Baerveldt glaucoma implants in the management of refractory glaucoma after vitreous surgery

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%.