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At least 19 recordsLinked to original sources

PubMed1994

Glaucoma drainage implants.

Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for which the risk of failure of conventional filtering surgery is high. The basic design of these devices is similar; a silicone tube shunts aqueous humor from the anterior chamber to a fibrous capsule surrounding a synthetic plate or band positioned at the equatorial region of the globe. The capsule serves as a reservoir for aqueous drainage. Drainage implants have been used in the treatment of various refractory glaucomas, including those associated with aphakia and pseudophakia, prior unsuccessful filtering surgery, anterior segment neovascularization, trauma, youth, uveitis, epithelial downgrowth, iridocorneal endothelial syndrome, vitreoretinal disorders, and penetrating keratoplasty. Modifications in implant design and surgical technique have been developed to limit the occurrence of postoperative complications such as hypotony and its related sequelae, and strabismus.

Child↗

PubMedDate not supplied

Plain film imaging of Baerveldt glaucoma drainage implants.

A glaucoma drainage implant was detected on plain skull radiographs before MR imaging examination of the brain. The patient was denied the MR imaging for fear of dislodging the "metallic foreign body." The Baerveldt glaucoma drainage implant was mistakenly identified as an orbital metallic object based on its radiographic characteristics. Because none of the current glaucoma drainage implants contain ferromagnetic material, patients with these devices can undergo MR imaging without special precaution.

Aged↗

PubMed2000

Complications of glaucoma drainage implant surgery.

Glaucoma drainage implants play an important role in the management of refractory glaucoma. It may be considered as a primary procedure in eyes with severe scarring of the conjunctiva and the limbus, neovascularization, multiple previous, failed filtering procedures, and severely glaucomatous eyes for which corneal graft is planned. Recommendations have been made regarding improving the biocompatibility of the materials used in the manufacture of these implants. The current state of development of glaucoma drainage implants is likened to that of intraocular lenses in the 1970s. Further development of devices and techniques will only serve to improve our armamentarium and success against glaucoma, specifically refractory glaucoma. Glaucoma posterior tube shunts have proved to be safe, with the majority of complications either nonsight-threatening, spontaneously resolving, or reversible. Considered primarily in the most severe cases of refractory glaucoma, it has otherwise changed the outlook for such patients.

Filtering Surgery↗

PubMed1998

Implantation of glaucoma drainage implant tube into the ciliary sulcus in patients with corneal transplants.

The placement of glaucoma drainage implants may be complicated by tube-corneal touch and endothelial decompensation, particularly after corneal transplantation. We describe an innovative surgical approach to glaucoma drainage implant procedures that may decrease such complications. The approach involves placement of the shunt tube into the ciliary sulcus. This approach may serve as an alternative to anterior chamber angle or pars plana implant placement in pseudophakic or aphakic eyes with refractory glaucoma and a high risk for corneal decompensation.

Adult↗

PubMed1997

Morphology of glaucoma drainage implantation.

Implantation of glaucoma drainage devices has become a standard procedure in various forms of intractable glaucoma. Indications include extensive conjunctival scanning at the upper limbal area, neovascular glaucoma (in addition to pars plana vitrectomy and endolasercoagulation), and secondary glaucoma due to uveitis or trauma. Implanting a glaucoma drainage device is an alternative to trabeculectomy with antimetabolites in young patients in whom delayed complications such as bleb-related endophthalmitis are more likely to occur. Intermediate-term success rates ranging from 70% to 90% are encouraging; however, long-term rates are substantially lower (< or = 50%). Major complications after glaucoma drainage device implantation include hypotony with suprachoroidal hemorrhage and shallowing of the anterior chamber, tube obstruction by fibrin clot, and long-term failure caused by bleb fibrosis. Various glaucoma drainage devices are commercially available; however, none of the designs has proved to be superior to the others.

Animals↗

PubMed2004

Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract.

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.

Adult↗

PubMed2002

Sequential or simultaneous cyclophotocoagulation and glaucoma drainage implant for refractory glaucoma.

PURPOSE: To describe the outcomes of combining cyclophotocoagulation and tube-shunt glaucoma drainage implants, either sequentially or simultaneously, for the control of refractory glaucomas. PATIENTS AND METHODS: A retrospective review was conducted of all patients that had been treated at our institute with both cyclophotocoagulation and a tube-shunt glaucoma drainage implant in the same eye between January 1996 and June 2000. Preoperative and postoperative intraocular pressure, number of glaucoma medications, vision, and complications data were collected for each eye. RESULTS: A total of 10 eyes of 9 patients met the study criteria. The minimum follow-up period after the last surgery was 15 months. Intraocular pressures were reduced from 28.5 +/- 7.2 mm Hg preoperatively to 13.9 +/- 5.4 mm Hg postoperatively at 15 months (P < 0.000, n = 9). Medications were reduced from 2.7 +/- 1.2 preoperatively to 0.3 +/- 0.5 postoperatively at 15 months (P < 0.000, n = 9). Of the eight eyes with measurable Snellen acuity, postoperative vision decreased two or more lines in five eyes (63%). Complications included transient hypotony (one eye), transient serous choroidal detachment (two eyes), cystoid macular edema (two eyes), corneal edema (three eyes), and panuveitis with chronic hypotony and traction retinal detachment (one eye). CONCLUSIONS: Combining cyclophotocoagulation with tube-shunt glaucoma drainage implants can effectively reduce intraocular pressure and number of glaucoma medications needed to achieve target intraocular pressure goals. Further study is needed to determine the safety of this combined approach compared with other available options to manage refractory glaucomas.

Adolescent↗

PubMed2000

Combined pars plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma.

PURPOSE: To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant. METHODS: The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively. RESULTS: At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure. CONCLUSIONS: Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.

Adult↗

PubMed2002

Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma.

OBJECTIVE: To evaluate the efficacy and safety of Baerveldt glaucoma drainage devices in the management of uveitic glaucoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-four eyes of 24 patients who underwent implantation of Baerveldt glaucoma drainage devices between 1996 and 2000 for the treatment of uveitic glaucoma refractory to medical therapy. INTERVENTION: Implantation of Baerveldt glaucoma drainage device. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP), number of glaucoma medications needed for adequate IOP control, visual acuity, complications associated with the surgery, and the effect of subsequent surgery on the ability of the device to control IOP. Success was defined as IOP >/=5 and </=21 mmHg with or without antiglaucoma medications and without need for further glaucoma surgery, loss of light perception, or phthisis. RESULTS: Cumulative life-table success rates were 95.8% at 3 months and 91.7% at 6 months, 12 months, and 24 months. The mean postoperative follow-up was 20.8 months. The IOP was reduced from a preoperative mean of 30.5 +/- 8.96 mmHg with 3.1 +/- 0.99 antiglaucoma medications to a postoperative mean at 6 months or 1 year of 13.0 +/- 4.6 mmHg (P < 0.001) with 0.8 +/- 0.8 antiglaucoma medications (P < 0.001). At last follow-up 14 of 24 eyes (58.3%) required no antiglaucoma medications. Best-corrected visual acuity improved or remained within 2 lines of preoperative visual acuity in 19 (79.2%) eyes. The most common complications were choroidal effusions in four (16.7%), hypotony in three (12.5%) eyes, cystoid macular edema in three (12.5%) eyes, and failure of corneal grafts in two (8.3%). Seven of 22 eyes (31.8%) in which successful control of IOP with the Baerveldt implant was achieved underwent subsequent nonglaucoma-related incisional surgery. None of these eyes (0%) lost IOP control after the subsequent procedure. CONCLUSIONS: The Baerveldt glaucoma drainage device offers reasonable safety and effectiveness for the control of IOP in eyes with uveitis and refractory glaucoma.

Adolescent↗

PubMed1999

Recent developments in glaucoma drainage implant surgery.

Refractory glaucoma remains a challenging problem for the ophthalmologist. Drainage implant surgery is a valuable and effective option for its treatment. Recent developments in implant design and surgical technique have decreased the incidence and severity of postoperative complications while increasing the efficacy of glaucoma drainage implant devices.

Filtering Surgery↗

PubMed2001

[Glaucoma drainage implants in the treatment of refractory glaucoma].

The authors describe their experience with the first three glaucoma drainage implants. All patients had previously several antiglaucomatous operations and a greatly reduced vision. The intraocular pressure was resistant to conservative treatment. In all patients the authors recorded postoperative complications reported in the literature. Glaucoma drainage implants extend possibilities in patients with refractory glaucoma.

Adult↗

PubMed1998

Penetrating keratoplasty with a valved glaucoma drainage implant for congenital glaucoma and corneal scarring secondary to hydrops.

The simultaneous management of glaucoma and corneal opacification is sometimes required in infants with severe congenital glaucoma if timely visual rehabilitation is to be achieved. A 1-month-old female infant presented with an enlarged, protuberant, opaque cornea in each eye and elevated intraocular pressure. An intrastromal, fluid-filled cleft was noted in both corneas. It resolved over 3 weeks as corneal scarring progressed. Peripheral corneal clearing allowed a view of an essentially normal anterior chamber. Penetrating keratoplasty and Ahmed (New World Medical Inc., Rancho Cucamonga, CA) valve implant surgery with mitomycin-C were performed simultaneously in the two eyes 1 months apart. At 15 months of age, the patient's grafts were clear and the intraocular pressure was well controlled in both eyes. One eye required multiple procedures for eventual glaucoma control. No postoperative overfiltration occurred. The authors conclude that the use of a valved implant should be considered in patients who require urgent simultaneous corneal and glaucoma surgery for severe congenital glaucoma. This combination may improve early postoperative control of aqueous outflow and positively affect long-term graft survival in these difficult cases.

Administration, Topical↗

PubMed2001

Pars plana tube insertion of glaucoma drainage implants and penetrating keratoplasty in patients with coexisting glaucoma and corneal disease.

PURPOSE: To determine the efficacy and associated complications of glaucoma drainage implant (GDI) surgery with pars plana tube insertion and penetrating keratoplasty (PK) in eyes with glaucoma and corneal disease. DESIGN: Retrospective, interventional case series. PARTICIPANTS: All patients who underwent both GDI surgery with pars plana tube insertion and PK before September 1997 were included. METHODS: The medical records of 34 consecutive patients (34 eyes) who had undergone GDI (Baerveldt, Pharmacia & Upjohn, Kalamazoo, MI; Molteno, IOP INC:, Costa Mesa, CA; Krupin, Hood Laboratories, Pembroke, MA; or Ahmed, New World Medical, Rancho Cucamonga, CA) insertion before, concurrent with, or after PK were reviewed retrospectively. All corneal grafts were clear before GDI surgery for patients who underwent glaucoma surgery after PK. Outcomes were evaluated using Kaplan-Meier life-table analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included corneal graft clarity, intraocular pressure (IOP), visual acuity, and identification of complications. RESULTS: Mean follow-up after completion of both GDI surgery and PK was 12.1 +/- 8.4 months (range, 0-31.8 months). Twelve- and 24-month life-table rates for complete success after both GDI and PK were 63% and 33%, respectively. Twelve- and 24-month life-table success rates for IOP control and corneal graft clarity were 85% and 62%, and 64% and 41%, respectively. Final postoperative visual acuity was the same as or better than (> or =2 Snellen lines) the preoperative level in 29 patients (85%). One or more posterior segment complications occurred in 15 (44%) patients. CONCLUSIONS: Pars plana tube insertion of GDIs is a reasonable option for patients who have undergone PK or in whom PK is anticipated, despite the need for a complete pars plana vitrectomy. Although complications related to limbal tube placement are avoided, the incidence of posterior segment complications may be higher for pars plana insertion. The potential for enhanced corneal graft survival with pars plana versus anterior segment tube placement warrants further investigation.

Adult↗

PubMed2006

Glaucoma drainage implants: a critical comparison of types.

PURPOSE OF REVIEW: The purpose of this review is to critically compare the various glaucoma drainage implants in popular use. RECENT FINDINGS: Glaucoma drainage implants are being increasingly utilized in the surgical management of glaucoma. Comparisons between the various drainage implants are difficult because most clinical data are derived from retrospective studies with different study populations, follow-up periods, and criteria defining success. The type of glaucoma under treatment is a major factor influencing surgical outcomes. The resistance to aqueous flow through glaucoma drainage implants occurs across the fibrous capsule around the end plate, and the major determinants of the final intraocular pressure are capsular thickness and filtration surface area. The use of antifibrotic agents as adjuncts to drainage implant surgery has not proven effective in modulating capsular thickness. Valved implants appear to reduce, but do not eliminate, the risk of hypotony. Bleb encapsulation is more frequently seen with the Ahmed valve implant than other drainage implants. Diplopia was a common complication with the Baerveldt glaucoma implant after its introduction, but design modifications have markedly reduced the incidence of this complication. SUMMARY: There are several glaucoma drainage implants that are currently available, and all have been shown to be safe and effective in reducing intraocular pressure. Greater pressure reduction may be achieved with implants with larger end plates, and valved implants appear to reduce the risk of postoperative hypotony.

Aqueous Humor↗

PubMed2004

Experience with the use of Baerveldt and Ahmed glaucoma drainage implants in an Asian population.

PURPOSE: To evaluate the efficacy and safety of Baerveldt and Ahmed glaucoma drainage implants in Asian patients with refractory glaucoma. DESIGN: Retrospective nonrandomized study. PARTICIPANTS: Forty-one patients. METHODS: The authors reviewed the insertion of 18 Ahmed glaucoma valved (AGV-S2) implants and 24 350 mm(2) Baerveldt glaucoma implants performed by a single surgeon at the Department of Ophthalmology, National University Hospital, Singapore, from January 1, 2000, to December 31, 2000. A total of 42 glaucoma drainage implants was inserted into the eyes of 41 patients. All patients had at least 6 months of follow-up. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, and complications. RESULTS: Both drainage implants achieved remarkable reductions in IOP; from pretreatment IOP of 40.1+/-13.8 mmHg and 43.7+/-9.3 mmHg to postoperative IOP of 17.4+/-6.2 and 14.9+/-5.5 mmHg in the Baerveldt and Ahmed groups, respectively. A decrease in IOP of 56.6% and 65.9% had been achieved. Success rates were 20 (83.3%) for Baerveldt and 12 (66.7%) for Ahmed implants, whereas qualified success occurred in 1 (4.2%) Baerveldt and 3 (16.7%) Ahmed implants. Conversely, failure to control IOP occurred in 3 (12.5%) Baerveldt implants and 3 (16.7%) Ahmed implants. More than 80% of the patients had maintained or improved visual function, whereas only 4 (16.0%) of the patients with Baerveldt implants and 2 (16.7%) patients with Ahmed implants had loss of more than 1 Snellen line. CONCLUSIONS: Both Baerveldt and Ahmed glaucoma drainage implants performed well in terms of IOP control, preservation of visual function, and having low complication rates.

Asian People↗

PubMed2002

Combined cataract extraction and Baerveldt glaucoma drainage implant: indications and outcomes.

PURPOSE: To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt glaucoma drainage implant surgery. DESIGN: Noncomparative, interventional, retrospective, consecutive case series. PARTICIPANTS: Thirty-three eyes of 33 patients. INTERVENTION: Combined phacoemulsification CE and Baerveldt glaucoma drainage implant (BGI) surgery at two tertiary care referral centers. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure (IOP), and complications. RESULTS: The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0-46.9). The most common indication for combined CE and Baerveldt glaucoma drainage implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was > or =20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (+/- standard deviation) of 21 +/- 7.3 mmHg preoperatively to 13.1 +/- 3.5 mmHg at last follow-up visit ( P < 0.001). The number of antiglaucoma medications was reduced from a mean (+/- standard deviation) of 2.3 +/- 1.0 preoperatively to 0.7 +/- 1.1 at last follow-up (P < 0.001). Three eyes met our criteria for failure, and cumulative survival of the glaucoma surgery at 18 months was 89%. Intraoperative complications were all related to the cataract surgery, whereas early and late postoperative complications were related both to the CE and BGI surgery. CONCLUSIONS: Combined CE and Baerveldt glaucoma drainage implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

Adult↗

PubMed1995

Clinical experience with the Baerveldt glaucoma drainage implant.

PURPOSE: To assess clinical outcomes in patients who were treated with the Baerveldt glaucoma drainage implant. METHODS: The authors performed a retrospective multicenter study of 100 patients (103 eyes) with medically uncontrollable glaucomas who underwent a one-stage implantation with either the 200-, 250-, 350-, or 500-mm2 Baerveldt implant. The authors defined surgical success as 5 mmHg less than intraocular pressure less than 22 mmHg without additional glaucoma surgery and without loss of light perception. RESULTS: With a mean follow-up of 13.6 +/- 0.9 months (range, 4-37 months), 74 eyes (71.8%) had successful outcomes. Cumulative life-table success rates were 90.3% at 3 months (n = 103), 72.6% at 6 months (n = 84), and 60.3% at 24 months (n = 34). Intraocular pressure (IOP) was reduced from a mean of 38.5 +/- 1.4 mmHg with 2.2 +/- 0.1 antiglaucoma medications to 15.1 +/- 0.8 mmHg (P < 0.0005) with 0.5 +/- 0.1 antiglaucoma medications (P < 0.0005). Visual acuity was improved or remained within one line of the preoperative visual acuity in 90 eyes (87.4%). Complications occurred in 74 eyes (71.8%). A significant portion of these complications (45%) was transient, resolving without any intervention. Only 8% were serious sight-threatening complications. The most common complications included shallow anterior chamber or hypotony (32%), choroidal effusion or hemorrhage (20.4%), corneal decompensation or edema (17.5%), hyphema (14.1%), and tube obstruction (12.6%). CONCLUSION: The Baerveldt implant is effective in lowering the IOP in patients with intractable glaucomas. Hypotony and other complications are common, which also have been reported in other nonvalved glaucoma drainage implants. However, the majority of these complications did not affect surgical outcome.

Adolescent↗

PubMedDate not supplied

Spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS).

PURPOSE: To report a case of spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). METHODS: An Ex-PRESS was implanted under the conjunctiva in a 76-year-old man with primary open-angle glaucoma. RESULTS: Two years after implantation, the Ex-Press extruded spontaneously. Despite this adverse event, there was no increase in intraocular pressure. CONCLUSIONS: This is the first report of spontaneous extrusion of an Ex-PRESS device. Implanting the device under a scleral flap should be considered to avoid adverse events such as extrusion or conjunctival erosion.

Aged↗