Suture Stenting of a Tube Fenestration for Early Intraocular Pressure Control After Baerveldt Glaucoma Implant Surgery

Gambini

et al. 2023

Vision

To describe a surgical variant for non-valved glaucoma drainage device implants using an easily removable non-absorbable double suture into the lumen of the tube. A retrospective, non-comparative case series of 10 patients who underwent a non-valved glaucoma drainage device implant with an endoluminal double-suture for refractory glaucoma. The sutures were easily removed postoperatively without the need for an operating room. Intraocular pressure, number of medications, and early and late complications were evaluated with a follow-up of 12 months. None of the eyes that underwent an operation developed early or late complications. The first endoluminal suture was removed in all eyes with a mean time of removal of 30 ± 7 days. The second suture was removed in all eyes with a mean time of removal of 90 ± 7 days. No complications were noted, either, after or during suture removal. The mean preoperative IOP was 27.3 ± 4.0 and the postoperative IOP, at the end of the follow-up, was 12.7 ± 1.4. At the end of the follow-up, six patients (60%) achieved complete success and four patients (40%) achieved qualified success. In conclusion, in our case series, the surgical variant allowed for a safe and gradual regulation of the flow during postoperative management. Considering the efficacy of non-valved glaucoma drainage devices, an improvement in the safety profile allows surgeons to broaden the surgical indications.

Section: Discussionmentioning

confidence: 99%

Internal Tube Occlusion with An Easily Removable Non-Absorbable Double Suture: A Novel Surgical Technique Adjunct for Non-Valved Glaucoma Drainage Devices

Gambini

et al. 2023

Vision

Journal of Current Glaucoma Practice

“…They reported similar IOP reduction and rates of early hypotony with fenestrations performed using a needle and blade; thus no difference was noted in outcomes with either technique. A recent retrospective study by Yadgarov et al 18 reviewed 119 eyes with a single tube fenestration stented with 10-0 polyglactin suture anterior to the occlusive ligature after Baerveldt surgery. They report a significant reduction in IOP and glaucoma medications 3 weeks postoperatively during the period tube occlusion and low incidence of hypotony-related complications.…”

Section: Discussionmentioning

confidence: 99%

OutƒPow Facility in Tube Shunt Fenestration

Fleischman¹,

Olayanju²,

Borrás³

et al. 2018

Aim: Determination of the effect of varying fenestration technique, and simulated patch graft on outflow facility for Baerveldt tube.Materials and methods: Silicone tubing similar to Baerveldt implant (AMO, Santa Ana, CA) with different fenestrations techniques was connected to a digital manometer in a closed system with a fluid-filled syringe on a stand to adjust pressure. The venting slits included: (A) 4 piercings with 7-0 TG140-8 needle; (B) a 2-mm slit with a 15º blade; (C) 4 piercings with a 15º blade; (D) 9-0 Nylon on CS140-6 needle with suture stenting the fenestration.

Clinical Exper Ophthalmology

“…Prevention of early hypotony in non-valved tubes is with a tube ligature suture (usually 5-8/0 Vicryl or 10/0 nylon) or an intraluminal stent suture (Supramid or nylon) or a combination of the two. Early postoperative IOP control techniques include slits to the tube, orphan trabeculectomies (unaugmented trabeculectomies that are expected to fail after a few weeks), wick sutures [107][108][109] and a combined XEN-GDD technique. 110 The anterior portion of the tube has been covered variously with partial thickness scleral flap, donor sclera, donor cornea, pericardium, dura and autologous fascia lata.…”

Section: Ab Externo Trabeculotomymentioning

confidence: 99%

The surgical management of glaucoma: A review

Lim

2022

After a long period of little change, glaucoma surgery has experienced a dramatic rise in the number of possible procedures in the last two decades. Glaucoma filtering surgeries with mitomycin C and glaucoma drainage devices remain the standard of surgical care. Other newer surgeries, some of which are minimally or microinvasive glaucoma surgeries, target existing trabecular outflow, enhance suprachoroidal outflow, create subconjunctival blebs, or reduce aqueous production. Some require the implantation of a device such as the iStent, Hydrus, Ex-PRESS, XEN and PRESERFLO, whilst others do not-Trabectome, Kahook dual blade, Ab interno canaloplasty, gonioscopy-assisted transluminal trabeculotomy, OMNI and excimer laser trabeculotomy. Others are a less destructive variation of an established procedure, such as micropulse transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cycloplasty. Cataract surgery alone can be a significant glaucoma operation. These older and newer glaucoma surgeries, their mechanism of action, efficacy and complications are the subject of this review.