Retrospective Review of Pars Plana Versus Anterior Chamber Placement of Baerveldt Glaucoma Drainage Device

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

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Recurrent intraocular haemorrhage due to pars plana Baerveldt glaucoma drainage device

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.13004 ◽

2017 ◽

Vol 46 (1) ◽

pp. 90-92

Author(s):

Alison Fraenkel ◽

Lawrence R Lee ◽

Graham A Lee

Keyword(s):

Glaucoma Drainage Device ◽

Drainage Device ◽

Pars Plana

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Pars Plana Tube Insertion of Glaucoma Drainage Device

Journal of Glaucoma ◽

10.1097/ijg.0000000000001300 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Author(s):

George Varghese Puthuran ◽

Hiruni Kaushalya Wijesinghe ◽

Naresh Babu Kannan

Keyword(s):

Glaucoma Drainage Device ◽

Tube Insertion ◽

Drainage Device ◽

Pars Plana

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A Novel Technique for Recurrent Tube Exposure Repair

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/6878025 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

J. Minjy Kang ◽

Yen Cheng Hsia ◽

Ying Han

Keyword(s):

Case Report ◽

Pars Plana Vitrectomy ◽

Glaucoma Drainage Device ◽

Effective Technique ◽

Novel Technique ◽

Drainage Device ◽

Device Implantation ◽

Pars Plana ◽

Successful Technique

Purpose. Tube exposure can lead to vision-threatening consequences and requires prompt surgical attention. Posterior repositioning of the tube to the pars plana has previously been reported as a successful technique. However, this method requires a pars plana vitrectomy (PPV). Here, we describe a novel technique of repositioning the tube into the ciliary sulcus without requiring PPV. Methods. This is a retrospective interventional case report of two patients who had undergone prior glaucoma drainage device implantation and prior tube exposure repair and developed recurrent tube exposure. Tube exposure in the subjects was repaired by repositioning the tube in the ciliary sulcus. Results. The two eyes remained exposure free postoperatively with 51- and 60-month follow-ups. Conclusions. Repositioning the tube to the ciliary sulcus may be an effective technique to avoid reexposure.

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Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) Outcomes in High-Risk Patients

10.21203/rs.3.rs-399743/v1 ◽

2021 ◽

Author(s):

Blanca Elizabeth Martínez-Báez ◽

Abraham Alejandro Medina-Andrade ◽

Gonzalo García de Oteyza ◽

Everardo Hernández Quintela ◽

Ana Mercedes Garcia-Albisua ◽

...

Keyword(s):

Visual Acuity ◽

High Risk ◽

Anterior Chamber ◽

Graft Failure ◽

Glaucoma Drainage Device ◽

Endothelial Keratoplasty ◽

Corneal Surgery ◽

High Risk Patients ◽

Drainage Device ◽

Risk Patients

Abstract Purpose To evaluate the results, survival rates, and proportion of complications related to Descemet Stripping Automated Endothelial Keratoplasty in high-risk patients. Methods Thirty-three patients (thirty-four eyes) who underwent DSAEK surgery between 2015 and 2019 were included in this retrospective, observational study. All participants were considered high-risk patients with a history of previous glaucoma surgery with glaucoma drainage device, previous graft failure, previous anterior chamber intraocular lens, or glaucoma with an indication of corneal surgery. Results After 7.1 months of follow-up (range from 1 to 35.9 months), seventeen eyes (50%) had graft failure. Among those, eight eyes (47%) belonged to the previous graft failure group, and seven eyes (41%) had a glaucoma drainage device in the anterior chamber. Although best-corrected visual acuity (BCVA) did not improve significantly postoperatively (p = 0.112), twelve eyes improved their visual acuity, and fifteen eyes remained unchanged. The percentage of eyes with BCVA of 20/40 or better improved from 11% preoperatively to 26% postoperatively. The most common surgical complication was lamellae dislocation, occurring in six eyes. Conclusions Adverse outcomes are highly common in high-risk patients who receive a DSAEK, especially in those patients for whom a graft previously failed or with a glaucoma drainage device. The most common complication was graft detachment, with a rate similar to other reports in non-high-risk patients. In our series, previous graft failure is a higher risk factor than a GDD.

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A Case of Persistent Shallow Anterior Chamber in Glaucoma Drainage Device Implantation Recovered by Fibrin Glue

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2015.56.5.794 ◽

2015 ◽

Vol 56 (5) ◽

pp. 794

Author(s):

Yoon Jae Wi ◽

Ka Young Lee ◽

Young Cheol Yoo

Keyword(s):

Anterior Chamber ◽

Fibrin Glue ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Device Implantation ◽

Shallow Anterior Chamber

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Double versus single suture stenting to manage hypertensive spikes after glaucoma drainage device implantation

European Journal of Ophthalmology ◽

10.1177/11206721211014386 ◽

2021 ◽

pp. 112067212110143

Author(s):

Francesca Chemello ◽

Anna Rodella ◽

Guido Barosco ◽

Piero Ceruti ◽

Roberto Tosi ◽

...

Keyword(s):

Anterior Chamber ◽

Early Postoperative Period ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Device Implantation ◽

Baerveldt Glaucoma Implant ◽

The Mean ◽

Group 2 ◽

Single Suture ◽

Group 1

Purpose: To evaluate the safety and efficacy of double compared to single intraluminal suture stenting in reducing early postoperative hypertensive spikes (HS) and hypotony after Baerveldt glaucoma implant surgery. Methods: For this retrospective study, we reviewed the medical charts of 60 patients (60 eyes) who underwent Baerveldt drainage device surgery between 2017 and 2019. Two groups were formed according to whether a single suture stent was placed within the tube (5-0 polypropylene, 30 eyes, group 1) or a double suture (5-0 and 6-0 polypropylene, 30 eyes, group 2). Intraocular pressure (IOP) was measured at baseline, at 6 h, and on postoperative days 1, 2, 5, 7, 14, 21, 30, 60, 90, 180. The occurrence of HS (IOP ⩾ 30 mmHg), anterior chamber reformation, decompressive paracentesis, anti-glaucoma medication, and adverse events were recorded. Results: There was a greater decrease in IOP from baseline at days 1, 2, and 21 ( p < 0.05) and number of HS at 6 h ( p = 0.006) and postoperative day 1 ( p < 0.001) in group 2. The mean number of decompressive paracentesis, anterior chamber reformation procedures, and topical anti-glaucoma medications was the same in both groups; the need for oral acetazolamide was significantly lower in group 2 at days 1, 21, and 30 ( p < 0.05). Conclusions: While both stenting methods provide a gradual, controlled decrease in IOP, the double stenting technique was associated with a sooner and greater postoperative reduction in IOP and a good safety profile thanks to fewer HS in the early postoperative period and less need for oral acetazolamide.

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Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-02136-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Naruka Mitsui ◽

Kae Sugihara ◽

Jiro Seguchi ◽

Etsuo Chihara ◽

Yuki Morizane ◽

...

Keyword(s):

Anterior Chamber ◽

Vitreous Body ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Ocular Infection ◽

Implant Surgery ◽

Drainage Device ◽

Old Japanese ◽

Patch Graft ◽

Baerveldt Glaucoma Implant

Abstract Background We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. Case presentation A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. Conclusion Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

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