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Review
. 2020 Sep 24:14:2789-2797.
doi: 10.2147/OPTH.S219271. eCollection 2020.

The Baerveldt Glaucoma Drainage Device: Efficacy, Safety, and Place in Therapy

Huub J Poelman  1 , Roger C W Wolfs  1 , Wishal D Ramdas  1
Affiliations
Review

The Baerveldt Glaucoma Drainage Device: Efficacy, Safety, and Place in Therapy

Huub J Poelman et al. Clin Ophthalmol. .

Abstract

Objective: This review summarizes published findings concerning the Baerveldt-350 glaucoma drainage device (GDD). Most studies focus on the comparison between different treatments; in this review, the primary focus is efficacy, safety, and place in therapy for the Baerveldt implant.

Methods: A systematic review was performed using the PubMed database for literature on March 13th, 2020. Efficacy was estimated by performing multiple meta-analyses to calculate the weighted mean difference in intraocular pressure (IOP) and IOP-lowering medication after surgery. In order to get an indication of the safety of the Baerveldt implant, all recorded peri- and postoperative complication were summarized.

Results: A total of 21 studies, including 12 randomized controlled trials, were included with a follow-up up to 5 years, covering a mix of glaucoma types. At the last follow-up point, at 5 years postoperative, the mean (95% confidence interval) reduction in IOP was 15.57 mmHg (14.43-16.71) and the mean (95% confidence interval) reduction in IOP-lowering medication after surgery was 1.81 (1.61-2.01). Most frequently observed postoperative complications were corneal edema (2-34%) and tube complications (4-33%). Rates of required re-intervention ranged from 0% to 51% across all included studies.

Conclusion: The efficacy of the Baerveldt implant is a significant reduction in IOP in the long term. The safety profile of the Baerveldt implant in terms of complication incidence is similar to those reported for other GDD's. For treatment of secondary glaucoma, we suggest the Baerveldt (or any other similar GDD) as the choice of treatment in patients where highest IOP reduction is desired.

Keywords: Baerveldt implant; glaucoma; glaucoma drainage device; intraocular pressure.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of Pubmed search. Abbreviation: RCT, randomized controlled trial
Figure 2
Figure 2
Calculated means for reduction IOP at 1 day (2.A), 1 week (2.B), 1 month (2.C), 6 months (2.D), 1 year (2.E), 3 years (2.F) and 5 years (2.G) follow-up. Notes: Black diamonds indicate the overall weighted mean difference (WMD). The size of the green box is inversely proportional to the variance. Horizontal lines indicate 95% confidence interval (CI). The solid vertical line in each panel shows the value for no difference (WMD = 0). Abbreviation: IOP, intraocular pressure.
Figure 3
Figure 3
Mean reduction in postoperative IOP (mmHg; solid line) and number of IOP-lowering medications (dashed line). Notes: Dots represent mean. Bars represent 95% confidence interval. Abbreviation: IOP, intraocular pressure.
Figure 4
Figure 4
Calculated means for IOP-lowering medication reduction at 1 day (4.A), 1 week (4.B), 1 month (4.C), 6 months (4.D), 1 year (4.E), 3 years (4.F) and 5 years (4.G) follow-up. Notes: Black diamonds indicate the overall weighted mean difference (WMD). The size of the green box is inversely proportional to the variance. Horizontal lines indicate 95% confidence interval (CI). The solid vertical line in each panel shows the value for no difference (WMD = 0). Abbreviation: IOP, intraocular pressure.
See this image and copyright information in PMC

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