Intraoperative Customized Reduction in Baerveldt Implant Plate Size in Elderly Patients with Glaucoma and Short Eyes

Abstract

Purpose

Larger surface area glaucoma drainage implant plates are associated with greater IOP reduction. Older age and short axial length of the eye have been reported to be risk factors for postoperative hypotony and suprachoroidal hemorrhage after glaucoma surgery. This pilot study, the first of its type, was conducted to determine the clinical outcome of intraoperative Baerveldt implant plate size reduction in elderly patients (≥80 years) with short axial length (<22 mm).

Methods

This was a retrospective study with a minimum 18-month follow-up involving 24 consecutive uncontrolled glaucoma patients who had previously undergone Baerveldt implantation with implant plate size reduction. Success was defined as intraocular pressure (IOP) < 21 mmHg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP > 5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception. The distance between the rectus muscles at the equator of the eyeball was measured using a surgical caliper. The Baerveldt implant plate was cut with straight dissecting scissors considering the distance between the muscles.

Results

The mean ±SD preoperative IOP before GDI was 30.2 ± 6.9 mmHg, and the mean IOP at the last follow-up visit was 13.3 ± 5.1 mmHg, the mean pressure drop being 16.9 mmHg (56%) (P<0.001). The number of antiglaucoma medications declined from mean 3.7 ± 1.0 (range 2–5) to 1.6 ± 1.1 (range 0–3) at the last visit (P<0.001). The success rate at the last follow-up visit was 79% (19 of 24 eyes). Fourteen (58%) eyes were classified as qualified success and five eyes (21%) were complete success. Complications included intraoperative suprachoroidal hemorrhage (1) and postoperative hyphema (2).

Conclusion

Baerveldt implantation with customized plate downsizing can be an effective treatment option for difficult glaucoma in elderly people with short eyes.

Keywords:

• short axial length
• glaucoma drainage implant
• hypotony
• suprachoroidal hemorrhage
• implant plate truncation

Data Sharing Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

The study was presented in part at the 15th European Glaucoma Society Congress on June 7th, 2022, Athens, Greece.

Disclosure

The author declares that there is no conflict of interest regarding the publication of this article.

Additional information

Funding

This work was supported by the Päijät-Häme Joint Authority for Health and Wellbeing (Finland) research grant.