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.

玻璃体切割联合青光眼Baerveldt植入物治疗难治性青光眼

目的:探讨玻璃体切割联合青光眼Baerveldt植入物(pars plana vitrectomy and Baerveldt glaucoma implant,PPV-BGI)治疗难治性青光眼的临床疗效。方法:回顾性分析2013-03/2015-12本院收治并实施PPV-BGI的129例132眼难治性青光眼患者的临床治疗资料,其中63眼为新生血管性青光眼(neovascular glaucoma,NVG),69眼为其他类型的青光眼(non-NVG)。分析两组患者的术后眼压(intraocular pressure,IOP)变化、手术结果、视力(visual acuity,VA)、青光眼药物的使用数量、并发症和手术成功率。结果:NVG组患者和non-NVG组患者1a累计成功率分别为46.0%、81.2%,差异有统计学意义(P<0.05)。NVG组患者IOP术后1a从术前40.1±10.4mmHg下降至17.8±4.9mmHg,non-NVG组患者则从30.4±10.2 mmHg下降至14.9±4.1mmHg,术前与术后1a相比,差异有统计学意义(P<0.05)。NVG及non-NVG组患者术前青光眼药物使用数量分别为2.9±1.4和2.7±1.2种,术后1a NVG及non-NVG组患者青光眼药物使用数量分别下降为0.96±1.18和0.51±0.96种,差异有统计学意义(P<0.05)。术后NVG组视力改善患者13例14眼,non-NVG组患者改善37例38眼,差异有统计学意义(P<0.05)。术后1d及术后随访1a结果表明,NVG组患者并发症发生情况明显高于non-NVG组,差异有统计学意义(P<0.05)。结论:PPV-BGI是难治性青光眼手术的一种可行性手术选择,但术后视力恢复效果往往不理想,因为术后往往会有并发症的发生,特别是新生血管性青光眼。

Ahemd与Baerveldt两种不同引流阀治疗青光眼的Meta分析

目的旨在对比Ahemd引流阀(AGV)及Baerveldt引流阀(BGI)治疗青光眼的有效性及安全性。方法计算机检索PubMed,Web of science,Cochrane Library,维普,万方以及中国知网数据库并收集所有与AGV及BGI相关的临床对照试验。有效性评价包括以加权平均数(WMD)作为测量指标的眼压下降幅度百分比(IOPR%)及青光眼用药减少百分比,以比值比(OR)作为测量指标的手术完全成功率、条件成功率以及再次青光眼手术发生率。安全性评价为以OR作为测量指标的并发症发生率。结果最终纳入文献5篇,包括811例患者(812眼)。对比AGV,BGI具有更高的IOPR%及青光眼用药减少百分比(WMD=-5.20,95%CI=[-9.55,-0.85],P=0.02;WMD=-14.89,95%CI=[-20.46,-9.32],P<0.001)。另外,BGI的手术完全成功率高于AGV(OR=0.53,95%CI=[-0.31,0.92],P=0.02),而再次青光眼手术发生率则低于AGV(OR=2.49,95%CI=[1.33,4.66],P=0.004)。在手术条件成功率及总并发症发生率方面二者差异并无统计学意义(OR=0.89,95%CI=[0.63,1.24],P=0.48;OR=0.74,95%CI=[0.52,1.04],P=0.09)。结论对比AGV,BGI在降低眼压及减少术后青光眼用药方面更为有效,同时BGI还具有手术成功率高及再次青光眼手术发生率低的特点,而两者在术后并发症发生率方面差异无统计学意义。

经睫状体平坦部行颞上或鼻下Baerveldt青光眼植入术的短期临床疗效比较

目的:研究并探讨Baerveldt青光眼植入术(BGI)的不同植入部位对眼压(IOP)的影响。方法:对日本Toho大学Sakura医疗中心接受BGI治疗的新生血管性青光眼的病例进行回顾性分析。所有患者分为两组:颞上植入组(16例患者18眼,其中男性13例,女性3例;平均年龄62.9±14.4岁)和鼻下植入组(15例患者17眼,其中男性11例,女性4例;平均年龄56.9±10.7岁)。术后12mo随访复查。比较两组术后12mo与术前相比的眼压降低率。结果:颞上植入组:术前平均IOP为31.1±10.0 mmHg,术后平均IOP为14.4±4.5 mmHg;鼻下植入组:术前平均IOP为34.9±9.7 mmHg,术后平均IOP为15.9±3.7 mmHg。颞上植入组IOP降低率为(50.0±19.0)%,鼻下植入组降低率为(51.2±16.3)%。两组间无显著统计学差异(t-test,P=0.590)。结论:经睫状体平坦部行颞上或鼻下BGI的短期临床疗效无差异。

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.

儿童患者中的Baerveldt青光眼移植

Aim: To evaluate the Baerveldt glaucoma implant (BGI) in paediatric glaucoma treatment. Methods: In a retrospective non-comparative case series 55 eyes of 40 consecutive paediatric patients (≤ 16 years) with primary or secondary glaucoma underwent Baerveldt (350 mm2) implantation. Surgical out come was evaluated by Kaplan-Meier table analysis. Results: The overall success rate was 80% at last follow up, with a mean follow up of 32 (range 2- 78) months. Cumulative success was 94% at 12 months and 24 months, 85% at 36 months, 78% at 48 months, and 44% at 60 months. 11 eyes (20% )-failed postoperatively because of an IOP > 21 mm Hg (eight eyes), persistent hypotony (two eyes), and choroidal haemorrhage following cataract surgery (one eye). The most frequent complication needing surgery was tube related (20% ). A new observation was mild to moderate dyscoria in 22% of the eyes, all buphthalmic, caused by entrapment of a tuft of peripheral iris in the tube track. Conclusions: The BGI is effective and safe in the management of primary and secondary glaucoma. When angle surgery has proved to be unsuccessful or inappropriate in paediatric patients, a BGI is a good treatment option. One must be prepared to deal with the tube related problems.

Baerveldt青光眼植入物在治疗儿童青光眼方面的经验

PURPOSE: To report the clinical outcome in 48 eyes of 48 children who received a Baerveldt glaucoma implant (BGI) for themanagement of pediatric glaucoma. DESIGN: Retrospective, noncomparative case series. METHODS: The medical records of all patientswith pediatric glaucomawho underwent a BGI at two tertiary care referral centers in LosAngeles between 1990 and 1999 were reviewed. Intraocular pressure (IOP)-, intraoperative and postoperative complications, number of glaucoma medications, visual acuity, and pre-and postoperative corneal diameter and axial length were collected from patient records. Criteria for success were IOPbetween 6 and 21 mmHg with or without glaucoma medications, no need for further glaucoma surgery,the absence of visually threatening complications, and some residual vision (minimum visual acuity of light perception). RESULTS: The study included 48 eyes from 48 patients aged 16 years and younger (mean age 4.1 years). Mean preoperative IOP was 31.2±25.7 mm Hg, and mean postoperative IOP was 16.4±4.9 mm Hg. Cumulative probability of success (based on the Kaplan-Meier survival curve) was 95%at 6 months, 90%at 1 year, 84%at 2 years, 74%at 36 months, and 58%at 48 months. On average, the BGIs were successful for a mean period of 5.6 years (67.7 months). Overall, 11 eyes failed, with the causes being uncontrolled IOP(eight eyes), retinal detachment (two eyes), and no light perception (one eye). CONCLUSIONS: Baerveldt glaucoma implants can be a safe and effective treatment modality for the management of pediatric glaucoma refractive to medical therapy.

350-mm^2Baerveldt青光眼引流管植入术治疗合并人工晶体植入后的难治性青光眼

目的评价350-mm2Baerveldt青光眼引流管植入术治疗合并人工晶体植入后的难治性青光眼的疗效。方法回顾性研究了2000年6月到2004年5月,在新加坡国立眼科中心32例33眼350-mm2Baerveldt青光眼引流管植入术治疗合并人工晶体植入术后的难治性青光眼,手术成功的标准定为眼压大于等于6mmHg同时小于等于21mmHg(1kPa=7.5mmHg),必要时用抗青光眼药物,手术失败的标准定为眼压小于6mmHg或大于21mmHg,再次行抗青光眼手术或视力光感消失。结果术后平均随访时间为30.78m±15.34m(14-49)m,平均眼压从术前32.30±7.52(23-50)mmHg,到术后最终随访时间15.41±5.85(5-25)mmHg(P<0.001)下降52.29%。完全成功眼压大于等于6mmHg和小于等于21mmHg且不用抗青光眼药物,最终随访时为51.52%,部分成功率上述相同眼压条件但加用抗青光眼药物为24.24%。手术后最终随访视力提高或不变者为16眼,占48.48%,20眼占60.60%无术中术后并发症,8眼手术后出现暂时性前房出血,3眼出现低眼压合并浅前房,其中2眼出现渗出性脉络膜脱离,2眼最后出现大泡性角膜病变,1眼引流管蚀出,1眼视力光感消失。结论350-mm2Baerveldt青光眼引流管植入物在治疗合并人工晶体植入术后的难治性青光眼中,大部分患者能有效的降低眼压,并且出现较少的严重手术并发症。