Abstract
Purpose :
Describe the role of an intrascleral tunnel approach for tube shunt surgery in PROSE (BostonSight, Needham, MA) patients in need of glaucoma surgery. Review the compatibility of this technique with PROSE in contrast to standard trabeculectomy or standard tube surgery.
Methods :
Case report and literature review
Results :
We report a successful case of a 68-year-old pseudophakic female with severe Sjogren’s syndrome, high myopia s/p LASIK OU, and advanced progressive chronic open-angle glaucoma returning to PROSE use after undergoing an AC tube (Baerveldt) with an intrascleral tunnel approach in the right eye. Preoperatively, ocular surface signs and symptoms were well-controlled utilizing a PROSE device for 8 years. Prior glaucoma management failed with SLT and a variety of topical ocular hypotensive agents. A glaucoma specialist recommended a trabeculectomy to achieve target IOP. The specialist wished for the patient to never return to PROSE in the operative eye following trabeculectomy due to risk of erosion, perforation and infection. The patient sought out a second opinion who suggested an AC tube (Baerveldt) with intrascleral tunnel approach, which she proceeded with. After surgery, her glaucoma was well-controlled, with a stable target IOP reached, which halted progression thus far in follow-up (1.5 years post-surgery).
Conclusions :
When faced with the prospect of traditional glaucoma surgery, many patients who rely on PROSE for comfort, ocular surface support and best corrected visual acuity are left with the prospect of not being able to return to PROSE wear postoperatively due to a risk of erosion, infection and perforation. The intrascleral tunnel approach for glaucoma tube shunt surgery in such patients provides a flat conjunctival and scleral bed postoperatively for a low risk landing zone, creating a low risk of erosion. Consideration of the intrascleral tunnel approach in PROSE patients can allow for continued control of both glaucoma and ongoing ocular surface disease.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.