Sahar Bedrood, Vikas Chopra, Tarek Alasil, Christine Lin, Laurie Dustin, Rohit Varma and Brian Francis
Purpose: To compare Intraocular Pressure (IOP) control and complications associated with the non-staged, complete Baerveldt implantation (CBVI) vs. two-stage Baerveldt implantation (SBVI) in patients with advanced glaucoma.
Design: Retrospective, comparative, parallel group, interventional study.
Subjects: Sixty-seven eyes that underwent CBVI were matched with 66 eyes that underwent SBVI based on glaucoma diagnosis and age.
Methods: The study included a 24-month follow-up of 67 eyes that underwent CBVI with temporary ligature vs. 66 eyes that underwent SBVI for advanced glaucoma.
Main Outcome Measures: The criterion for surgical success was reduction of IOP of greater than or equal to 20% from baseline, with postoperative IOP from 6 mmHg to 21 mmHg on two or more consecutive measurements with or without the use of glaucoma medications and without loss of light perception or necessity for further surgical intervention for complications or high IOP.
Results: 67 eyes of 67 patients who underwent the CBVI and 66 eyes of 66 patients who had the SBVI were included in the analysis. After the CBVI, the cumulative probability of success by the Kaplan-Meier life-table analysis was 72% and 68% at 12 and 24 months respectively. The cumulative probability of success in the SBVI group was 82% and 80% at 12 and 24 months respectively (P=0.18). In the CBVI group, the median preoperative IOP of 27.1 (± 11.9) mmHg decreased to 14.9 mmHg (± 7.2) and the number of IOP lowering medications decreased from three to one. In the SBVI group, the median preoperative IOP of 25.9 (± 9.5) mmHg decreased to 14.0 mmHg (± 5.1) and the medications decreased from four to two. Visual acuity remained within one Snellen line or improved in 64% of the CBVI group, and 59% of the SBVI group (P=0.77). Corneal edema was the most common complication in both groups, with 25% and 32% in the CBVI and SBVI groups, respectively (P=0.45). Hypotony was the second most common complication, 24% and 18% in the CBVI and SBVI groups, respectively (P=0.52).
Conclusions: Staged BVI and complete BVI showed similar efficacy and rate of complications in the surgical treatment of advanced glaucoma.