ABSTRACT.Purpose: To examine the effectiveness and safety of Baerveldt glaucoma implants in eyes with refractory glaucoma following vitrectomy. Methods: We performed a retrospective study of a non-comparative case series of 30 eyes of 30 patients who had undergone the implantation of a Baerveldt glaucoma device. All eyes (30 ⁄ 30) had a minimum follow-up of 6 months, and 16 ⁄ 30 (53%) had a follow-up of 24 months. Surgical success was defined as intraocular pressure (IOP) < 22 mmHg on the last two follow-up visits with or without glaucoma medication and a decrease in IOP of at least 20% compared to preoperative values with or without glaucoma medication. Results: The mean IOP before implantation of a Baerveldt glaucoma device was 30 mmHg [± 11.4 mmHg standard deviation (SD)] with maximally tolerated medical therapy. Six months after implantation of the Baerveldt glaucoma device, the mean IOP was 17.3 mmHg (± 6.7 mmHg SD) and the mean number of glaucoma medications had gone down from 3.0 (± 0.4 SD) to 0.3 (± 0.3 SD). Successful outcomes were found in 24 eyes (80%). Small complications occurred in six eyes (20%): transient postoperative hypotony (17%) and tube retraction (3%). Larger complications occurred in another six eyes (20%): corneal decompensation requiring keratoplasty (7%), suprachoroidal haemorrhage (3%) and persistently high IOP (10%). Conclusion: Baerveldt glaucoma devices are a valid treatment option in eyes with refractory glaucoma after vitreous surgery, although failure occurred in 20% of our patients. Transient complications occurred in 20% and severe complications in another 20%.

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Medical personnel are entitled to protection in armed conflicts under international law. However, that protection will be lost unless such personnel strictly comply with the requirements set out in the relevant conventions. The authors examine the protection regime available to medical personnel including the regime applicable to hospital ships and medical aircraft. The authors argue that any permanent military medical personnel who engage in hostile acts without being correctly reassigned permanently from their medical role could be liable for their conduct under the criminal law because they do not possess combatant immunity. The difficulty in reassigning personnel from medical to non-medical roles and vice versa is examined against the background of the concept of civilians directly participating in hostilities. The authors examine the interpretive guidance issued by the International Committee of the Red Cross and the significant criticism of that guidance.

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