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J Glaucoma. 2012 Oct-Nov;21(8):523-9. doi: 10.1097/IJG.0b013e318227a565.

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

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1
University of California, Davis Health System Eye Center, Sacramento, CA 95817, USA.

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.

PMID:
21878818
DOI:
10.1097/IJG.0b013e318227a565
[Indexed for MEDLINE]

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