Effectiveness of nonocclusive ligature and fenestration used in Baerveldt aqueous shunts for early postoperative intraocular pressure control.

PURPOSE: The authors determined the effectiveness of two different methods of modification of Baerveldt aqueous shunts in the control of early postoperative intraocular pressure.

METHODS

The authors retrospectively reviewed charts of 122 eyes of 113 patients who underwent a Baerveldt 350-mm(2) modified with tube fenestration and charts of 129 eyes of 122 patients who underwent a Baerveldt 350-mm(2) modified with a nonocclusive ligature to examine early postoperative intraocular pressure control. In the fenestration group, the tube was modified with a 4-0 intraluminal suture and an occlusive 6-0 external polyglactin ligature before ocular placement. After ocular placement, the tube was further modified with one to three perforating fenestrations. In the nonocclusive-ligature group, the tube was modified with a 4-0 nylon intraluminal suture with a nonocclusive 6-0 external polyglactin ligature before ocular placement.

RESULTS

A total of 94 eyes (77%) achieved adequate intraocular pressure control with or without adjunctive medications and. A total of 28 eyes (23%) had postoperative hypertension or hypotony in the fenestration group versus 81 (62.8%) and 48 (37.2%) eyes in the nonocclusive-ligature group (P = 0.014), respectively. The mean change in intraocular pressure preoperatively and 3 months postoperatively was 18.2 mm Hg versus 21.0 mm Hg (P = 0.11) in the fenestration and nonocclusive-ligature groups, respectively.

CONCLUSIONS

Both the nonocclusive ligature and the fenestration methods provide desirable decreases in intraocular pressure in the immediate postoperative period and 3 months postoperatively; however, the fenestration modification may achieve adequate intraocular pressure control more often in the early postoperative period.