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Laura Beltran-Agullo, Stephanie Jones, Elizabeth Galvis, K Sheng Lim; Fibrinous uveitis following stent suture removal in patients with Baerveldt tube implant. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6149. doi: https://doi.org/.
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The development of fibrinous uveitis is a known complication following intraocular surgery. We aimed to determine the prevalence and discuss the risk factors for fibrinous anterior uveitis after removal of the stent suture used to prevent postoperative hypotony in patients with non-valved glaucoma drainage devices(GDD)
All patients with uncontrolled glaucoma that had a Baerveldt tube implanted between June 2006 and May 2011 with a 3-0 Supramid suture were included in this retrospective study. The suture was placed subconjunctivally with the end buried under the plate. Stent suture was removed through a small conjunctival incision under topical anaesthesia in the operating room under sterile conditions. Topical antibiotics and intensive therapy with topical steroids was initiated immediately after surgery. Data regarding age, IOP pre and post suture removal, number of medications, type of glaucoma, time to removal of Supramid suture, previous ocular surgery and concomitant eye disease was collected.
127 patients were included in the study. Only one eye per patient was included. The Supramid was removed in 110 eyes (86%) 74±59 days (mean±SD; range 27 - 483 days) after the implantation of the tube. Fibrinous anterior uveitis occurred in 6 of the eyes (5.4 %) immediately after stent suture removal. Of these, 3 had primary open angle glaucoma, one had pseudoexfoliative glaucoma and one had neovascular glaucoma secondary to diabethic retinopathy. All patients had previous glaucoma surgery and were pseudophakic. All except one eye that required recombinant tissue plasminogen activator (tPA) responded well to topical steroids. Statistical analysis was not possible due to the small number of eyes with fibrinous uveitis.
Fibrinous anterior uveitis occurred in 5% of the eyes with non-valved GDD following stent suture removal. Risk factors for postoperative fibrin exudation after cataract surgery include diabetis, uveitis, manipulation of the iris, and pseudoexfoliation. Fibrinous uveitis has also been reported following laser in situ keratomileusis (LASIK). We hypothesize uveal trauma due to sudden eye decompression, similar to what would happen during LASIK surgery after releasing the suction ring, could trigger an inflammatory response. Although inflammation responded to intensive steroid therapy, tPA, might be used. However, care should be taken to exclude endophthalmitis.
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