Baerveldt-Baerveldt Apposition: A New Surgical Technique to Salvage Obstructed Glaucoma Drainage Tubes.
Blockage
Clinical technique
Complications
Erosion
Extender
Glaucoma
Glaucoma drainage devices
Obstruction
Refractory
Revision
Journal
Journal of current glaucoma practice
ISSN: 0974-0333
Titre abrégé: J Curr Glaucoma Pract
Pays: India
ID NLM: 101492611
Informations de publication
Date de publication:
Historique:
entrez:
21
5
2020
pubmed:
21
5
2020
medline:
21
5
2020
Statut:
ppublish
Résumé
Glaucoma drainage device (GDD) failure is usually rectified by the replacement of the entire device or using a tube extender, both of which were associated with postoperative complications. To minimize these risks, we developed a technique to replace the failing section of a tube while keeping the filtration plate in place, and without resorting to an extender clip. We describe the case of a 69-year-old man, whose left posttraumatic glaucoma was initially treated with a XEN-augmented Baerveldt procedure. Following recurrent obstructions, a kinked section of the Baerveldt tube was sectioned and replaced. After sectioning the blocked section of the tube, a new Baerveldt tube was inserted into the anterior chamber. Its filtration plate was removed, and the posterior end of the new tube was connected to the anterior end of the existing device so that both lumens would be continuous. The adjoining tubes were stitched to each other with two 8-0 nylon sutures passing through the walls of the tubes. An allograft patch was replaced over the tubes and the conjunctival fornix was closed. Intraocular pressure (IOP) normalized immediately after surgery and remained stable through 6 months. This surgical approach offers a new way to salvage a failing Baerveldt tube without replacing the filtration plate, repeating a complete surgery, or potentially compromising the conjunctiva with an extender. The minimal residual gap at the junction between the tubes appears to provide the same additional IOP-lowering effect as the "venting slits" that are sometimes performed to minimize the initial hypertensive phase without causing hypotony. This report illustrates a simple yet effective technique to replace the failing section of a GDD or lengthen a short GDD without replacing the entire device or using an extender clip, and thus minimizing the risks of complications. Gillmann K, Mansouri K, Bravetti GE,
Sections du résumé
AIM
OBJECTIVE
Glaucoma drainage device (GDD) failure is usually rectified by the replacement of the entire device or using a tube extender, both of which were associated with postoperative complications. To minimize these risks, we developed a technique to replace the failing section of a tube while keeping the filtration plate in place, and without resorting to an extender clip.
BACKGROUND
BACKGROUND
We describe the case of a 69-year-old man, whose left posttraumatic glaucoma was initially treated with a XEN-augmented Baerveldt procedure. Following recurrent obstructions, a kinked section of the Baerveldt tube was sectioned and replaced.
TECHNIQUE
METHODS
After sectioning the blocked section of the tube, a new Baerveldt tube was inserted into the anterior chamber. Its filtration plate was removed, and the posterior end of the new tube was connected to the anterior end of the existing device so that both lumens would be continuous. The adjoining tubes were stitched to each other with two 8-0 nylon sutures passing through the walls of the tubes. An allograft patch was replaced over the tubes and the conjunctival fornix was closed. Intraocular pressure (IOP) normalized immediately after surgery and remained stable through 6 months.
CONCLUSION
CONCLUSIONS
This surgical approach offers a new way to salvage a failing Baerveldt tube without replacing the filtration plate, repeating a complete surgery, or potentially compromising the conjunctiva with an extender. The minimal residual gap at the junction between the tubes appears to provide the same additional IOP-lowering effect as the "venting slits" that are sometimes performed to minimize the initial hypertensive phase without causing hypotony.
CLINICAL SIGNIFICANCE
CONCLUSIONS
This report illustrates a simple yet effective technique to replace the failing section of a GDD or lengthen a short GDD without replacing the entire device or using an extender clip, and thus minimizing the risks of complications.
HOW TO CITE THIS ARTICLE
UNASSIGNED
Gillmann K, Mansouri K, Bravetti GE,
Identifiants
pubmed: 32431477
doi: 10.5005/jp-journals-10078-1257
pmc: PMC7221244
doi:
Types de publication
Case Reports
Langues
eng
Pagination
110-112Informations de copyright
Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.
Déclaration de conflit d'intérêts
Source of support: Nil Conflict of interest: None
Références
J Glaucoma. 2018 May;27(5):421-428
pubmed: 29462014
J Glaucoma. 2018 Dec;27(12):1169-1174
pubmed: 30256275
Ophthalmology. 2016 Oct;123(10):2093-102
pubmed: 27544023
J Glaucoma. 2007 Jan;16(1):62-7
pubmed: 17224752
BMC Ophthalmol. 2018 Sep 14;18(Suppl 1):222
pubmed: 30255798
Am J Ophthalmol. 2012 May;153(5):804-814.e1
pubmed: 22244522
J Glaucoma. 2018 Mar;27(3):e64-e67
pubmed: 29329136
J Glaucoma. 2018 May;27(5):e102-e104
pubmed: 29521720