title: Occlusive ligature and standardized fenestration of a Baerveldt tube with and without antimetabolites for early postoperative intraocular pressure control.
abstract: OBJECTIVE
  To determine the effectiveness of a surgical modification for a nonvalved aqueous tube shunt in controlling intraocular pressure (IOP) in the early postoperative period. The effect of antimetabolite use on IOP also was studied.
  
  
  METHODS
  A retrospective study of consecutive patients who underwent modified Baerveldt 350-mm2 implant with varied, nonrandomized, exposure to antimetabolites.
  
  
  METHODS
  Fifty-one eyes of 46 patients with uncontrolled glaucoma were examined.
  
  
  METHODS
  Identical surgical modification of a Baerveldt 350-mm2 tube was performed in all cases and consisted of placement of an occlusive 7-0 polyglactin suture just anterior to the plate followed by a through-and-through penetration of the tube just anterior to the occlusive ligature with a standardized 15 degrees blade. Seventeen eyes were not exposed to antimetabolite, while 2 groups of 17 eyes had 3 minutes' episcleral exposure to either 5-fluorouracil 50 mg/ml or mitomycin C 0.4 mg/ml at the location corresponding to the fenestration. The Tenon's layer and conjunctiva were not exposed because of concerns regarding conjunctival erosion over the device.
  
  
  METHODS
  Intraocular pressure and number of antiglaucoma medications required were analyzed.
  
  
  RESULTS
  For the group, mean IOP before surgery and on postoperative days 1, 4, 10, 21, 42, 63, 84, and 112 was (in millimeters of mercury) 34.6, 20.1, 17.0, 17.2, 22.0, 17.3, 18.7, 17.4, and 15.6, respectively. There was an elevation of IOP at day 21 relative to fibrotic blockage of the fenestration before suture autolysis. This was temporized with antiglaucoma medication until suture autolysis occurred or treated with laser suture lysis (8 eyes). On day 1, hypotony occurred in 3 (6%) eyes whereas IOP greater than 30 mmHg was observed in 13 (26%) eyes. By day 10, the frequency had decreased to one (2.1 %) eye and three (6.4%) eyes, respectively. The use of antimetabolites did not result in lower IOP or less medication needed for any group at any interval (analysis of variance).
  
  
  CONCLUSIONS
  This modification of a nonvalved glaucoma tube shunt device provides adequate IOP control in the early postoperative period with a low rate of hypotony and surgical complications. If elevation of IOP occurs before suture autolysis, it generally is well controlled by antiglaucoma medications or laser suture lysis. Antimetabolite exposure did not influence early postoperative IOP in this study.
authors.affiliation: Eye Institute, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Trible
authors.forename: D B
authors.initials: DB
authors.lastname: Brown
mesh_terms: D000368:Aged; D000963:Antimetabolites / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000502:physiology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D008026:Ligation; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013537:Sutures
chemical_list: D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil