XEN-augmented Baerveldt drainage device implantation in refractory glaucoma: 1-year outcomes.
Bravetti Giorgio Enrico, Mansouri Kaweh, Gillmann Kevin, Rao Harsha L, Mermoud André
AI Summary
XEN-augmented Baerveldt implants moderately reduced IOP in refractory glaucoma, but 41.5% required reoperation within a year, indicating limited long-term success despite initial IOP reduction.
Abstract
Purpose
To evaluate outcomes of XEN-augmented Baerveldt drainage device implantation in refractory glaucoma and factors predicting surgical success.
Method
All eyes undergoing XEN-augmented Baerveldt for refractory open-angle glaucoma at a tertiary glaucoma centre between January 2016 and November 2017 were retrospectively enrolled. Intraocular pressure (IOP), number of anti-glaucomatous medications and postoperative adverse events (AEs) were analysed for 1 year postoperatively. Surgical success was defined as achieving (1) an IOP ≤ 15 mmHg or (2) ≤ 18 mmHg, with or without (qualified) or without medications (complete). Any subsequent glaucoma surgery was considered failure.
Results
Out of 60 eyes enrolled, 12-month data were available for 41 eyes (71.4%). Mean age was 64.7 ± 23.1 years (50% female). Following surgery, IOP decreased significantly from a baseline of 29.9 ± 13.2 to 15.2 ± 6.6 mmHg (- 49.2%; P < 0.0001) at 12 months. Anti-glaucoma medications decreased from 3.0 ± 1.3 to 1.3 ± 0.9. Complete success was achieved by 14.6% of eyes using both the ≤ 15 mmHg and the ≤ 18 mmHg thresholds, and qualified success was achieved in 43.9% and 48.8%, respectively. Throughout the follow-up period, AEs were observed in 51.2% (hypotony = 24.4%; XEN blockage = 17.1%; displacement of XEN gel stent = 4.9%; hyphema = 4.9%). The 12-month success rate was significantly higher in patients who presented an IOP ≤ 10 mmHg at 1 week (58.6%, P = 0.001). Overall, 41.5% of patients required reoperation at 12 months (58.8% revision of the surgery; 41.2% transscleral cyclodestruction).
Conclusion
XEN-augmented Baerveldt is a safe and moderately effective technique to reduce IOP and anti-glaucoma medications in refractory glaucoma. IOP at 1 week seems to be a predictor for surgical success. Nevertheless, a high proportion of patients requires reoperation.
MeSH Terms
Shields Classification
Key Concepts6
XEN-augmented Baerveldt drainage device implantation in refractory open-angle glaucoma significantly decreased intraocular pressure (IOP) from a baseline of 29.9 13.2 mmHg to 15.2 6.6 mmHg (-49.2%; P < 0.0001) at 12 months.
Following XEN-augmented Baerveldt drainage device implantation in refractory open-angle glaucoma, anti-glaucoma medications decreased from 3.0 1.3 to 1.3 0.9 at 12 months.
Complete success (IOP ≤ 15 mmHg or ≤ 18 mmHg without medications) was achieved by 14.6% of eyes, and qualified success (IOP ≤ 15 mmHg or ≤ 18 mmHg with medications) was achieved in 43.9% and 48.8% respectively, after XEN-augmented Baerveldt drainage device implantation in refractory open-angle glaucoma at 12 months.
Adverse events were observed in 51.2% of eyes following XEN-augmented Baerveldt drainage device implantation in refractory open-angle glaucoma, including hypotony (24.4%), XEN blockage (17.1%), displacement of XEN gel stent (4.9%), and hyphema (4.9%) at 12 months.
The 12-month success rate of XEN-augmented Baerveldt drainage device implantation in refractory open-angle glaucoma was significantly higher in patients who presented an IOP ≤ 10 mmHg at 1 week (58.6%, P = 0.001).
Overall, 41.5% of patients required reoperation at 12 months after XEN-augmented Baerveldt drainage device implantation for refractory open-angle glaucoma, with 58.8% undergoing revision of the surgery and 41.2% undergoing transscleral cyclodestruction.
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