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Esfandiari H, Hassanpour K, Knowlton P, Shazly T, Yaseri M, Loewen NA. Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison. JOVR [Internet]. 2020Oct.25 [cited 2024Apr.27];15(4):509–516. Available from: https://knepublishing.com/index.php/JOVR/article/view/7789

https://doi.org/10.18502/jovr.v15i4.7789

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authors

  • Hamed Esfandiari

    Hamed Esfandiari

    Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kiana Hassanpour

    Kiana Hassanpour

    Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Peter Knowlton

    Peter Knowlton

    Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Tarek Shazly

    Tarek Shazly

    Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Mehdi Yaseri

    Mehdi Yaseri

    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  • Nils A. Loewen

    Nils A. Loewen

    Department of Ophthalmology, University of Würzburg, Würzburg, Germany

Published Date

  • Oct 25, 2020
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Journal of Ophthalmic and Vision Research (JOVR) / October–December 2020, Volume 15, Issue 4 / Pages 509–516

Abstract

Purpose: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone.


Method: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA).


Results: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668).


Conclusion: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

Keywords:

Ab Interno Trabeculectomy, Baerveldt Glaucoma Implantation, Glaucoma Drainage Devices, Trabectome Surgery, Tube Ligation

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