title: Vision Loss and Recovery after Baerveldt Aqueous Tube Shunt Implantation.
abstract: This study aims to determine the course of vision loss after Baerveldt aqueous tube shunt placement and identify risk factors associated with unexplained severe long-term vision loss, or snuff-out. We retrospectively reviewed 247 eyes of 222 patients who underwent Baerveldt implantations at one of two academic institutions. Postoperative vision loss at 6 months following surgery was categorized as mild-to-moderate versus severe and long-term versus transient. Long-term vision loss, defined as 3 or more lines of Snellen visual acuity (VA) loss compared with preoperative VA, occurred in 63 of 247 eyes (25.5%), and 39 had mild-to-moderate and 24 had severe loss. Of these 63 eyes, 18 had no identifiable cause of vision loss. On multivariate analysis, poorer Snellen VA on postoperative day 1 (POD1) was found to be a significant risk factor for long-term vision loss (p= 0.005). In addition, the negative change in preoperative versus POD1 Snellen VA (p= 0.021) and the presence of split fixation involving the inferonasal quadrant on preoperative Humphrey visual field (p= 0.044) were significant risk factors for snuff-out. Transient vision loss occurred in 76 of 242 eyes (30.8%). In conclusion, vision loss is not uncommon after Baerveldt surgery, with snuff-out occurring in 2.4% of cases in this study.
authors.affiliation: University of Southern California Eye Institute, Department of Ophthalmology, Keck School of Medicine, The University of Southern California, Los Angeles, CA, USA; Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Esther Lee
authors.initials: EL
authors.lastname: Kim
authors.affiliation: University of Southern California Eye Institute, Department of Ophthalmology, Keck School of Medicine, The University of Southern California, Los Angeles, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tran
authors.affiliation: Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Töteberg-Harms
authors.affiliation: University of Southern California Eye Institute, Department of Ophthalmology, Keck School of Medicine, The University of Southern California, Los Angeles, CA, USA.
authors.forename: Jasdeep
authors.initials: J
authors.lastname: Chahal
authors.affiliation: Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology and Visual Sciences, Case Western Medical Center, Cleveland, OH, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Rhee
authors.affiliation: Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Vikas
authors.identifier: 0000-0002-3372-0026
authors.initials: V
authors.lastname: Chopra
authors.affiliation: Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Brian
authors.identifier: 0000-0001-6493-5313
authors.initials: B
authors.lastname: Francis