Choroidal Detachment After Baerveldt Glaucoma Implant Surgery: Incidence and Risk Factors

To investigate the incidence and risk factors for postoperative choroidal detachment (CD) following Baerveldt glaucoma implant (BGI) surgery.

We conducted a retrospective cohort study including adult patients who underwent BGI surgery using a 350-mm² endplate at Fukui University Hospital between April 2012 and March 2025. We excluded patients who had eyes with no light perception, prior tube-shunt surgery, postoperative follow-up of ˂3 months, or additional intraocular surgery within 3 months. CD was diagnosed by fundoscopy using B-scan ultrasonography when fundus visualization was limited. The clinical characteristics and postoperative intraocular pressure (IOP) were compared between eyes with and without CD. Multivariable logistic regression analysis was performed to identify independent risk factors for CD, and exploratory analyses were conducted to compare early- and delayed-onset CD. For these exploratory analyses, early-onset CD was defined as occurring within 10 days after surgery and delayed-onset CD as occurring 30 days or later.

We analyzed the data of 261 eyes, and postoperative CD developed in 48 eyes (18.4%). Eyes with CD were significantly older and showed lower postoperative day 1 IOP and the lowest postoperative IOP within 7 days compared with those without CD. Multivariable analysis revealed that older age (odds ratio [OR] 1.06 per year, P < 0.01) and greater postoperative IOP reduction (OR 1.08 per mmHg, P < 0.01) were independently associated with CD. Among the eyes with CD, 37 were classified as early onset and 11 as delayed onset. Exploratory analyses suggested that early-onset CD tended to be associated with a greater number of previous intraocular surgeries, longer axial length, differences in tube insertion site, and lower postoperative day 1 IOP compared with delayed-onset CD.

Older age and greater postoperative IOP reduction were independently associated with CD after BGI surgery, suggesting that rapid postoperative IOP reduction may play an important role in CD pathogenesis. Early- and delayed-onset CD may reflect different postoperative mechanisms of aqueous humor dynamics following BGI surgery.