A Retrospective Cohort Study Analyzing Postoperative Safety and Efficacy of a Baerveldt Glaucoma Implant Modification for Earlier Intraocular Pressure Lowering, Compared to Nonmodified Baerveldt Implants at 3 Months.

AIM AND BACKGROUND: The Baerveldt glaucoma implant (BGI) is a tube shunt that has proven long-term safety and efficacy in lowering intraocular pressure (IOP). However, it requires temporary ligation for 6-8 weeks before it can take effect. This study compares the efficacy and safety of the BGI modified with a reversible ventilating mattress suture (vsBGI) to allow early flow with the unmodified BGI. MATERIALS AND METHODS: A retrospective cohort study was performed at the University of Iowa, including patients who underwent either an unmodified Baerveldt tube shunt (BGI) or a vsBGI between 2016 and 2023. Primary outcomes were IOP, number of glaucoma medications, and best-corrected visual acuity. Adverse events within 3 months postoperatively were recorded. RESULTS: A total of 124 eyes from 114 patients were included in the study. The vsBGI group had 62 eyes from 58 patients, and the BGI group had 62 eyes from 56 patients. At baseline, median IOP was significantly higher in the vsBGI group compared to those receiving the standard BGI (p < 0.001), but on day 1 and week 1, the median IOP was significantly lower in the vsBGI group than BGI (p < 0.001). By month 3, there was no significant difference in IOP between the two groups. From week 1 through month 3, patients in the vsBGI group required significantly fewer topical medications compared to those with the standard BGI (all p ≤ 0.017), even though no baseline differences were observed. Visual acuity was not significantly different between the groups at any time point. The number of adverse events or rate of reoperations in the 3-month postoperative period were not statistically different between vsBGI and BGI. CONCLUSION: The reversible ventilating suture modification to the BGI tube shunt is a safe and effective method of allowing early aqueous humor flow and reducing IOP in the early postoperative period. CLINICAL SIGNIFICANCE: The ventilating suture modification to the BGI provides a practical approach to overcoming the delay in IOP lowering that accompanies traditional tube ligation. By permitting controlled early aqueous flow, the vsBGI achieves meaningful pressure reduction in the immediate postoperative period without increasing adverse events or reoperation rates.