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Intraluminal shunt occlusion controls IOP, minimizes hypotony
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Intraluminal occlusion of a glaucoma shunt enabled controlled IOP reduction and low rates of hypotony and other complications, according to a study.
The prospective study included 116 eyes of 112 patients who underwent Baerveldt tube (Abbott Medical Optics) implantation. The most common diagnoses were open-angle glaucoma, angle closure and pseudoexfoliation.
The main outcome measure was transient or persistent hypotony, defined as IOP of 5 mm Hg or lower, or hypertony, defined as IOP exceeding 21 mm Hg. Patients were followed for 1 year.
Mean preoperative IOP was 26.9 mm Hg with a mean of three glaucoma medications.
During the first year, 30 eyes (26%) underwent laser suture lysis and 93 eyes (80%) underwent stent removal.
Transient hypotony occurred in one case, transient hypertony in 10 cases and persistent hypertony in three cases; no cases of persistent hypotony were reported.
IOP was 5 mm Hg or lower in nine eyes at one or more time points. Eight eyes (7%) developed hypotony-related complications.
Mean IOP at 1 year was 12.8 mm Hg with a mean of 1.1 glaucoma medications.
Postoperative complications occurred in 11 eyes (9%).
Qualified success with or without medications was achieved in 94% of eyes and complete success was achieved in 32% of eyes at 12 months.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopDouglas J. Rhee, MD
Non-valved tube shunts, eg, Baerveldt glaucoma drainage devices, are a vital part of our surgical armamentarium. Even with decades of clinical experience and several prospective randomized controlled trials, there remain numerous nuances that are important to the clinical care of the patient. Preventing immediate postoperative hypotony remains art and experience more than data-driven protocols. The use of stent sutures (ie, placement of a nonabsorbable suture within the lumen of the tube with the hopes of enhancing resistance) with/without a ligature suture (ie, tying off the tube external to the tube to either occlude or significantly narrow the lumen of the tube either with absorbable or nonabsorbable) or a ligature suture alone without a stent suture are various methods employed to prevent hypotony in the early postoperative period without resorting to a two staged procedure.
This retrospective case series provides useful information regarding the safety of the use of stent and occlusive sutures. Of note, there were no significant hypotony complications when occlusion was relieved at an average of 6 ± 3 weeks. Anecdotally, one generally wants to allow some time for fibrosis to develop around the reservoir plate before opening the tube. These data demonstrate opening within that time frame was associated with good safety.
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