Early clinical experience with the Baerveldt implant in complicated glaucomas.

PURPOSE: To evaluate our early experience with the Baerveldt implant in patients with complicated glaucoma. METHODS: We reviewed the charts of all patients with more than six months of follow-up after placement of a Baerveldt implant at LSU Eye Center. Surgery was considered a success if intraocular pressure was 21 mm Hg or less (with or without antiglaucoma medications) at the last postoperative visit, except when further glaucoma surgery had been performed or when loss of light perception occurred. RESULTS: Fifty eyes (50 patients) were divided into six diagnostic groups, with mean follow-up times of 16.1 to 19.2 months. Success was achieved in 36 of 50 patients (72%): 26 of 35 (74%) patients with aphakia or pseudophakia, nine of 12 (75%) patients with previously failed filtering surgery, three of seven patients with neovascular glaucoma, all three patients under the age of 13 years, nine of 13 (69%) patients who underwent penetrating keratoplasty, and four of five phakic patients. Overall, visual acuity improved or remained within one line of the preoperative acuity in 32 (64%) patients. The most frequently observed short- and long-term complications were serous choroidal effusion associated with hypotony in 13 (26%) patients and corneal graft failure in six of 13 (46%) corneal transplant patients, respectively. CONCLUSION: Within the study follow-up time, the Baerveldt implant appeared to be safe and effective, with success rates for intraocular pressure control similar to those reported in a recent retrospective study of the Molteno implant.

Hyperthermic treatment of rabbit corneas.

Well defined heat doses (temperature X time) were applied to normal rabbit corneas in an effort to determine thermal tolerance, and to examine the effects of heat on this tissue. A purely conductive heater was chosen to minimize intraocular penetration, and avoid findings attributable to nonthermal effects of inductive sources. The etched element heater was sewn to 38 rabbit corneas. Thirty-six were treated to temperatures of 38, 45, 52 and/or 59 degrees centigrade for durations of 5, 15, or 45 min. Three eyes were treated at each time-temperature interval and sacrificed at either time 0, 1 day or 1 week follow-up. Histologic examinations were performed on all corneas. A corneal haze was first noted at 45 degrees C X 45 minutes X 1 day follow-up. This correlated with a mild stromal edema on light microscopy. Higher thermal doses produced a spectrum of damage, with complete destruction of all keratocytes and endothelial cells at 59 degrees C X 45 min. At levels greater than 45 degrees C x 45 min, heat damage was noted to be increased at 24 hr followup. Some recovery was noted by 1 week follow-up, with the exception of the 59 degrees C X 15 or 45 min groups. These two heat doses induced a drop-out of cellular elements with evidence of disintegration and fragmentation of collagen fibrils. Conductive heating of up to 45 degrees C X 15 min appeared well tolerated by normal rabbit corneas.