Long-term results of combined endoscope-assisted pars plana vitrectomy and glaucoma tube shunt surgery

Abstract

Purpose: To assess outcomes after endoscope-assisted pars plana vitrectomy with concurrent pars plana tube shunt placement.

Methods: Records of 18 adult patients (19 eyes) with uncontrolled chronic angle-closure glaucoma associated with corneal opacification or fibrosed pupils were retrospectively reviewed. All eyes underwent endoscope-assisted pars plana vitrectomy with Baerveldt tube shunt placement into the vitreous cavity between 1997 and 2005. Intraocular pressure reduction, glaucoma medication reduction, complications, and visual acuity were analyzed.

Results: Mean follow-up duration was 62 months (range, 10-106 months). Mean preoperative intraocular pressure was 31.3 ± 10.5 mmHg on 3.4 ± 1.0 glaucoma medications. Intraocular pressure was significantly reduced at each postoperative time point examined. In the 17 eyes without phthisis, intraocular pressure was significantly reduced at the final follow-up examination to a mean of 11.4 ± 2.9 mmHg (P < 0.0001) on 1.3 ± 1.2 medications (P < 0.0001). No complications occurred in 14 of 19 eyes. Postoperatively, best-attained visual acuity improved in 14 of 19 eyes, remained unchanged in 4 of 19 eyes, and was reduced in 1 of 19 eyes.

Conclusion: Combined endoscope-assisted pars plana vitrectomy with placement of a Baerveldt tube shunt into the vitreous cavity is a useful intervention in patients with uncontrolled chronic angle-closure glaucoma, media opacities, and limited surgical options.

Figure 1

Patient #6 demonstrating an edematous, failed corneal graft (left) and patient # 9 demonstrating a fibrosed pupil (right).

Figure 2

Mean intraocular pressure (mmHg) values with standard deviation at baseline and at postoperative follow-up intervals.

Figure 3

Kaplan-Meier cumulative probability curve of success (with or without medications) for intraocular pressure (IOP) ≤21 mmHg.