trabeculectomy than after BGI surgery.

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PURPOSE: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. METHODS: A retrospective study was done between April 2016 and April 2018 on patients with ≥12 months of follow-up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. RESULTS: : The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti-glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow-up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan-Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8-33.5%) at 3 months, 18.7% (95% CI; 8.9-37.0%) at 6 months, and 25.0% (95% CI; 13.4-43.8%) at 12 months. CONCLUSION: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti-glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology.

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IMPORTANCE: Few studies have analyzed associations between sociodemographic factors and neovascular glaucoma (NVG) outcomes. AIM AND BACKGROUND: To determine the potential impact of sociodemographic and economic factors on the NVG tube shunt surgery outcomes. DESIGN: Retrospective, single-center, comparative case series. PARTICIPANTS: Consecutive patients who underwent tube shunt surgery for NVG and had ≥6 months of follow-up. MATERIALS AND METHODS: Regional average adjusted gross income (AGI) was determined by cross-referencing self-reported residential zip codes with average AGI per zip code supplied by the Internal Revenue Service. Two groups were created: (1) lower-income: individuals from neighborhoods with the lowest 10% of AGI (near the United States poverty line), (2) higher-income: the remaining 90% of individuals. MAIN OUTCOME MEASURES: Visual acuity (VA), intraocular pressure (IOP), and glaucoma medication number at 6 months and the most recent visit. RESULTS: The mean annual AGI in the higher-income group (130 patients) was $69,596 ± 39,700 and the lower-income group (16 patients) was $27,487 ± 1,600 (p < 0.001). Age, sex, distance to the clinic, language, and all baseline clinical variables (including VA and IOP) were comparable between groups. Lower-income was associated with non-white race (81.3 vs 52.3%; p = 0.024). At month 6, VA in the lower-income group [median: HM (20/70-NLP)] was worse than the higher-income group [median: CF (20/25-NLP)] (log MAR VA: 2.32 ± 0.8 vs 1.77 ± 1.1; p = 0.02); these trends persisted through the most recent visit (p = 0.043). Follow-up IOP and medications were similar between groups. CONCLUSIONS AND RELEVANCE: Lower-income may be associated with worse VA outcomes following NVG tube shunt surgery. HOW TO CITE THIS ARTICLE: Shalaby WS, Arbabi A, Myers JS, et al. Sociodemographic and Economic Factors in Outcomes of Tube Shunts for Neovascular Glaucoma. J Curr Glaucoma Pract 2021;15(2):70-77.

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PURPOSE: To determine the prognostic factors for success 3 years after Baerveldt glaucoma implant (BGI) surgery. STUDY DESIGN: Single-center retrospective clinical study. METHODS: We analyzed 27 eyes (24 patients) treated with BGI surgery between 2012 and 2016 at Osaka University Hospital. Patients were followed for a minimum of 3 years postoperatively. We analyzed the success rates and risk factors. Failure was defined as the need for additional surgery for IOP reduction, loss of light perception, and intraocular pressure (IOP) ≧22 mmHg (definition 1) or ≧17 mmHg (definition 2) at two consecutive follow-up visits. RESULTS: The mean number of previous eye surgeries was 4.1 ± 3.3. The success rates were 81.5% and 77.8%, respectively, 1 year and 3 years after surgery based on definition 1 and 51.9% and 48.2%, respectively, based on definition 2. The early and late surgical complication rates, respectively, were 29.6% and 22.2%. An IOP 2 months after BGI surgery of ≧17 mmHg and the number of previous eye surgeries were significant risk factors for failure based on definition 2. CONCLUSION: The long-term results and complication rates after BGI surgery for refractory glaucoma in our hospital were similar to previous reports, and the IOP 2 months after BGI surgery and the number of previous eye surgeries were associated with the prognosis.

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PURPOSE: The purpose of this study was to evaluate the 3-year surgical outcome of the sulcus fixation of Baerveldt glaucoma implant (BGI), focusing on corneal damage. METHODS: This prospective observational study included 37 patients who underwent a median of two previous glaucoma surgeries and sulcus fixation of BGI for the first time. Each patient's intraocular pressure (IOP), glaucoma drug score, corneal endothelial cell density (ECD), and logMAR-converted best-corrected visual acuity (VA) were measured preoperatively and postoperatively until 36 months after surgery. Complete success was defined as reduced IOP (5-21 mmHg and >20% rate), without corneal damage (postoperative development of decompensation, unmeasurable ECD, or reduction in ECD of >20%), without loss of light perception, and without additional surgery requirement. Qualified success was defined by excluding the corneal criteria from complete success. RESULTS: A total of 51% (19/37) patients experienced complete treatment success, whereas 86% (32/37) had qualified success. The median IOP (glaucoma drug score) decreased from 26 mmHg (5) to 15 mmHg (2) at three years postoperatively. The median postoperative ECD (reduction rate) decreased from 1838 cells/cm2 preoperatively to 1587 cells/mm2 (14%) at one year, 1358 cells/mm2 (26%) at two years, and 1228 cells/mm2 (33%) at three years postoperatively. One month after surgery, the VA was significantly reduced from preoperative values but did not decline after that. CONCLUSION: Sulcus fixation of BGI was effective for IOP reduction. However, ECD decreased over time.

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PURPOSE: To determine the outcomes of Ahmed glaucoma valve (AGV; New World Medical Inc) and Baerveldt glaucoma implant (BGI; Advanced Medical Optics) surgery in the setting of neovascular glaucoma (NVG). DESIGN: Single-center, retrospective study. PARTICIPANTS: Consecutive patients who underwent AGV or BGI surgery for the treatment of NVG and had ≥6 months of follow-up. METHODS: Chart review of AGV and BGI surgical outcomes in patients with NVG. MAIN OUTCOME MEASURES: Progression to no light perception (NLP) vision and 6-month surgical failure, which was defined as intraocular pressure (IOP) >21 mmHg with medications or <5 mmHg at 2 consecutive visits, or glaucoma reoperation. RESULTS: A total of 152 eyes (91 AGV, 61 BGI) were included with an average follow-up of 29.6 ± 25.8 months. Baseline demographics and clinical characteristics were comparable between groups. At month 6, failure was similar between AGV and BGI eyes (21.6% vs. 25.9%; P = 0.552), but glaucoma medication use was lower in BGI eyes (P < 0.001). At the final visit, 18.7% of AGV and 14.8% of BGI eyes progressed to NLP vision (P = 0.530), and medication use was lower in BGI eyes (P < 0.0001). Multivariate analysis identified lower preoperative visual acuity (VA) (P = 0.001), failure to receive panretinal photocoagulation within 2 weeks of surgery (P = 0.003), and bilaterality of the underlying ischemic retinal pathology (P = 0.026) as the strongest predictors of NLP outcome. Age, sex, race, NVG etiology, tube type, preoperative IOP, extent of synechial angle closure preoperatively, preoperative hyphema, IOP at the first NLP visit, and final IOP were not significant predictors of NLP vision. CONCLUSIONS: Eyes with AGV and BGI had comparable outcomes in NVG, although fewer medications were required in BGI eyes to control IOP. Progression to NLP vision was associated with poor baseline VA, delayed retinal treatment, and bilaterality of the underlying ischemic retinal pathology.

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PURPOSE: The Aurolab® aqueous drainage implant is a low-cost alternative to the Baerveldt glaucoma implant. The aim of this study was to test the hypothesis that the two implants are comparable in terms of surgical success and safety. METHODS: We conducted a retrospective case-control study of Aurolab aqueous drainage implant done at our institution from May 2015 and May 2017. Twenty-five consecutive patients who received an Aurolab aqueous drainage implant were matched by age and diagnosis to patients who received a Baerveldt glaucoma implant. Data were collected pre-operative and post-operative visits, including visual acuity and intraocular pressure, number of medications, and complications. Surgical success was defined as intraocular pressure between 5 and 21 mmHg with a minimum 20% reduction from baseline, without loss of light perception or the need for further glaucoma surgery. Cox regression analysis was used to predict factors associated with surgical success. RESULTS: The median (interquartile range, IQR) intraocular pressure at 1 year was 16.0 (8.0) mmHg for the Baerveldt glaucoma implant and 13.0 (8.0) mmHg for the Aurolab aqueous drainage implant, p = 0.38. Success (mean ± SE) at 1 year for the intraocular pressure >21-mmHg failure criterion was 65% ± 15% for the Baerveldt glaucoma implant and 79% ± 11% for the Aurolab aqueous drainage implant (p = 0.80). The frequency of complications listed was similar for the two groups (Fisher's exact p = 0.71). In the Cox regression, the type of implant was not found to be associated with surgical success. CONCLUSIONS: Our preliminary results suggest that the Aurolab aqueous drainage implant is comparable to the Baerveldt glaucoma implant. Further long-term data in a larger population are needed to confirm these findings.

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@#AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant(BGI)surgery produce different outcomes in terms of the reduction of intraocular pressure(IOP). <p>METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery <i>via</i> the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group \〖18 eyes in 16 subjects(13 males, 3 females; mean age 62.9±14.4a)\〗 and the inferonasal insertion group \〖17 eyes in 15 subjects(11 males, 4 females; mean age 56.9±10.7a)\〗. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups.<p>RESULTS: The mean preoperative IOP was 31.1±10.0 mmHg and postoperative IOP was 14.4±4.5 mmHg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mmHg and postoperative IOP was 15.9±3.7 mmHg. The IOP reduction rate of the superotemporal group was(50.0±19.0)% and that of the inferonasal group was(51.2±16.3)%. There was no significant correlation between the two groups(Student's<i> t</i>-test, <i>P</i>=0.590).<p>CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed <i>via</i> the pars plana route.

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Purpose: Delayed hypotony can be a vision threatening complication following aqueous shunt surgery in patients with glaucoma. Multiple medical and surgical management strategies have been utilized, but results have been inconsistent. The present case series describes management of delayed hypotony associated with the Baerveldt glaucoma implant (BGI) by surgically introducing 4-0 polypropylene suture into the tube lumen. Observations: The cases of four patients who presented with hypotony following BGI surgery were reviewed. Following BGI tube lumen occlusion with suture, sustained intraocular pressure increase (mean 7.25 mmHg, range 4-14) was noted in all patients and visual acuity improved in three cases. Conclusions and importance: This is the first report of ab interno suture occlusion of the BGI for management of post-operative hypotony. Further studies are required to determine the utility of this procedure, but our results suggest that in select patients, ab interno suture occlusion be advantageous in managing delayed hypotony refractive to medical therapy.

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PURPOSE: Angle surgery is the gold standard for the management of many types of childhood glaucoma, yet glaucoma drainage devices (GDD) are effective tools for refractory advanced cases or secondary childhood glaucomas. The purpose of this article is to review recently published literature focused on the use of GDDs for pediatric glaucoma, including GDD general principles and surgical outcomes. METHODS: Literature review of various electronic databases was performed. RESULTS: 71 papers were reviewed for outcomes of GDD in childhood glaucomas. Success rates were usually defined by intraocular pressure (IOP) of 5-22 mmHg, with or without medications. Success rates were typically higher for non-valved GDDs but varied by length of follow-up. Non-valved GDDs afford lower and longer-lasting IOP control in pediatric eyes than valved GDD, however, no randomized controlled trials exist in childhood glaucoma. CONCLUSION: Various designs of GDDs are available for management of childhood glaucoma with good short-term success rates; individual patient factors should be taken into consideration when selecting a specific device.

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PURPOSE: To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel. MATERIALS AND METHODS: Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications. RESULTS: Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases. CONCLUSION: We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.

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PURPOSE: To determine the cost (loss of visual function associated with the procedure) and benefit (long-term preservation of the visual field) of glaucoma surgery. METHODS: We included 100 patients who underwent glaucoma surgery (Baerveldt glaucoma implant [BGI], n = 61; trabeculectomy [TE], n = 39). Preoperatively, the median (interquartile range [IQR]) standard automated perimetry mean deviation (MD) was -12 (-16 to -6) dB. We analysed the change in visual acuity (BCVA) and MD due to the procedure and, in a subset with at least 5 years of perimetric follow-up both pre- and postoperatively (n = 20), the change in rate of progression (ROP; time rate of change in MD). For the surgery-induced change in ROP, we also performed a meta-analysis including the current and previously published studies. From the surgery-induced decrease in MD and change in ROP, we calculated the average postoperative duration needed for the benefit to surpass the cost. RESULTS: Mean (standard deviation) MD decline was 1.3 (2.7) and 1.0 (2.3) dB for BGI (p < 0.001) and TE (p = 0.009), respectively; no significant surgery-induced changes in BCVA were found (p = 0.08 and p = 0.12, respectively). In our study, surgery was associated with a non-significant deceleration of ROP (from -0.37 [0.52] to -0.15 [0.48] dB/year; p = 0.23). The meta-analysis, based on eight studies, showed an overall surgery-induced change in ROP of 0.44 (95% confidence interval 0.25 to 0.64; p < 0.0001) dB/year. CONCLUSION: Glaucoma surgery significantly reduces the progression velocity in glaucoma. On average, the benefit of glaucoma surgery surpasses the cost after approximately 1.5 years.

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PURPOSE: The purpose of this study was to evaluate the surgical success of sulcus fixation of Baerveldt glaucoma implant (BGIs) in special reference to corneal damage. METHODS: This observational prospective cohort study included 24 patients who underwent a median of 3.0 previous intraocular surgeries and sulcus fixation of BGIs for the first time. The intraocular pressure (IOP), the number of ocular hypotensives used, corneal endothelial cell density (ECD), and logMAR-converted best-corrected visual acuity (VA) of each patient were measured preoperatively and postoperatively until 12 months after surgery. Surgical success was evaluated after 12 months based on the reduction of IOP (5-21 mmHg and > 20% reduction), corneal damage (postoperative development of decompensation, unmeasurable ECD, or ECD reduction of > 20%), loss of light perception, and need for additional surgeries. RESULTS: Surgical success was noted in 16 (66.7%) patients when corneal damage was included as a failure criterion, whereas surgery was successful in 21 (87.5%) patients when solely judged using IOP control similarly as previous clinical trials. The median IOP decreased from 27.5 mmHg preoperatively to 14.5 mmHg postoperatively (P < 0.0001). The number of ocular hypotensives was significantly reduced postoperatively (P < 0.0001). The median postoperative ECD reduction was only 0.15%, although ECD could not be measured during follow-up or it was significantly reduced by > 20% in six patients. VA was not significantly reduced after surgery. Adverse effects were observed in 15 patients (62.5 cumulative %). CONCLUSION: Sulcus fixation of BGIs may be effective and safe in patients with glaucomatous eyes who underwent multiple prior intraocular surgeries.

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