IOP control and corneal endothelial cell density changes

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IOP control and corneal endothelial cell density changes P-FS-316 IOP control and corneal endothelial cell density changes after Baerveldt glaucoma implant fixed at the ciliary sulcus Sotaro Mori1※, Mari Sakamoto1 , Kaori Ueda1 , Yukako Inoue1 , Takuji Kurimoto1, Akiyasu Kanamori1 , Yuko Yamada1 , Makoto Nakamura1 1 ) Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine *E-mail address: smori@med.kobe-u.ac.jp Purpose There is increasing popularity to perform Baerveldt glaucoma implant (BGI) for the treatment of refractory glaucoma. However, the placement of BGI tube in the anterior chamber is known to increase a chance of corneal endothelial damages, while the ciliary body-fixed type BGI requires vitrectomy. The placement of BGI tube at the ciliary sulcus may be used as an option to reduce the risk for corneal endothelial damage. To test this issue, we investigated the IOP control and corneal endothelial density (ECD) after the ciliary sulcus-fixed BGI. Methods This study is a prospective interventional non-randomized non-comparative case series, which comprised twenty eight eyes of 27 consecutive patients that underwent the ciliary sulcus-fixed BGI and were followed up for at least 6 months from December 2013 to November 2016. Primary outcome measures were postoperative intraocular pressure (IOP), best-corrected log MAR visual acuity (VA), and ECD. Surgical Technique A 350mm2 BGI was placed underneath extraocular muscles. Scleral tunnel was made by 26G needle insertion at 1.5mm posterior to the limbus and parallel to the iris. The tunnel was broadened by the second insertion of 21G needle. An ILM forceps was inserted into the anterior chamber through the corneal side port, which was infixed into the pre-inserted 21G needle and pulled out of the scleral tunnel. Then, the BGI tube was grasped by the ILM forceps and dragged into the posterior chamber in front of the IOL. Figure 1. IOP and glaucoma drug score changes Results Table 1. Patient Characteristics (mean ±SD otherwise specified) Friedman test: P<0.0001 No of eyes 27 Age at Surgery (Yrs) 55.7±22.3 Gender (% men) 59.3 Eye (% right eye) 55.6 Combined cataract surgery (%) 22.2 Glaucoma type (n (%)) Primary angle-closure glaucoma, 13 (48.1) Secondary glaucoma 9 (33.3) Exfoliation glaucoma 1 (3.7) Childhood glaucoma 4 (14.8) Preoperative IOP (mmHg) 30.1±8.6 Preoperative glaucoma drug score 4.5±1.1 Preoperative logMAR visual acuity 0.64±0.53 No. of Previous glaucoma operation 2.4±1.4 Preoperative endothelial cell density (cells/mm2) 1669.9±812.2 Figure 2. Visual acuity and corneal endothelial cell density changes (cells/mm2) Table 2. Success rate and Adverse event (n (%)) Overall outcome Success (=IOP 5～21mmHg w/o reoperation) 22 (81.5) Failure 5 (18.5) Adverse Event Hyphema 3 (11.1) Choroidal detachment 4 (14.8) Macular edema Vitreous hemorrhage 2 (7.4) Tube corneal touch Reoperation logMAR VA： P=0.047 (Friedman test) Discussion The magnitude and rate of IOP reduction in eyes with sulcus-fixed BGI in the present study were similar to those in eyes with anterior chamber or vitreous cavity-fixed BGI1,2). There are not more frequent adverse event compared to fixed with other BGI1,2). In comparison, the endothelial loss, on average, was insignificant in the present study, while previous studies demonstrated long tube shunt surgery cause loss of ECD3,4). As the distance between the tube and cornea is reportedly a risk factor of ECD loss 4), two cases that showed significant reduction of ECD in the present study also underwent the tube-corneal touch due to the very shallow anterior chamber. Conclusion The ciliary sulcus-fixed BGI may be a promising option both to achieve good IOP control and avoid corneal endothelial damages in eyes with refractory glaucoma. References Saheb H, et al. Am J Ophthalmol. 2014; 157: 1179-1189 Budenz DL, et al. Am J Ophthalmol. 2017; 163: 75-82 Chihara E et al. Jpn J Ophthalmol. 2012;56:119-27 Tan, AN, et al. Acta Ophthalmol. 2017; 95: 91-96 Conflict of interest (COI) : No potential COI to disclose.