Baerveldt-350 with adjunctive goniotomy: One-year outcomes

To report one-year outcomes of non-valved aqueous shunt implantation with concurrent excisional goniotomy.

This retrospective chart review included twenty-seven eyes from 25 patients. All eyes underwent goniotomy at the time of implantation of a superotemporal Baerveldt-350 device. All tubes were fenestrated three times using a spatulated SE-160-8 needle. Concurrent cataract surgery was performed in 56 % of eyes; all others were pseudophakic. Mean patient age was 71 years, 56 % were female, 96 % were Black, and 85 % had primary open-angle glaucoma. The mean pre-op IOP was 21.9 mmHg on 4.2 medications and mean IOP at postoperative year 1 (POY1) was 10.8 mmHg (50.7 % reduction) on 2.2 medications (47.7 % reduction). At POY1, no eyes had IOP ≤5 mmHg for two consecutive visits after three months, lost light perception, or required reoperation for glaucoma. All eyes had medicated IOP <21 mmHg but 3 of 27 eyes (11 %) had an IOP reduction <20 %, though two of those eyes had undergone surgery for the purpose of medication reduction. Our failure rate, average IOP reduction, and average medication reduction (11.0 %, 50.7 %, and 47.7 %, respectively) compare favorably to those of PTVT (17.3 %, 40.8 %, and 32.2 %, respectively).

Baerveldt-350 implantation with concurrent goniotomy is a safe and efficacious method to enhance early IOP lowering prior to ligature dissolution as well as one-year IOP and medication outcomes. This technique compares favorably to BGI-350 results in the literature, and future studies with larger sample sizes and longer follow-up are warranted.