Probability of Success Higher After Baerveldt Glaucoma Implant Than Trabeculectomy

Masaru Inatani, MD, PhD

Baerveldt glaucoma implant surgery had a higher success rate than trabeculectomy in patients with neovascular glaucoma, while the rates of posopterative complications were similar between both surgical procedures, according to new research.

Additional glaucoma surgery was more often required after trabeculatectomy than after Baerveldt glaucoma implant surgery, according to the data.

Led by Masaru Inatani, MD, PhD, Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, the investigators set out to compare the surgical outcomes between Baerveldt glaucoma implant surgery and traveculectomy with mitomycin C for the patient population.

The retrospective clinical cohort study at 5 clinical centers in Japan recruited patients treated with trabeculectomy or Baerveldt glaucoma implant for neovascular glaucoma between April 2012 and December 2019. Inclusion criteria were age ≥20 years and having neovascular glaucoma and exclusion criteria were eyes with no light perception vision and with previous tube-shunt surgery.

They noted that if both eyes in the same patient satisfied the inclusion criteria, eyes treated first were investigated. The study included 100 eyes undergoing Baerveldt glaucoma implant surgery and 204 eyes undergoing trabeculectomy.

Primary outcomes for the study was surgical success or failure, with failure being defined according to 3 criteria: <20% reduction of the preoperative intraocular pressure (IOP) or criterion A (IOP >21 mmHg), criterion B (IOP >17 mmHg), or criterion C (IOP >14 mmHg). Other failures identified were causes of reoperation, a loss of light perception vision, or hypotony.

Results show the probability of success was significantly higher in patients undergoing Baerveldt glaucoma implant surgery than in those receiving trabeculatomy for criteria A (P <.01) and B (P = .01).

Trabeculatomy was significantly associated with surgical failure in the multivariable analysis for criterion A (hazard ratio [HR], 1.70) and criterion B (HR, 1.50). The overall incidence of postoperative complications was similar between the 2 groups.

Moreover, reoperations were required significantly more frequently in the travecultomy group than in the Baerveldt glaucoma implant surgery group (20.1% vs. 5.0%; P <.01), according to the investigators.

The abstract, “Comparing Surgical Outcomes in Neovascular Glaucoma between Tube and Trabeculectomy: A Multicenter Study,” was published in Ophthalmology Glaucoma.