Resolution of an exposed pars plana Baerveldt shunt in a patient with a Boston keratoprosthesis type 1 without surgery

Patients with a keratoprosthesis often develop complications including glaucoma, requiring glaucoma drainage devices. In most of these patients, glaucoma drainage devices have been shown to be safe and effective. However, occasionally, a glaucoma drainage device in the setting of a keratoprosthesis can lead to conjunctival erosion with mechanical trauma. While repeat surgical intervention may appear necessary, we report a case of a patient who had improved conjunctival erosion and glaucoma drainage device exposure after refitting of a therapeutic contact lens. Therapeutic contact lenses can be used to maintain hydration and decrease exposure while improving cosmesis and refractive error. Complications following keratoprosthesis surgery are an understudied area, particularly regarding glaucoma drainage devices, and we seek to show that careful fitting of therapeutic contact lenses may avoid the risks of repeat surgical intervention.

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Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Pars Plana ◽

Sclerotomy Site

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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Patch graft using collagen matrix (Ologen) for glaucoma drainage device exposure in a patient with Boston Keratoprosthesis type 1

American Journal of Ophthalmology Case Reports ◽

10.1016/j.ajoc.2018.08.003 ◽

2018 ◽

Vol 12 ◽

pp. 32-35

Author(s):

Samir Jabbour ◽

Mark R. Lesk ◽

Mona Harissi-Dagher

Keyword(s):

Collagen Matrix ◽

Glaucoma Drainage Device ◽

Boston Keratoprosthesis ◽

Drainage Device ◽

Patch Graft

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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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Surgical intervention for dynamic movement of a glaucoma drainage device with shifting tube position associated with corneal edema and cataract

American Journal of Ophthalmology Case Reports ◽

10.1016/j.ajoc.2020.100802 ◽

2020 ◽

Vol 20 ◽

pp. 100802

Author(s):

James Plotnik

Keyword(s):

Surgical Intervention ◽

Corneal Edema ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Dynamic Movement ◽

Tube Position

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Vision retention in early versus delayed glaucoma surgical intervention in patients with Boston Keratoprosthesis type 1

PLoS ONE ◽

10.1371/journal.pone.0182190 ◽

2017 ◽

Vol 12 (8) ◽

pp. e0182190 ◽

Cited By ~ 4

Author(s):

Mark Lin ◽

Anand Bhatt ◽

Asghar Haider ◽

Grace Kim ◽

Marjan Farid ◽

...

Keyword(s):

Surgical Intervention ◽

Boston Keratoprosthesis

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Predicting Failures of Molteno and Baerveldt Glaucoma Drainage Devices Using Machine Learning Models

10.5121/csit.2020.101610 ◽

2020 ◽

Author(s):

Paul Morrison ◽

Maxwell Dixon ◽

Arsham Sheybani ◽

Bahareh Rahmani

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Glaucoma Drainage Device ◽

Recursive Feature Elimination ◽

Support Vector ◽

Learning Models ◽

Demographic Information ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Machine Learning Models

The purpose of this retrospective study is to measure machine learning models' ability to predict glaucoma drainage device (GDD) failure based on demographic information and preoperative measurements. The medical records of sixty-two patients were used. Potential predictors included the patient's race, age, sex, preoperative intraocular pressure (IOP), preoperative visual acuity, number of IOP-lowering medications, and number and type of previous ophthalmic surgeries. Failure was defined as final IOP greater than 18 mm Hg, reduction in IOP less than 20% from baseline, or need for reoperation unrelated to normal implant maintenance. Five classifiers were compared: logistic regression, artificial neural network, random forest, decision tree, and support vector machine. Recursive feature elimination was used to shrink the number of predictors and grid search was used to choose hyperparameters. To prevent leakage, nested cross-validation was used throughout. Overall, the best classifier was logistic regression.

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