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Abstract #28084 Published in IGR 13-1
Late bleb leak management with trabeculectomy shutdown, baerveldt glaucoma device implantation, and titratable tube lumen size
Miller G; Tam DY; Ahmed IIKJournal of Glaucoma 2011; 20: 51-56
Purpose: To report a case of late subconjunctival bleb leak, and its management to preserve vision and achieve optimal pressure control in a patient with advanced glaucoma, a 3+ Seidel positive bleb leak, and hypotony maculopathy in the better-seeing eye. Design: Case Report. Methods: Shutdown of the earlier trabeculectomy site with a scleral graft was achieved before insertion of a 250-mm Baerveldt glaucoma device. An absorbable ligature was used around the tube to prevent early postoperative hypotony. Additional pressure control was obtained by using a permanent polypropylene ligature to decrease the effective lumen size after the resorbence of the vicryl ligature. This suture was left in a location that would be accessible to laser suture-lysis, or manual removal if necessary. Results: Intraocular pressure at 1 year postoperatively was 13 mm Hg on no medications with resolution of the macular folds and 3 lines of improvement of Snellen corrected distance visual acuity. The leak was completely resolved. Conclusion: Excellent pressure control was achieved in the surgical management of a late onset bleb leak by shutting down the old trabeculectomy, and inserting a new Baerveldt tube shunt with an adjustable lumen size.
I. I. K. Ahmed. Credit Valley Eye Care, 3200 Erin Mills Parkway, Mississauga, ON L5L 1W8, Canada. ike.ahmed@utoronto.ca
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)