Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM:To report the outcome of Baerveldt glaucoma implant(BGI)with Supramid©ripcord use in neovascular glaucoma(NVG).METHODS:We retrospectively evaluated the surgical outcome of the BGI with Supramid©3/0 ripcord stent in patients with NVG.No tube ligation or venting slits were performed.Supramid was removed after 3mo if the target intraocular pressure(IOP)was not achieved.Surgical success was defined as IOP≤21 mm Hg with(qualified success)or without IOP-lowering medications(complete success).RESULTS:Twenty-six eyes from 24 patients were included in the study.The median duration of follow-up was 4[interquartile range(IQR)=1-5]y,ranging from 0.5 to 5y.IOP decreased by a mean of 24.2 mm Hg(59.7%);from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg,P≤0.001.The number of glaucoma medications reduced from a median of 5(IQR=5-6)to 1(IQR=0-2,P≤0.001)at the final follow-up.Overall success rates were 88.0%at 1y,34.8%at 3y,66.7%at 4y,and 50%at 5y.Hypertensive phase(HP)in the first 3mo occurred in 15/26 eyes(57.7%)with a mean IOP of 31.1 mm Hg.CONCLUSION:BGI with Supramid©ripcord stent gives close to 90%of the overall survival rate at the final follow-up without significant early hypotony.However,early HP is still a challenge.

Review of the Ahmed versus Baerveldt study-5-year treatment outcomes

The results from the tube versus trabeculectomy(TVT)study provided the evidence to support the use of aqueous shunt surgery and its increasing popularity in the world.The Ahmed versus Baerveldt(AVB)study,a randomized controlled study,compared the efficacy and safety between two of the most commonly used glaucoma drainage implants.A significant proportion of the participants had failed trabeculectomy,neovascular or uveitic glaucoma.The 5-year results showed that the cumulative probability for failure is significantly lower for Baerveldt compared to Ahmed group(52.3%vs.40.0%,P=0.039).The most common reason for failure was high intraocular pressure(IOP)but 4%of the Baerveldt group has refractory hypotony.Both surgeries were also effective in reducing dependency on intra-ocular pressure lowering medications but the Baerveldt group is superior in this aspect(median of 1 medication compared to 2 medications for Ahmed group).Both surgeries experienced 60-70%rate of complications but most were self-limiting.The most common long-term complication was corneal decompensation(10%).Overall,the results of the AVB study mirrored the results from the Ahmed Baerveldt Comparison(ABC)study.In conclusion,the 5-year report from the AVB study suggested that the Baerveldt tube is more appropriate for eyes which require much lower IOP such as eyes with advanced glaucoma or in young patients.The Ahmed tube would be more suitable for patients who are at risk of hypotony(such as uveitic and neovascular glaucoma)and those who require immediate IOP lowering after surgery.

Comparison of complications after Ahmed versus Baerveldt implant in glaucoma patients:one year follow-up

AIM:To compare surgical results of the Ahmed and Baerveldt implant procedures in glaucoma patients at 1 y follow-up at Jakarta Eye Center(JEC)Eye Hospitals.METHODS:This cohort retrospective study was conducted on glaucoma patients aged≥18 y who had undergone Ahmed and Baerveldt implant surgery.Intraocular pressure(IOP),visual acuity,glaucoma medication,success rate,early and late postoperative complications,and the number of resurgeries were analyzed.RESULTS:A total of 351 eyes in the Ahmed group and 94 eyes in the Baerveldt group were included in this study.At 1 y follow-up,the mean IOP was found to be significantly lower in the Baerveldt group(13±4.47 mm Hg)compared to the Ahmed group(15.02±5.73 mm Hg;P=0.025).Glaucoma medication was required in both the Ahmed and Baerveldt groups(58.92%vs 71.67%).Comparable success rate was found in both groups.The Ahmed group revealed a complete and qualified success of 86.82%,and failure of 13.17%.Similarly,the Baerveldt group showed complete and qualified success in 87.75%and failure in 12.25%cases.In the Ahmed group,11.97%early complications,26.06%late complications and 9.97%resurgeries were observed.In comparison,in the Baerveldt group,23.40%early complications,30.95%late complications and 11.70%resurgeries were observed.CONCLUSION:Both groups of glaucoma implants show significant IOP reduction,however,the Baerveldt implant group demonstrates greater IOP reduction with more failure rates and complications than the Ahmed implant group.