Rososinski Anthony, Wechsler David, Grigg John
*University of Sydney †Central Clinical School ††Sydney Medical School, The University of Sydney ‡Australian School of Advanced Medicine, Macquarie University §Concord Hospital ∥Liverpool Hospital ¶Department of Ophthalmology, Save Sight Institute, Sydney Eye Hospital Campus #Sydney Eye Hospital **The Children's Hospital Westmead, Sydney, Australia.
J Glaucoma. 2015 Feb;24(2):95-9. doi: 10.1097/IJG.0b013e31829d9be2.
To evaluate outcomes of pars plana (PP) versus anterior chamber (AC) placement of Baerveldt glaucoma drainage device (GDD).
This study is a nonrandomized, retrospective case series evaluating 63 eyes that underwent GDD insertion with Baerveldt 350 device under the supervision of 2 surgeons at 5 centers. The drainage tube was either inserted into the AC or through the PP into the vitreous cavity where eyes had been vitrectomized. Surgery was conducted between 2003 and 2010 with minimum patient follow-up of 6 months. Data on postoperative intraocular pressure (IOP), visual acuity, number of hypotensive medications, and surgical complications were recorded.
Of the 63 drainage device surgeries, 34 tubes were placed in the AC and 29 were placed into the posterior segment through the PP. Preoperative mean IOP was 32.3±20.3 mm Hg in the AC group and 32.8±18.4 mm Hg in the PP group. Postoperative mean IOP was reduced at all follow-up time points in both the groups. Postoperative mean IOP in the anterior tube group was 14.0, 12.9, and 14.0 mm Hg and in the PP group was 14.2, 14.2, and 14.0 mm Hg, at the 1-, 2-, and 3-year follow-up, respectively. The qualified success rate at 2 years was 94% for the PP group and 91% for the AC group, whereas absolute success was 35% for the PP group and 27% for the AC group at 2-year follow-up.
Insertion of the tube of the Baerveldt GDD into the PP is a safe and effective method for IOP control in aphakic, pseudophakic, and vitrectomized eyes where there is a need to avoid anterior tube placement such as coexisting corneal pathology. IOP control results appear comparable to conventional AC placement.
评估Baerveldt青光眼引流装置（GDD）经睫状体扁平部（PP）植入与前房（AC）植入的效果。
本研究为非随机回顾性病例系列，评估了在5个中心由2名外科医生指导下，使用Baerveldt 350装置进行GDD植入的63只眼。引流管要么插入前房，要么经睫状体扁平部插入已行玻璃体切割术的玻璃体腔。手术于2003年至2010年进行，患者最少随访6个月。记录术后眼压（IOP）、视力、降眼压药物使用数量及手术并发症的数据。
在63例引流装置手术中，34根引流管植入前房，29根经睫状体扁平部植入眼后段。前房组术前平均眼压为32.3±20.3 mmHg，睫状体扁平部组为32.8±18.4 mmHg。两组在所有随访时间点的术后平均眼压均降低。前房管组在1年、2年和3年随访时的术后平均眼压分别为14.0、12.9和14.0 mmHg，睫状体扁平部组分别为14.2、14.2和14.0 mmHg。睫状体扁平部组2年的合格成功率为94%，前房组为91%；而在2年随访时，睫状体扁平部组的绝对成功率为35%，前房组为27%。
对于无晶状体眼、人工晶状体眼及已行玻璃体切割术且需要避免前房管植入（如并存角膜病变）的眼睛，将Baerveldt GDD的引流管经睫状体扁平部植入是一种控制眼压的安全有效方法。眼压控制结果与传统前房植入相当。
