Long-term outcomes of Baerveldt glaucoma implants with the scleral flap and patch technique and vitreous cavity insertion: a 5-year follow-up.

BACKGROUND

Our earlier report described the scleral flap and patch technique for a Baerveldt glaucoma implant (BGI). In this procedure, the Hoffman elbow is covered not only with a scleral flap (autograft) but also with a grafted sclera from a donor. This technique is expected to be effective in preventing tube erosion. Herein, we investigated the surgical outcomes of this method.

PATIENTS AND

METHODS

This was a single-facility retrospective analysis of 120 consecutive patients (140 eyes) who underwent BGI surgery with the scleral flap and patch technique and were followed or > 1 year. We used two criteria for success concerning the patients' postoperative intraocular pressure (IOP) values: IOP ≤ 21 and IOP ≤ 15 mmHg.

RESULTS

The preoperative IOP was 31.4 ± 9.8 mmHg. BGI surgery significantly decreased the IOP to 11.3 ± 3.6, 11.4 ± 3.9, 12.2 ± 4.4, 12.5 ± 4.2, and 12.2 ± 3.9 mmHg at 1, 2, 3, 4 and 5 years post-surgery (p0.001), respectively. The success rates at 5 years were 83.8% (≤21 mmHg) and 72.1% (≤15 mmHg). There were eight cases in which the patient lost the sense of light. There was no case of tube erosion or hypotony. Bullous keratopathy occurred in three cases. The corneal endothelial cell density (CECD) had changed from 1891 ± 614 to 1882 ± 761 after 5 years (p=0.776).

CONCLUSIONS

BGI surgery with the scleral flap and patch can effectively prevent tube erosion, hypotony, and CECD loss over a long term.