Intraoperative Customized Reduction in Baerveldt Implant Plate Size in Elderly Patients with Glaucoma and Short Eyes

PURPOSE: Larger surface area glaucoma drainage implant plates are associated with greater IOP reduction. Older age and short axial length of the eye have been reported to be risk factors for postoperative hypotony and suprachoroidal hemorrhage after glaucoma surgery. This pilot study, the first of its type, was conducted to determine the clinical outcome of intraoperative Baerveldt implant plate size reduction in elderly patients (≥80 years) with short axial length (<22 mm). METHODS: This was a retrospective study with a minimum 18-month follow-up involving 24 consecutive uncontrolled glaucoma patients who had previously undergone Baerveldt implantation with implant plate size reduction. Success was defined as intraocular pressure (IOP) < 21 mmHg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP > 5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception. The distance between the rectus muscles at the equator of the eyeball was measured using a surgical caliper. The Baerveldt implant plate was cut with straight dissecting scissors considering the distance between the muscles. RESULTS: The mean ±SD preoperative IOP before GDI was 30.2 ± 6.9 mmHg, and the mean IOP at the last follow-up visit was 13.3 ± 5.1 mmHg, the mean pressure drop being 16.9 mmHg (56%) (P<0.001). The number of antiglaucoma medications declined from mean 3.7 ± 1.0 (range 2–5) to 1.6 ± 1.1 (range 0–3) at the last visit (P<0.001). The success rate at the last follow-up visit was 79% (19 of 24 eyes). Fourteen (58%) eyes were classified as qualified success and five eyes (21%) were complete success. Complications included intraoperative suprachoroidal hemorrhage (1) and postoperative hyphema (2). CONCLUSION: Baerveldt implantation with customized plate downsizing can be an effective treatment option for difficult glaucoma in elderly people with short eyes.