Baerveldt tube shunt implantation through a long scleral tunnel

Abstract

Purpose:

To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel.

Materials and methods:

Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications.

Results:

Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases.

Conclusion:

We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.

Keywords

Baerveldt glaucoma implant long scleral tunnel scleral patch self-scleral flap

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References

Lloyd

Baerveldt

Heuer

et al . Initial clinical experience with the Baerveldt implant in complicated glaucomas. Ophthalmology 1994; 101: 640–650.

Gedde

Schiffman

Feuer

et al . Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of following-up. Am J Ophthalmol 2012; 153: 789–803.

Gedde

Herndon

Brandt

et al . Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012; 153: 804–814.

Liu

et al . Modified scleral tunnel to prevent tube exposure in patients with refractory glaucoma. J Glaucoma 2016; 25(11): 883–885.

Albis-Donado

Sánchez-Noguera

Cárdenas-Gómez

et al . Achieving target pressures with combined surgery: primary patchless Ahmed valve combined with phacoemulsification vs primary phacotrabeculectomy. J Curr Glaucoma Pract 2015; 9: 6–11.

D’Alessandro

Guidotti

Mansouri

et al . XEN-augmented Baerveldt: a new surgical technique for refractory glaucoma. J Glaucoma 2017; 26: e90–e92.

Grehn

Hoffmann

Klink

. XEN-Baerveldt implantation may be helpful to avoid late corneal complications. J Glaucoma 2017; 28: e258–e259.

Ozdamar

Aras

Ustundag

et al . Scleral tunnel for the implantation of glaucoma seton devices. Ophthalmic Surg Lasers 2001; 32(5): 432–435.

Kugu

Erdogan

Sevim

et al . Efficacy of long scleral tunnel technique in preventing Ahmed glaucoma valve tube exposure through conjunctiva. Semin Ophthalmol 2015; 30(1): 1–5.

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