PURPOSE: The authors determined the effectiveness of two different methods of modification of Baerveldt aqueous shunts in the control of early postoperative intraocular pressure. METHODS: The authors retrospectively reviewed charts of 122 eyes of 113 patients who underwent a Baerveldt 350-mm(2) modified with tube fenestration and charts of 129 eyes of 122 patients who underwent a Baerveldt 350-mm(2) modified with a nonocclusive ligature to examine early postoperative intraocular pressure control. In the fenestration group, the tube was modified with a 4-0 intraluminal suture and an occlusive 6-0 external polyglactin ligature before ocular placement. After ocular placement, the tube was further modified with one to three perforating fenestrations. In the nonocclusive-ligature group, the tube was modified with a 4-0 nylon intraluminal suture with a nonocclusive 6-0 external polyglactin ligature before ocular placement. RESULTS: A total of 94 eyes (77%) achieved adequate intraocular pressure control with or without adjunctive medications and. A total of 28 eyes (23%) had postoperative hypertension or hypotony in the fenestration group versus 81 (62.8%) and 48 (37.2%) eyes in the nonocclusive-ligature group (P = 0.014), respectively. The mean change in intraocular pressure preoperatively and 3 months postoperatively was 18.2 mm Hg versus 21.0 mm Hg (P = 0.11) in the fenestration and nonocclusive-ligature groups, respectively. CONCLUSIONS: Both the nonocclusive ligature and the fenestration methods provide desirable decreases in intraocular pressure in the immediate postoperative period and 3 months postoperatively; however, the fenestration modification may achieve adequate intraocular pressure control more often in the early postoperative period.
PURPOSE: The authors determined the effectiveness of two different methods of modification of Baerveldt aqueous shunts in the control of early postoperative intraocular pressure. METHODS: The authors retrospectively reviewed charts of 122 eyes of 113 patients who underwent a Baerveldt 350-mm(2) modified with tube fenestration and charts of 129 eyes of 122 patients who underwent a Baerveldt 350-mm(2) modified with a nonocclusive ligature to examine early postoperative intraocular pressure control. In the fenestration group, the tube was modified with a 4-0 intraluminal suture and an occlusive 6-0 external polyglactin ligature before ocular placement. After ocular placement, the tube was further modified with one to three perforating fenestrations. In the nonocclusive-ligature group, the tube was modified with a 4-0 nylon intraluminal suture with a nonocclusive 6-0 external polyglactin ligature before ocular placement. RESULTS: A total of 94 eyes (77%) achieved adequate intraocular pressure control with or without adjunctive medications and. A total of 28 eyes (23%) had postoperative hypertension or hypotony in the fenestration group versus 81 (62.8%) and 48 (37.2%) eyes in the nonocclusive-ligature group (P = 0.014), respectively. The mean change in intraocular pressure preoperatively and 3 months postoperatively was 18.2 mm Hg versus 21.0 mm Hg (P = 0.11) in the fenestration and nonocclusive-ligature groups, respectively. CONCLUSIONS: Both the nonocclusive ligature and the fenestration methods provide desirable decreases in intraocular pressure in the immediate postoperative period and 3 months postoperatively; however, the fenestration modification may achieve adequate intraocular pressure control more often in the early postoperative period.