Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison
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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Knowledge E
2020-10-01
|
| Series: | Journal of Ophthalmic & Vision Research |
| Subjects: | |
| Online Access: | https://doi.org/10.18502/jovr.v15i4.7789 |
| _version_ | 1828159208292352000 |
|---|---|
| author | Hamed Esfandiari Kiana Hassanpour Peter Knowlton Tarek Shazly Mehdi Yaseri Nils A. Loewen |
| author_facet | Hamed Esfandiari Kiana Hassanpour Peter Knowlton Tarek Shazly Mehdi Yaseri Nils A. Loewen |
| author_sort | Hamed Esfandiari |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T23:57:37Z |
| format | Article |
| id | doaj.art-8f20f1ff1e5647219bb69199b05b84fa |
| institution | Directory Open Access Journal |
| issn | 2008-322X |
| language | English |
| last_indexed | 2024-04-11T23:57:37Z |
| publishDate | 2020-10-01 |
| publisher | Knowledge E |
| record_format | Article |
| series | Journal of Ophthalmic & Vision Research |
| spelling | doaj.art-8f20f1ff1e5647219bb69199b05b84fa2022-12-22T03:56:19ZengKnowledge EJournal of Ophthalmic & Vision Research2008-322X2020-10-011550951610.18502/jovr.v15i4.7789Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched ComparisonHamed Esfandiari0Kiana Hassanpour1Peter Knowlton2Tarek Shazly3Mehdi Yaseri4Nils A. Loewen5 Department of Ophthalmology, University of Würzburg, Würzburg, Germany Department of Ophthalmology, University of Würzburg, Würzburg, Germany Department of Ophthalmology, University of Würzburg, Würzburg, Germany Department of Ophthalmology, University of Würzburg, Würzburg, Germany Department of Ophthalmology, University of Würzburg, Würzburg, Germany Department of Ophthalmology, University of Würzburg, Würzburg, GermanyPurpose: 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.https://doi.org/10.18502/jovr.v15i4.7789ab interno trabeculectomybaerveldt glaucoma implantationglaucoma drainage devicestrabectome surgerytube ligation |
| spellingShingle | Hamed Esfandiari Kiana Hassanpour Peter Knowlton Tarek Shazly Mehdi Yaseri Nils A. Loewen Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison Journal of Ophthalmic & Vision Research ab interno trabeculectomy baerveldt glaucoma implantation glaucoma drainage devices trabectome surgery tube ligation |
| title | Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison |
| title_full | Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison |
| title_fullStr | Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison |
| title_full_unstemmed | Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison |
| title_short | Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison |
| title_sort | combining baerveldt implant with trabectome negates tube fenestration a coarsened matched comparison |
| topic | ab interno trabeculectomy baerveldt glaucoma implantation glaucoma drainage devices trabectome surgery tube ligation |
| url | https://doi.org/10.18502/jovr.v15i4.7789 |
| work_keys_str_mv | AT hamedesfandiari combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison AT kianahassanpour combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison AT peterknowlton combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison AT tarekshazly combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison AT mehdiyaseri combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison AT nilsaloewen combiningbaerveldtimplantwithtrabectomenegatestubefenestrationacoarsenedmatchedcomparison |