The BGDD plays an important role in the surgical management of elevated IOP in eyes with refractory glaucoma. We consider the BGDD the best option for the treatment of difficult to manage glaucoma associated with severe conjunctival scarring, iris neovascularization, failed filtering procedures, and the need for possible future penetrating keratoplasty. Careful preoperative planning and meticulous attention to operative technique can minimize complications and enhance surgical safety and efficacy. Innovative revisions in implantation technique and modifications of the Baerveldt glaucoma drainage device have improved our ability to achieve and maintain a low IOP in these challenging glaucomatous eyes.
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