title: Pars plana Baerveldt tube insertion with pars plana vitrectomy for refractory glaucoma.
abstract: BACKGROUND
  Glaucoma drainage implants (GDIs) are used for managing recalcitrant glaucoma and are usually placed in the anterior chamber. This approach may lead to complications such as corneal decompensation, and so a pars plana approach is used in at risk eyes.
  
  
  OBJECTIVE
  To compare functional outcomes and complications of 250 mm(2) and 350 mm(2) pars plana Baerveldt tube insertion with pars plana vitrectomy (PPV) (both 20- and 23-gauge) for managing refractory glaucoma.
  
  
  METHODS
  A retrospective chart review of 38 patients (39 eyes) undergoing combined PPV-Baerveldt procedure for glaucoma recalcitrant to maximal medical treatment or previous filtering procedures with >6 weeks of follow-up.
  
  
  METHODS
  Main outcome measures were visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications.
  
  
  METHODS
  A paired 't' test was used to evaluate changes in IOP and glaucoma medications, Fisher's exact test was used to compare complication rates, and Kaplan-Meier survival curves were constructed for comparison of overall outcomes.
  
  
  RESULTS
  Mean patient age was 62.2 years. Mean follow-up period was 33.7 months, with 36 (92%) eyes followed for ≥6 months. Mean±SD preoperative IOP and number of glaucoma medications were significantly reduced by the combined procedure (P<0.05). Thirty-five (90%) eyes maintained final IOP between 6 and 21 mmHg. Vision improved by ≥2 lines in 10 (26%) eyes, remained stable in 15 (38%) eyes, and decreased in 14 (36%) eyes. Two (5.1%) eyes developed no light perception vision, with one (2.6%) eye becoming phthisical. Twenty-four (62%) eyes developed complications managed with conservative measures. Five (13%) eyes required ≥1 surgeries within a year of the combined procedure.
  
  
  CONCLUSIONS
  Pars plana Baerveldt tube implantation with PPV can preserve vision, reduce IOP, and decrease the number of glaucoma medications necessary to achieve target IOP in patients with recalcitrant glaucoma.
authors.affiliation: The Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
authors.forename: Anton M
authors.initials: AM
authors.lastname: Kolomeyer
authors.forename: H Jane
authors.initials: HJ
authors.lastname: Kim
authors.forename: Albert S
authors.initials: AS
authors.lastname: Khouri
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Lama
authors.forename: Robert D
authors.initials: RD
authors.lastname: Fechtner
authors.forename: Marco A
authors.initials: MA
authors.lastname: Zarbin
authors.forename: Neelakshi
authors.initials: N
authors.lastname: Bhagat