title: Long-term Outcomes of a Modified Technique Using the Baerveldt Glaucoma Implant for the Treatment of Refractory Glaucoma.
abstract: The purpose of the study was to evaluate the long-term effectiveness and safety profile of Baerveldt glaucoma implant (BGI) in patients with refractory glaucoma operated using a modified technique to avoid postoperative complications.
  
  
  
  A total of 160 eyes from 147 glaucomatous patients were enrolled in a consecutive interventional noncomparative case series. All the patients were treated with a 350-mm BGI using a modified technique. Intraocular pressure (IOP), the number of medications, the complications, and the postoperative interventions were reported preoperatively and during the follow-up. Postoperative IOP and the rate of complications were the primary outcome measures. The complete and qualified surgical success was the second endpoint.
  
  
  
  BGI obtained a mean IOP reduction from 31.8±6.4 mm Hg (baseline) to 14.4±3.5 mm Hg after a mean follow-up period of 38.4±9.6 months. The mean number of medications reduced between preoperative (n=3.17±1.03) and postoperative period (n=0.58±0.83) (P<0.0001). Cumulative probability of maintaining an IOP between 5 and 21 mm Hg and/or a 25% or greater reduction in IOP was 78.7% at 1 year and 72.1% at 4 years, including 39 eyes (24.4%) in which postoperative interventions were required (qualified success). If we exclude those eyes from the analysis, the probability of complete success was 93.4% at 1 year and 91.4% at 4 years in 75.4% of the eyes.
  
  
  
  This modified technique achieved a high percentage of surgical success during the whole follow-up time and was effective in preventing the most serious immediate complications of nonvalved tube shunts.
authors.affiliation: *Eye Clinic, Department of Neurological and Movement Sciences †Unit of Epidemiology & Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Marchini
authors.forename: Piero
authors.initials: P
authors.lastname: Ceruti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vizzari
authors.forename: Marco
authors.initials: M
authors.lastname: Toscani
authors.forename: Camilla
authors.initials: C
authors.lastname: Amantea
authors.forename: Roberto
authors.initials: R
authors.lastname: Tosi
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Marchetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008875:Middle Aged; D011184:Postoperative Period; D013997:Time Factors; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult