Abstract
Purpose: :
To describe safety and efficacy of tying-off of Glaucoma Drainage Devices (GDDs) as a management of secondary hypotony. We describe a particular type of surgical management of hypotony. According to our knowledge this is the first such description in published literature.
Methods: :
Retrospective case review of all patients having undergone this procedure between January'07 and December'10 in one tertiary centre. 22 eyes of 21 patients (13.7% of total tube surgery), mean age was 29.0 years (2-72; 20.6), males:females-11:10. Mean follow-up was 34.6 months (12.2).
Results: :
50% were uveitic glaucoma cases. The types of GDDs were 6, 11 and 5 for Molteno, Baerveldt 250 and Baerveldt 350 respectively. Average pre-op IOP was 4.4mmHg (4.7). At day 1, mean IOP increased to 8.8mmHg (7.2) and mean final IOP was 10.0mmHg (5.4). Qualified and unqualified success, defined as resolution of hypotony and complications (IOP 6-22mmHg) with/without medication was 13.6% and 36.4% respectively. Visual acuity (LogMAR) increased in 12 eyes, was unchanged in 4 and decreased in 6 eyes when comparing pre-operative and final VA. Mean pre-operative VA was 1.3 (0.9) and mean final VA was 1.1 (1.2). The commonest complication was uncontrolled IOP increase and 4 patients required either untying of tube or laser suture lysis. Others included persistent hypotony, choroidal/retinal detachments, endophthalmitis or phthisis (8 eyes).
Conclusions: :
Tying-off of GDDs is an effective measure to manage hypotony, including in paediatric patients.
Keywords: intraocular pressure • outflow: trabecular meshwork