Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma

Purpose: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. Materials and Methods: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. Results: The mean ± SD follow-up period for 38 eyes of 36 patients was 34 ± 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (± SD) preoperative value of 35.7 ± 12.8 to 12.7 ± 4.7 mm Hg at 1-year follow-up and 11.9 ± 5.5 mm Hg at the last follow-up visit (P < 0.001). Number of medicines used for glaucoma was reduced from a mean ± SD preoperative value of 2.5 ± 0.9 to 0.5 ± 0.6 at 1-year follow-up and 0.6 ± 0.8 at the last follow-up visit (P < 0.001). LogMar visual acuity remained stable at mean of 1.15 ± 0.85 preoperatively, compared with 1.14 ± 1.05 at 1-year follow-up, but declined to 1.61 ± 1.01 at the last follow-up visit, a loss of an average of four lines of vision (P = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. Conclusions: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.