Baerveldt Plate Area Comparison (BPAC)

This research is being done to compare the safety and effectiveness of two sizes of the Baerveldt glaucoma implant.

A Baerveldt glaucoma implant is one of the most common types of glaucoma operations performed. This procedure works by providing a route by which fluid can drain out of the eye to decrease the intraocular pressure. The Baerveldt implant does this by placing a tube into the eye which shunts aqueous fluid to a silicone plate which is attached to the sclera (white portion of the eye). It is this plate that comes in two different sizes (250 square millimeters and 350 square millimeters).

Earlier studies have shown that larger plate sizes produce lower eye pressures but that they may also result in more complications. While both Baerveldt devices are currently in use and have been shown to be safe and effective, it is unclear if one is superior to the other. The purpose of this study is to see if one size of device works better with fewer complications.

Inclusion criteria (must have all of the following):

1. Age over 18 Y N
2. IOP > 18 mm Hg and < 40 mm Hg on medical therapy Y N
3. Previous ocular surgery limited to cataract, corneal transplant, trabeculectomy, vitrectomy Y N
4. Consent signed Y N

Exclusion criteria (cannot have any of the following):

1. Unwilling or unable to give consent, unwilling to accept randomization, or unable to Y N return for scheduled protocol visits
2. Pregnant or nursing Y N
3. NLP vision Y N
4. Iris neovascularization or proliferative retinopathy Y N
5. Iridocorneal endothelial syndrome Y N
6. Epithelial or fibrous downgrowth Y N
7. Chronic or recurrent uveitis Y N
8. Steroid-induced glaucoma Y N
9. Severe posterior blepharitis Y N
10. Previous cyclodestructive procedure Y N
11. Conjunctival scarring from prior ocular trauma or cicatrizing disease (e.g. Stevens Johnson syndrome, ocular pemphigoid) precluding Baerveldt implantation. Y N
12. Functionally significant cataract Y N
13. Need for Baerveldt implant combined with other ocular procedures (ie cataract surgery, Y N penetrating keratoplasty, or retinal surgery) or anticipated need for additional ocular surgery
14. Prior glaucoma drainage device (tube) implant Y N
15. Prior retinal surgery with remaining silicone oil Y N
16. Prior scleral buckling procedures

• Experimental: Arm A - Baerveldt 250 mm2
  Patients receiving Baerveldt 250 mm2
  Intervention: Procedure: Baerveldt Device surgical Procedure
• Experimental: Arm B - Baerveldt 350 mm2
  Patients receiving Baerveldt 350 mm2
  Intervention: Procedure: Baerveldt Device surgical Procedure

Inclusion Criteria:

• Age over 18
• IOP > 18 mm Hg and < 40 mm Hg on medical therapy
• Previous ocular surgery limited to (cataract, corneal transplant, trabeculectomy, vitrectomy)
• Consent signed

Exclusion Criteria:

• Unwilling or unable to give consent, unwilling to accept randomization, or unable to return for scheduled protocol visits
• Pregnant or nursing
• NLP vision
• Iris neovascularization or proliferative retinopathy
• Epithelial or fibrous downgrowth
• Chronic or recurrent uveitis
• Steroid-induced glaucoma
• Severe posterior blepharitis
• Previous cyclodestructive procedure
• Conjunctival scarring from prior ocular trauma or cicatrizing disease (e.g. Stevens Johnson syndrome, ocular pemphigoid) precluding Baerveldt implantation.
• Functionally significant cataract
• Need for Baerveldt implant combined with other ocular procedures (ie cataract surgery,penetrating keratoplasty, or retinal surgery) or anticipated need for additional ocular surgery
• Prior glaucoma drainage device (tube) implant
• Prior retinal surgery with remaining silicone oil
• Prior scleral buckling procedures