Outcomes of fornix-based versus limbus-based conjunctival incisions for glaucoma drainage device implant

Abraham W. Suhr, Michele C Lim, James D Brandt, Juan Carlos Izquierdo, Neil Willits

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

PURPOSE: To determine the effect of conjunctival incision location on the long-term efficacy of nonvalved glaucoma drainage devices. MATERIALS AND METHODS: We conducted a retrospective review of patients ≥18 years of age with uncontrolled glaucoma [intraocular pressure (IOP) ≥18 mm Hg] who underwent glaucoma drainage device implantation. A comparison was made of a limbal-based (LB-BGI) versus fornix-based (FB-BGI) conjunctival flap during placement of a 350-mm Baerveldt glaucoma implant (AMO, Santa Ana, CA) in subjects with at least 1 year of follow-up data. The primary outcome measure was IOP; secondary outcome measures were medication burden, visual acuity, and surgical complications. RESULTS: One hundred sixty eyes of 147 glaucoma patients were included. Two years after surgery, the IOP in the LB-BGI group was 14.3±5.3 mm Hg and in the FB-BGI group 13.1±4.7 mm Hg (P=0.47). Overall success of IOP control was achieved at the final visit (range 1 to 5 y) in 90% of the LB-BGI group and 87% of the FB-BGI group (P=0.63). The medication burden of the 2 groups at 1 and 2 years after surgery was not statistically significantly different. Worsening of visual acuity by more than 2 lines was not statistically different between the groups 2 years after the surgery and at the final visit (P=0.47, P=0.60, respectively). A greater number of eyes developed endophthalmitis and were more likely to undergo subsequent tube revision in the FB-BGI group, but the differences were not significant. CONCLUSIONS: Both incision techniques were equally effective in controlling IOP. Each surgical approach has its advantages and this study suggests that either technique may be used safely and effectively.

Original languageEnglish (US)
Pages (from-to)523-529
Number of pages7
JournalJournal of Glaucoma
Volume21
Issue number8
DOIs
StatePublished - Oct 2012

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Glaucoma Drainage Implants
Intraocular Pressure
Glaucoma
Equipment and Supplies
Visual Acuity
Drainage
Outcome Assessment (Health Care)
Endophthalmitis

Keywords

  • Baerveldt glaucoma implant
  • conjunctival incision
  • glaucoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Outcomes of fornix-based versus limbus-based conjunctival incisions for glaucoma drainage device implant. / Suhr, Abraham W.; Lim, Michele C; Brandt, James D; Izquierdo, Juan Carlos; Willits, Neil.

In: Journal of Glaucoma, Vol. 21, No. 8, 10.2012, p. 523-529.

Research output: Contribution to journalArticle

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N2 - PURPOSE: To determine the effect of conjunctival incision location on the long-term efficacy of nonvalved glaucoma drainage devices. MATERIALS AND METHODS: We conducted a retrospective review of patients ≥18 years of age with uncontrolled glaucoma [intraocular pressure (IOP) ≥18 mm Hg] who underwent glaucoma drainage device implantation. A comparison was made of a limbal-based (LB-BGI) versus fornix-based (FB-BGI) conjunctival flap during placement of a 350-mm Baerveldt glaucoma implant (AMO, Santa Ana, CA) in subjects with at least 1 year of follow-up data. The primary outcome measure was IOP; secondary outcome measures were medication burden, visual acuity, and surgical complications. RESULTS: One hundred sixty eyes of 147 glaucoma patients were included. Two years after surgery, the IOP in the LB-BGI group was 14.3±5.3 mm Hg and in the FB-BGI group 13.1±4.7 mm Hg (P=0.47). Overall success of IOP control was achieved at the final visit (range 1 to 5 y) in 90% of the LB-BGI group and 87% of the FB-BGI group (P=0.63). The medication burden of the 2 groups at 1 and 2 years after surgery was not statistically significantly different. Worsening of visual acuity by more than 2 lines was not statistically different between the groups 2 years after the surgery and at the final visit (P=0.47, P=0.60, respectively). A greater number of eyes developed endophthalmitis and were more likely to undergo subsequent tube revision in the FB-BGI group, but the differences were not significant. CONCLUSIONS: Both incision techniques were equally effective in controlling IOP. Each surgical approach has its advantages and this study suggests that either technique may be used safely and effectively.

AB - PURPOSE: To determine the effect of conjunctival incision location on the long-term efficacy of nonvalved glaucoma drainage devices. MATERIALS AND METHODS: We conducted a retrospective review of patients ≥18 years of age with uncontrolled glaucoma [intraocular pressure (IOP) ≥18 mm Hg] who underwent glaucoma drainage device implantation. A comparison was made of a limbal-based (LB-BGI) versus fornix-based (FB-BGI) conjunctival flap during placement of a 350-mm Baerveldt glaucoma implant (AMO, Santa Ana, CA) in subjects with at least 1 year of follow-up data. The primary outcome measure was IOP; secondary outcome measures were medication burden, visual acuity, and surgical complications. RESULTS: One hundred sixty eyes of 147 glaucoma patients were included. Two years after surgery, the IOP in the LB-BGI group was 14.3±5.3 mm Hg and in the FB-BGI group 13.1±4.7 mm Hg (P=0.47). Overall success of IOP control was achieved at the final visit (range 1 to 5 y) in 90% of the LB-BGI group and 87% of the FB-BGI group (P=0.63). The medication burden of the 2 groups at 1 and 2 years after surgery was not statistically significantly different. Worsening of visual acuity by more than 2 lines was not statistically different between the groups 2 years after the surgery and at the final visit (P=0.47, P=0.60, respectively). A greater number of eyes developed endophthalmitis and were more likely to undergo subsequent tube revision in the FB-BGI group, but the differences were not significant. CONCLUSIONS: Both incision techniques were equally effective in controlling IOP. Each surgical approach has its advantages and this study suggests that either technique may be used safely and effectively.

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