Esfandiari, Hamed and Hassanpour, Kiana and Knowlton, Peter and Shazly, Tarek and Mehdi, Yaseri and Loewen, Nils A.
(2017)
Trabectome Surgery Combined with Baerveldt Glaucoma Implantation Negates Tube Fenestration.
(Submitted)
Abstract
Purpose: To evaluate the efficacy and survival rates of the same session ab interno trabeculectomy with trabectome and Baerveldt glaucoma implant (BT) compared to Baerveldt implant alone (B).
Method: A total of 175 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 60 eyes which underwent BT and 115 eyes which received B alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was surgical success defined as 5 mmHg > IOP ≤ 21 mmHg and IOP reduction ≥ 20% from baseline, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures were intraocular pressure, the number of glaucoma medications, and best corrected visual acuity (BCVA).
Results: The cumulative probability of success at 1 year was 61% in BT, and 50% in B. IOP decreased significantly from 23.6±8.9 mmHg at baseline to 13.7±3.9 mmHg at the final follow up in BT (P= 0.001). The corresponding numbers for B were 23.3±7.5 and 14.2±4.5, 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 comparable in both groups (2.1±1.1 in BT versus 2.4±1 in B, p=0.07). However, BT needed statistically significant fewer drops in all postoperative time intervals and used 0.9±0.9 (BT) and 1.6±1.2 eyedrops (B) at the final follow-up visit (P= 0.004). No dangerous hypertony or hypertension occurred in BT.
Conclusion: Similar rates of success and IOP reduction were observed in BT and B. Eyes who underwent trabectome surgery needed significantly fewer glaucoma medications during 1-year follow-up period while tubes did not require fenestration resulting in fewer postoperative hypotony or hypertension.
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