Internal Glaucoma Drainage Device Tube Fenestration for Uncontrolled Postoperative Intraocular Pressure

Campbell, Robert J.; Buys, Yvonne M.; McIlraith, Ian; Trope, Graham E.

doi:10.1097/ijg.0b013e318162251a

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…[23] Despite this, a postoperative hypertensive spike may develop secondary to obstruction of the fenestration, slit malfunction, or an insufficient number of fenestrations. [9,28] It is hard to titrate the function of these fenestrations and they are hardly reproducible. Intraoperative techniques such as irrigating the tube after fenestration, cautery of the bleeding episcleral vessels, and removing the debris from the field of surgery are proposed to improve the outcomes of fenestrations but it is still unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Esfandiari

Hassanpour

Knowlton

et al. 2020

JOVR

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Purpose: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. Method: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668). Conclusion: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

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Section: Discussionmentioning

confidence: 99%

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Esfandiari

Hassanpour

Knowlton

et al. 2020

JOVR

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“…Therefore, tube ligation is mostly carried out in conjunction with intraoperative longitudinally oriented 2 mm fenestrations proximal to the ligation [22]. Despite this, a postoperative hypertensive spike may develop secondary to fibrotic growth around the fenestration, malfunction of the slit valves, or insufficient fenestrations [8,27]. Considering the limitations of fenestration, we proposed to perform trabectome surgery in the same session to prevent postoperative IOP spikes.…”

Section: Discussionmentioning

confidence: 99%

Coarsened Exact Matching of Trabectome Surgery Combined with Baerveldt to Baerveldt: Same Session Trabectome Negates Tube Fenestration

Esfandiari¹,

Hassanpour²,

Knowlton³

et al. 2018

Preprint

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Purpose: To evaluate the efficacy and survival rates of trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implants (BT) in comparison to Baerveldt glaucoma implant alone (B).Method: A total of 175 eyes undergoing primary glaucoma surgery (60 eyes BT and 115 B) were enrolled in this retrospective comparative case series. Participants were identified using the procedural terminology codes. Groups were then matched using Coarsened Exact Matching (51 eyes in each group). The primary outcome measure was surgical success, defined as 5 mmHg < IOP ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no reoperation for glaucoma. Secondary outcome measures were intraocular pressure, the number of glaucoma medications, and best corrected visual acuity (BCVA).Results: The cumulative probability of success at one year was 61% in BT, and 50% in B. IOP decreased significantly from 23.5±2.4 mmHg at baseline to 14.1±2.7 mmHg at the final follow up in BT (P= 0.001). The corresponding numbers for B were 23.2± 2.0 and 13.9± 1.6, respectively (P= 0.001). There was no significant difference in IOP at the final follow-up (P=0.56). The number of medications at baseline was 2.3±0.3 in both groups. However, BT needed significantly fewer drops at all postoperative time intervals and used 1.1±0.3 (BT) and 2.0±0.4 eye drops (B) at the final follow-up visit (P= 0.004). No dangerous hypotony or hypertension occurred in BT.Conclusion: Similar rates of success and IOP reduction were observed in BT and B. BT needed significantly fewer glaucoma medications. Tube fenestration was not necessary in BT resulting in less postoperative hypotony and hypertension.

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The Effect of Suture Wick Technique on Early Intraocular Pressure Control After Nonvalved (Baerveldt 350) Glaucoma Drainage Device Surgery

Rothman

Herndon

2018

Journal of Glaucoma

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Internal Glaucoma Drainage Device Tube Fenestration for Uncontrolled Postoperative Intraocular Pressure

Abstract: Transanterior chamber internal GDD tube fenestration is a novel, straightforward approach to early IOP control after GDD implantation. This procedure adds to our armamentarium of methods for controlling IOP during the early postoperative period.

Cited by 3 publications

References 8 publications

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Coarsened Exact Matching of Trabectome Surgery Combined with Baerveldt to Baerveldt: Same Session Trabectome Negates Tube Fenestration

The Effect of Suture Wick Technique on Early Intraocular Pressure Control After Nonvalved (Baerveldt 350) Glaucoma Drainage Device Surgery

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