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Donald L Budenz - One of the best experts on this subject based on the ideXlab platform.

  • Glaucoma Drainage Implant surgery
    Developments in ophthalmology, 2012
    Co-Authors: Ahmad A. Aref, Steven J Gedde, Donald L Budenz
    Abstract:

    Glaucoma Drainage Implant (GDI) surgery represents a significant advance in the treatment of refractory Glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of Implants are currently available and differ in surface area, shape, composition, and presence or absence of a flow-restricting valve. A prospective, randomized clinical trial comparing two types of GDIs is ongoing. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.

  • outcomes of inferonasal baerveldt Glaucoma Drainage Implant surgery
    Journal of Glaucoma, 2006
    Co-Authors: Kara Hoffman Harbick, Anna S Venkatraman, Megan Bruther, Douglas K Grayson, Anne Ko, Paul A Sidoti, Donald L Budenz, Glara N Yi
    Abstract:

    PURPOSE: To determine the outcomes of inferonasal Baerveldt Glaucoma Implant (BGI) surgery. PATIENTS AND METHODS: A retrospective, non-comparative case series of 182 eyes of 182 patients who underwent inferonasal placement of a Baerveldt Glaucoma Implant. The main outcome measures included intraocular pressure, number of Glaucoma medications, best corrected visual acuity, and complications. RESULTS: Patients were followed for an average (+/- SD) of 19 +/- 15 months. Median Snellen visual acuity was unchanged at last follow-up. Intraocular pressure was reduced from a mean (+/- SD) of 28.6 +/- 11.5 mm Hg preoperatively to 13.4 +/- 5.7 mm Hg at most recent follow-up (P < 0.001). The number of antiGlaucoma medications was reduced from a mean (+/- SD) of 2.7 +/- 1.3 preoperatively to 1.1 +/- 1.1 at most recent follow-up. Nineteen eyes met our criteria for failure, yielding a cumulative percent survival of 92% at 12 months, 88% at 24 months, and 77% at 44 months. The most common complications were hyphema (14 eyes, 8%), choroidal effusion (12 eyes, 7%), and corneal decompensation (19 eyes, 10%). Endophthalmitis and diplopia occurred rarely (1 eye, <1%; 3 eyes, 2%, respectively). CONCLUSIONS: Inferonasal Baerveldt Glaucoma Implant placement appears to be a safe and effective surgical option that may be helpful in certain clinical situations.

  • baerveldt Glaucoma Implant in the management of refractory childhood Glaucomas
    Ophthalmology, 2004
    Co-Authors: Donald L Budenz, Steven J Gedde, James D Brandt, David Kira, William J. Feuer, Eric Larson
    Abstract:

    Abstract Purpose To evaluate the effectiveness and safety of the Baerveldt Glaucoma Drainage Implant (GDI) in the management of pediatric Glaucomas. Design Retrospective noncomparative case series. Participants Sixty-two children younger than 18 years who underwent Baerveldt GDI surgery. Main outcome measures Intraocular pressure (IOP), intraoperative and postoperative complications, number of Glaucoma medications, and VA. Success was defined as IOP of Results Sixty-two eyes of 62 patients were identified. The mean patient age (± standard deviation) at time of Baerveldt Glaucoma Implant surgery was 6.5±5.6 years (range, 6 weeks–17 years). With an average follow-up of 23.4±21.7 months (range, 1–106), IOP was reduced from a mean of 35.0±8.7 mmHg (range, 17–54) preoperatively to 17.6±8.4 mmHg (range, 5–45) at last follow-up visit ( P P = 0.21). Conclusion Baerveldt Glaucoma Implant surgery seems to be an effective treatment for primary and secondary refractory Glaucomas in children. There is a risk of retinal detachment that may be related to the Implant or other ocular conditions.

  • combined baerveldt Glaucoma Drainage Implant and trabeculectomy with mitomycin c for refractory Glaucoma
    Journal of Glaucoma, 2002
    Co-Authors: Donald L Budenz, Michael Bueche, Quang H. Nguyen, Ingrid U. Scott, Marcelo T Nicolela, William J. Feuer, Kuldev Singh, Paul Palmberg
    Abstract:

    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 ( < 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 ( < 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 ( = 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.

  • combined cataract extraction and baerveldt Glaucoma Drainage Implant indications and outcomes
    Ophthalmology, 2002
    Co-Authors: Kara Hoffman, Steven J Gedde, Donald L Budenz, Robert M Feldman, Grace Abou Chacra, Joyce C Schiffman
    Abstract:

    Abstract Purpose To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt Glaucoma Drainage Implant surgery. Design Noncomparative, interventional, retrospective, consecutive case series. Participants Thirty-three eyes of 33 patients. Intervention Combined phacoemulsification CE and Baerveldt Glaucoma Drainage Implant (BGI) surgery at two tertiary care referral centers. Main outcome measures Visual acuity, intraocular pressure (IOP), and complications. Results The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0–46.9). The most common indication for combined CE and Baerveldt Glaucoma Drainage Implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was ≥20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (± standard deviation) of 21 ± 7.3 mmHg preoperatively to 13.1 ± 3.5 mmHg at last follow-up visit ( P P Conclusions Combined CE and Baerveldt Glaucoma Drainage Implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

Steven J Gedde - One of the best experts on this subject based on the ideXlab platform.

  • Glaucoma Drainage Implant surgery
    Developments in ophthalmology, 2012
    Co-Authors: Ahmad A. Aref, Steven J Gedde, Donald L Budenz
    Abstract:

    Glaucoma Drainage Implant (GDI) surgery represents a significant advance in the treatment of refractory Glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of Implants are currently available and differ in surface area, shape, composition, and presence or absence of a flow-restricting valve. A prospective, randomized clinical trial comparing two types of GDIs is ongoing. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.

  • baerveldt Glaucoma Implant in the management of refractory childhood Glaucomas
    Ophthalmology, 2004
    Co-Authors: Donald L Budenz, Steven J Gedde, James D Brandt, David Kira, William J. Feuer, Eric Larson
    Abstract:

    Abstract Purpose To evaluate the effectiveness and safety of the Baerveldt Glaucoma Drainage Implant (GDI) in the management of pediatric Glaucomas. Design Retrospective noncomparative case series. Participants Sixty-two children younger than 18 years who underwent Baerveldt GDI surgery. Main outcome measures Intraocular pressure (IOP), intraoperative and postoperative complications, number of Glaucoma medications, and VA. Success was defined as IOP of Results Sixty-two eyes of 62 patients were identified. The mean patient age (± standard deviation) at time of Baerveldt Glaucoma Implant surgery was 6.5±5.6 years (range, 6 weeks–17 years). With an average follow-up of 23.4±21.7 months (range, 1–106), IOP was reduced from a mean of 35.0±8.7 mmHg (range, 17–54) preoperatively to 17.6±8.4 mmHg (range, 5–45) at last follow-up visit ( P P = 0.21). Conclusion Baerveldt Glaucoma Implant surgery seems to be an effective treatment for primary and secondary refractory Glaucomas in children. There is a risk of retinal detachment that may be related to the Implant or other ocular conditions.

  • combined cataract extraction and baerveldt Glaucoma Drainage Implant indications and outcomes
    Ophthalmology, 2002
    Co-Authors: Kara Hoffman, Steven J Gedde, Donald L Budenz, Robert M Feldman, Grace Abou Chacra, Joyce C Schiffman
    Abstract:

    Abstract Purpose To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt Glaucoma Drainage Implant surgery. Design Noncomparative, interventional, retrospective, consecutive case series. Participants Thirty-three eyes of 33 patients. Intervention Combined phacoemulsification CE and Baerveldt Glaucoma Drainage Implant (BGI) surgery at two tertiary care referral centers. Main outcome measures Visual acuity, intraocular pressure (IOP), and complications. Results The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0–46.9). The most common indication for combined CE and Baerveldt Glaucoma Drainage Implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was ≥20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (± standard deviation) of 21 ± 7.3 mmHg preoperatively to 13.1 ± 3.5 mmHg at last follow-up visit ( P P Conclusions Combined CE and Baerveldt Glaucoma Drainage Implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

  • tube fenestrations in baerveldt Glaucoma Implant surgery 1 year results compared with standard Implant surgery
    Journal of Glaucoma, 2002
    Co-Authors: Geoffrey T. Emerick, Steven J Gedde, Donald L Budenz
    Abstract:

    PURPOSE: To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery. PATIENTS AND METHODS: The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory Glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 Implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications. RESULTS: Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of Glaucoma medications used by group 1 patients was significantly lower up to 3 months (P Glaucoma medicines up to 12 months after surgery. CONCLUSION: Tube fenestrations provide safe and effective short-term intraocular pressure control with fewer Glaucoma medications in a ligated nonvalved Glaucoma Drainage Implant, with comparable intraocular pressure control and medications required at 1 year. However, not all patients have sustained reduction of intraocular pressure in the immediate postoperative period with fenestrations, making the effect somewhat unpredictable.

  • long term surgical outcomes of patients with Glaucoma secondary to the iridocorneal endothelial syndrome
    Ophthalmology, 2001
    Co-Authors: Donald L Budenz, Steven J Gedde, Nauman R Imami
    Abstract:

    Abstract Purpose To report the long-term outcomes of patients with iridocorneal endothelial (ICE) syndrome who required surgery for Glaucoma. Design Retrospective, noncomparative case series. Participants Twenty-six patients with ICE syndrome who underwent surgery for Glaucoma at one institution between January 1987 and January 2000. Main outcome measures Intraocular pressure (IOP), visual acuity, number of Glaucoma medications, and further surgical interventions were measured. Results Five eyes had a trabeculectomy with an antifibrotic agent alone, seven eyes had a trabeculectomy with an antifibrotic agent and a subsequent Glaucoma Drainage Implant (GDI), and 14 eyes had a GDI alone. In eyes that underwent a trabeculectomy with an antifibrotic agent, preoperative IOP was reduced from a mean of 38.8 ± 10.5 mmHg on 2.3 ± 0.8 Glaucoma medications to a mean of 11.8 ± 4.3 mmHg on 1.2 ± 1.4 medications at last follow-up after surgery (83.8 ± 40.3 months). In eyes that underwent GDI surgery, preoperative IOP was reduced from a mean of 35.2 ± 13.0 mmHg on 2.0 ± 1.3 Glaucoma medications to a mean of 8.7 ± 11.2 mmHg on 1.2 ± 1.1 medications at last follow-up after surgery (50.5 ± 40.7 months). Twenty-four eyes (92%) had an IOP less than 22 mmHg, and 22 eyes (85%) had visual acuity 20/400 or better at last follow-up (55.8 ± 41.5 months). Mean number of Glaucoma surgeries per patient over the follow-up period was 1.6 ± 1.2. Trabeculectomy with antifibrotic agents had a survival of 73% at 1 year, 44% at 3 years, and 29% at 5 years. Glaucoma Drainage Implants had a survival of 71% at 1 year, 71% at 3 years, and 53% at 5 years. Conclusions Glaucoma associated with ICE syndrome can be managed successfully surgically, although multiple procedures are often needed.

Ingrid U. Scott - One of the best experts on this subject based on the ideXlab platform.

  • Glaucoma Drainage Implant surgery-An evidence-based update with relevance to Sub-Saharan Africa
    Middle East African Journal of Ophthalmology, 2013
    Co-Authors: Ardalan E Aminlari, Ingrid U. Scott, Ahmad A. Aref
    Abstract:

    Glaucoma represents a leading cause of preventable vision loss in Sub-Saharan Africa. Recent studies evaluating outcomes of Glaucoma Drainage Implant (GDI) surgery suggest an important role for this approach in the African patient population. The Tube Versus Trabeculectomy study demonstrated a higher success rate with non-valved GDI surgery compared to trabeculectomy with mitomycin C after five years. The Ahmed Baerveldt Comparison study showed no difference in surgical failure rates between the Ahmed Glaucoma Valve and the Baerveldt Glaucoma Implant (BGI) but better intraocular pressure outcomes with the BGI at one year. The Ahmed Versus Baerveldt study demonstrated a lower failure rate for the BGI, but also a requirement for more post-operative interventions. Further study of GDI surgery in the Sub-Saharan Africa is necessary to determine its optimal place in the treatment paradigm for Glaucoma patients in the region.

  • combined baerveldt Glaucoma Drainage Implant and trabeculectomy with mitomycin c for refractory Glaucoma
    Journal of Glaucoma, 2002
    Co-Authors: Donald L Budenz, Michael Bueche, Quang H. Nguyen, Ingrid U. Scott, Marcelo T Nicolela, William J. Feuer, Kuldev Singh, Paul Palmberg
    Abstract:

    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 ( < 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 ( < 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 ( = 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.

  • Late endophthalmitis associated with Glaucoma Drainage Implants
    Ophthalmology, 2001
    Co-Authors: Steven J Gedde, Donald L Budenz, Ingrid U. Scott, Homayoun Tabandeh, David S. Greenfield, Harry W Flynn
    Abstract:

    Abstract Objective To report the clinical course of a series of patients who had late endophthalmitis develop after Glaucoma Drainage Implant (GDI) surgery. Design Noncomparative, interventional, consecutive case series. Participants Four patients were identified with late endophthalmitis associated with Baerveldt Glaucoma Implants. Methods The medical records of all patients with endophthalmitis associated with a GDI treated at the Bascom Palmer Eye Institute or University of Florida between January 1, 1987 and December 31, 1999 were retrospectively reviewed. Patients with culture-positive endophthalmitis diagnosed more than 1 month after GDI surgery were included in this series. Main outcome measures Visual acuity and intraocular pressure (IOP). Results Late endophthalmitis associated with Baerveldt Glaucoma Implants developed 7 weeks to 2 years postoperatively. Exposure of the GDI tube was present in all cases. The Implant was removed in three of four patients. Visual acuity worsened from preinfection level in two of four cases. IOP was controlled at last follow-up in all patients, although replacement of the explanted GDI was required in one patient. Conclusions Late endophthalmitis may occur after GDI surgery. Exposure of the GDI tube seems to represent a major risk factor for these infections. To prevent this potentially devastating complication, we recommend prophylactic surgical revision with a patch graft in all cases in which there is an exposed GDI tube.

  • combined pars plana vitrectomy and Glaucoma Drainage Implant placement for refractory Glaucoma
    American Journal of Ophthalmology, 2000
    Co-Authors: Ingrid U. Scott, Steven J Gedde, Donald L Budenz, Joyce C Schiffman, George Alexandrakis, Harry W Flynn, William E Smiddy, Timothy G Murray, Francisco Fantes, Richard K Parrish
    Abstract:

    Abstract PURPOSE: To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a Glaucoma Drainage Implant. METHODS: The medical records of all patients who underwent combined pars plana vitrectomy and placement of a Glaucoma Drainage Implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular Glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure Glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively. RESULTS: At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7.5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiGlaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiGlaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiGlaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further Glaucoma surgery for uncontrolled intraocular pressure. CONCLUSIONS: Although combined pars plana vitrectomy and placement of a Glaucoma Drainage Implant is often a successful management option in selected patients with refractory Glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.

Ahmad A. Aref - One of the best experts on this subject based on the ideXlab platform.

  • Glaucoma Drainage Implant surgery combined with pars plana vitrectomy and kpro Implantation
    2015
    Co-Authors: Thasarat S Vajaranant, Ahmad A. Aref
    Abstract:

    Glaucoma occurs with a relatively high frequency after Boston KPro (KPro) Implantation. Disease course is often aggressive in nature and requires surgical intervention. Combined surgical techniques involving Glaucoma Drainage Implant (GDI) surgery at the time of initial KPro Implantation provide for successful postoperative results. The current chapter describes a technique involving combined GDI, KPro, and vitreoretinal surgeries. Posterior placement of the GDI tube allows for adequate postoperative contact lens fitting, decreasing the risk of conjunctival erosion and subsequent tube exposure. Patient candidates for this procedure must demonstrate medical and social stability as rigorous postoperative care is required to allow for proper monitoring and adjustment of medications. Coordination of care among expert ophthalmic subspecialists allows for optimal surgical outcome.

  • outcomes of pars plana Glaucoma Drainage Implant in boston type 1 keratoprosthesis surgery
    Journal of Glaucoma, 2014
    Co-Authors: Eun S Huh, Ahmad A. Aref, Thasarat S Vajaranant, Jose De La Cruz, Felix Y Chau, Maria S Cortina
    Abstract:

    PURPOSE Glaucoma Drainage Implantation in conjunction with Boston Type 1 Keratoprosthesis placement is a surgical option in controlling postoperative Glaucoma. The purpose of this study is to report outcomes of combined pars plana vitrectomy and Glaucoma Drainage Implantation with corneal patch graft in Boston Type 1 Keratoprosthesis patients. PATIENTS AND METHODS A retrospective review of patients who underwent pars plana Glaucoma Drainage Implantation in combination with Boston Type 1 Keratoprosthesis was performed. Preoperative and postoperative parameters collected and analyzed included: visual acuity, intraocular pressure, number of Glaucoma medications to achieve intraocular pressure control, bandage contact lens fit, and postoperative complications. RESULTS Twenty eyes of 20 patients were identified; 95% had preoperative diagnosis of Glaucoma, utilizing on an average 2.5 medications with an average intraocular pressure of 19.8 mm Hg (±6.3 mm Hg; range, 9 to 32.8 mm Hg). After placement of the pars plana Glaucoma Drainage Implant, an average intraocular pressure of 19 mm Hg (±7.0 mm Hg; range, 8 to 30 mm Hg) by scleral pneumotonometry was achieved and 85% were deemed to have normal pressures by digital palpation. An average of 2.1 intraocular pressure-lowering medications were required on last follow-up. Average follow-up was 31.6 months (±17.4 mo; range, 12.3 to 71.6 mo). Two eyes required Glaucoma Drainage Implant explantation: one eye due to endophthalmitis from a nonhealing corneal ulcer and the other eye due to corneal melt. None of our patients experienced conjunctival erosion over a pars plana positioned Glaucoma Drainage Implant or tube. CONCLUSIONS For the long-term management of Glaucoma in keratoprosthesis patients, a posteriorly placed pars plana Glaucoma Drainage Implant with corneal patch graft in conjunction with keratoprosthesis has a low risk of erosion and postoperative complications.

  • Glaucoma Drainage Implant surgery and ocular surface transplant graft preservation.
    Seminars in ophthalmology, 2013
    Co-Authors: Ahmad A. Aref, Kavitha R. Sivaraman, Ali R. Djalilian
    Abstract:

    Glaucoma may develop or worsen after ocular surface transplantation and often requires surgical management for adequate intraocular pressure control. Traditional Glaucoma filtering procedures in patients with prior ocular surface transplant may be problematic for several reasons, which include mechanical disruption of the pre-existing graft, epithelial and stem cell toxicity induced by antifibrotic agents, and increased risk of future corneal transplantation failure. We describe the Implantation of a Glaucoma Drainage Implant via a limbal-based conjunctival incision with tube placement in the ciliary sulcus in three eyes of two patients with prior ocular surface transplantation. At a follow-up interval of 3–7 months, all three eyes have excellent postoperative control of intraocular pressure, stable vision, and healthy ocular surface grafts.

  • Glaucoma Drainage Implant surgery-An evidence-based update with relevance to Sub-Saharan Africa
    Middle East African Journal of Ophthalmology, 2013
    Co-Authors: Ardalan E Aminlari, Ingrid U. Scott, Ahmad A. Aref
    Abstract:

    Glaucoma represents a leading cause of preventable vision loss in Sub-Saharan Africa. Recent studies evaluating outcomes of Glaucoma Drainage Implant (GDI) surgery suggest an important role for this approach in the African patient population. The Tube Versus Trabeculectomy study demonstrated a higher success rate with non-valved GDI surgery compared to trabeculectomy with mitomycin C after five years. The Ahmed Baerveldt Comparison study showed no difference in surgical failure rates between the Ahmed Glaucoma Valve and the Baerveldt Glaucoma Implant (BGI) but better intraocular pressure outcomes with the BGI at one year. The Ahmed Versus Baerveldt study demonstrated a lower failure rate for the BGI, but also a requirement for more post-operative interventions. Further study of GDI surgery in the Sub-Saharan Africa is necessary to determine its optimal place in the treatment paradigm for Glaucoma patients in the region.

  • Glaucoma Drainage Implant surgery
    Developments in ophthalmology, 2012
    Co-Authors: Ahmad A. Aref, Steven J Gedde, Donald L Budenz
    Abstract:

    Glaucoma Drainage Implant (GDI) surgery represents a significant advance in the treatment of refractory Glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of Implants are currently available and differ in surface area, shape, composition, and presence or absence of a flow-restricting valve. A prospective, randomized clinical trial comparing two types of GDIs is ongoing. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.

Peter A Netland - One of the best experts on this subject based on the ideXlab platform.

  • treatment of uveitis and outcomes of Glaucoma Drainage Implant surgery a meta analysis
    Ocular Immunology and Inflammation, 2020
    Co-Authors: Meenakshi Chaku, Asima Bajwa, Jae K Lee, Peter A Netland
    Abstract:

    Purpose: We performed a meta-analysis to evaluate the effect of uveitis treatment on Glaucoma Drainage Implant surgical outcomes.Methods: We included 16 articles in the meta-analysis. Two groups we...

  • The evolution of Glaucoma Drainage Implants
    Wolters Kluwer Medknow Publications, 2018
    Co-Authors: Frank S Ashburn, Peter A Netland
    Abstract:

    The modern Glaucoma Drainage Implant era was initiated with Implantation of a plate posterior to the limbus connected to the anterior chamber by a long silicone tube. Non-restrictive (Molteno and Baerveldt Implants) and flow-restrictive (Ahmed Glaucoma Valve) Implants were developed. With increased clinical experience, variables influencing success and failure of Glaucoma Drainage Implant surgery were better understood. In an iterative process, complications were reduced and indications for Drainage Implant surgery were broadened. Growth of utilization of Glaucoma Drainage Implants has dramatically increased in recent years. Glaucoma Drainage Implants have improved the prognosis for surgical success for refractory Glaucoma, and have a well-established role in the surgical treatment of Glaucoma

  • risk factors for tube exposure as a late complication of Glaucoma Drainage Implant surgery
    Clinical Ophthalmology, 2016
    Co-Authors: Meenakshi Chaku, Peter A Netland, Kyoko Ishida, Douglas J Rhee
    Abstract:

    Purpose The purpose of this study was to evaluate the risk factors for tube exposure after Glaucoma Drainage Implant surgery.

  • management of Glaucoma Drainage Implant tube kink and obstruction with pars plana clip
    Ophthalmic Surgery and Lasers, 2005
    Co-Authors: Peter A Netland, Stefanie G Schuman
    Abstract:

    Increased intraocular pressure after Glaucoma Drainage Implant surgery may be caused by obstruction of the tube. A case of obstruction of an Ahmed Glaucoma valve tube after pars plana insertion due to kinking of the tube was treated with a Pars Plana Clip (New World Medical, Rancho Cucamonga, CA).

  • clinical experience with the baerveldt Glaucoma Drainage Implant
    Ophthalmology, 1995
    Co-Authors: Scott W Siegner, Peter A Netland, Robert C Urban, Sydney A Williams, David W Richards, Mark A Latina, James D Brandt
    Abstract:

    Purpose: To assess clinical outcomes in patients who were treated with the Baerveldt Glaucoma Drainage Implant. Methods: The authors performed a retrospective multicenter study of 100 patients (103 eyes) with medically uncontrollable Glaucomas who underwent a one-stage Implantation with either the 200-, 250-, 350-, or 500-mm2 Baerveldt Implant. The authors defined surgical success as 5 mmHg less than intraocular pressure less than 22 mmHg without additional Glaucoma surgery and without loss of light perception. Results: With a mean follow-up of 13.6 ± 0.9 months (range, 4-37 months), 74 eyes (71.8%) had successful outcomes. Cumulative life-table success rates were 90.3% at 3 months (n = 103), 72.6% at 6 months (n = 84), and 60.3% at 24 months (n = 34). Intraocular pressure (IOP) was reduced from a mean of 38.5 ± 1.4 mmHg with 2.2 ± 0.1 antiGlaucoma medications to 15.1 ± 0.8 mmHg ( P P Conclusion: The Baerveldt Implant is effective in lowering the IOP in patients with intractable Glaucomas. Hypotony and other complications are common, which also have been reported in other nonvalved Glaucoma Drainage Implants. However, the majority of these complications did not affect surgical outcome.