Intermediate-term results of Baerveldt tube shunt surgery with mitomycin C use.

BACKGROUND AND OBJECTIVE: To study the intermediate-term results of the Baerveldt glaucoma drainage device with adjunctive use of intraoperative mitomycin C. PATIENTS AND METHODS: Charts of 243 consecutive patients with advanced glaucoma who had undergone tube shunt surgery between 1992 and 1999 were retrospectively analyzed. A total of 64 patients were eligible for the study. Patients were observed for a mean of 34.3 +/- 21 months. Kaplan-Meier survival analysis was used to determine intermediate-term success. RESULTS: The mean preoperative intraocular pressure (IOP) was 34.4 mm Hg and the 1-year postoperative IOP was 16.6 mm Hg. The mean percent IOP reduction after surgery was 51.7%, 53.2%, and 51.4% at 1, 2, and 5 years, respectively. Kaplan-Meier analysis showed a 77% success rate at 1 year, 66% at 2 years, and 59% at 5 years. The most common complication was choroidal detachment (18.8%). CONCLUSION: The use of mitomycin C with Baerveldt implantation showed IOP control equivalent to that without mitomycin C at intermediate follow-up.

Posner-Schlossman syndrome and nonarteritic anterior ischemic optic neuropathy.

A 41-year-old woman with acute OD pain and decreased visual acuity presented with anterior uveitis, an intraocular pressure of 56 mm Hg, an open angle, ipsilateral nerve fiber bundle visual field defects, and optic nerve edema. With control of intraocular pressure and uveitis, visual acuity improved to 20/25, visual field defects persisted, and optic disc pallor developed. She has remained stable over 23 months of follow-up. This case represents a concurrence of glaucomatocyclitic crisis (Posner-Schlossman syndrome, PSS) and nonarteritic ischemic optic neuropathy (NAION). Although this combination occurs rarely, patients with PSS and other risk factors for NAION, including an optic disc that lacks a physiologic cup, should be protected against NAION by prophylactic treatment with ocular antihypertensive medications.