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Jonathan M Schulhof, Joseph Panarelli, Paul A Sidoti; Controlled tube ligature release following Baerveldt Glaucoma Implant. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6491.
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© ARVO (1962-2015); The Authors (2016-present)
Hypotony is a significant adverse event following Baerveldt glaucoma implants (BGI). We studied a novel method for controlling intraocular pressure (IOP) by in-office tube ligature release (TLR) followed by visoelastic injection to fill the anterior chamber.
We performed a retrospective clinical study of patients who underwent BGI surgery from 2010 - 2015. All patients who had anterior chamber or sulcus placement of a BGI followed by TLR and viscoelastic injection were included, and there were no exclusion criteria. The data reviewed included IOP preceding TLR, 30 minutes post-TLR, and then at 2 days, 1-2 weeks, and 1 month following. The primary outcome measure was clinically significant hypotony requiring repeat viscoelastic fill, and/or surgical intervention.
56 patients satisfied the criteria and were included in the study. The majority underwent implant of the Baerveldt 350 while 16/54 (29.6%) had a Baerveldt 250 implanted. Pre-operative glaucoma diagnoses included primary open angle (48.2%) followed by exfoliative (19.6%), chroic angle closure (12.5%), uvetic and neovascular (8.9% each), and pigmentary (1.8%). The average time from surgery to TLR was 4.04 weeks. Mean IOP pre-TLR was 28 mmHg, using an average of 2.33 glaucoma medications. Immediately post-TLR, mean IOP was 4.67 mmHg (range 2 - 15 mmHg,) and after viscoelastic injection the IOP increased to 19.63 mmHg (7 – 38 mmHg). At day 2 post-TLR, mean IOP was 11.55 mmHg, and it was 12.82 mmHg at the week 1-2 visit. By 1 month post- TLR, mean IOP was 15.16 mmHg. Visual acuity remained stable or improved at the 1 month post-TLR visit in 49/56 patients (87.5%). Six patients (10.7%) developed peripheral choroidal effusions, of which 4 resolved spontaneously by the 1 month visit or sooner. All 4 of these patients maintained stable or improved visual acuity from pre-TLR. One patient’s choroidal effusions progressed posteriorly and were kissing. The patient required 2 repeat viscoelastic injections after which the effusions resolved and visual acuity returned to baseline. One patient developed hemorrhagic choroidal effusions requiring surgical drainage and resulting in CF vision.
Our current series demonstrates that in-office TLR followed by viscoelastic injection is an effective method of preventing hypotony, and controlling intraocular pressure in patients with Baerveldt glaucoma implants.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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