Surgical Outcomes of Baerveldt Glaucoma Implant Versus Ahmed Glaucoma Valve in Neovascular Glaucoma: A Retrospective Multicenter Study.

INTRODUCTION

This multicenter retrospective study compared the surgical outcomes of Baerveldt glaucoma implant (BGI) surgery with those of Ahmed glaucoma valve (AGV) surgery in patients with neovascular glaucoma (NVG).

METHODS

The study included patients with NVG aged ≥ 20 years who had undergone BGI (223 eyes) or AGV (146 eyes) surgery between April 1, 2012 and December 31, 2021 across 10 clinical centers in Japan. Surgical success or failure was the primary outcome measure of this study. We defined surgical failure as a reduction of < 20% in the pre-operative intraocular pressure (IOP) or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). In addition, we considered a requirement for re-operation, loss of light perception, and hypotony as surgical failure.

RESULTS

The surgical success rate of the BGI surgery group was significantly higher than that of the AGV group for criteria A (P = 0.01) and B (P = 0.01). Multivariate analysis revealed that AGV surgery showed significant associations with surgical failure for criteria A (hazard ratio, 1.74), B (hazard ratio, 1.72), and C (hazard ratio, 1.34). The overall incidence of postoperative complications was comparable between the two groups. The requirement for re-operation in the AGV surgery group was significantly higher than that in the BGI surgery group (12.3% vs. 5.8%, P = 0.03).

CONCLUSIONS

BGI surgery yielded a higher success rate than AGV surgery in patients with NVG for a target IOP of < 21 or < 17 mmHg. No significant differences were observed between the two procedures in terms of the incidence of postoperative complications. Additional glaucoma surgery was required more frequently following AGV surgery. Therefore, BGI surgery may be a more suitable and efficacious option for the management of IOP in patients with neovascular glaucoma compared with AGV surgery.