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EyeWatch Rescue of Refractory Hypotony After Baerveldt Drainage Device Implantation: Description of a New Technique.

Abstract：

:The most effective way to control glaucoma is by lowering intraocular pressure (IOP) in order to prevent the progression of the disease. Glaucoma drainage devices (GDDs) are surgical option reserved for refractory cases and have been designed to address known complications of conventional filtering surgery. They are, however, associated with a higher rate of complications related to early hypotony and late corneal decompensation. In the case of the commonly used Baerveldt Glaucoma Implant (BGI), techniques exist in an attempt to prevent early postoperative hypotony but can be highly variable and surgeon dependent. Moreover, the additional steps required can result in unstable IOP in the immediate postoperative period. In 2014, Villamarin and colleagues described for the first time an adjustable GDD, called the eyeWatch implant, designed to better control IOP fluctuations and avoid hypotony during the early postoperative period via magnetic control of the device tube lumen. This innovation provides the possibility to adjust the amount of aqueous humor outflow after device implantation in a noninvasive manner. We report the case of an 83-year-old patient with advanced pseudoexfoliative glaucoma, referred to our tertiary center because of disease progression despite topical therapy and having undergone deep sclerectomy. First, a BGI was implanted but was unfortunately complicated by a 3-month chronic refractory hypotony from day 8, and choroidal detachment despite medical management, choroidal drainage, and viscoelastic injections. After 3 months, the decision was made to rescue the situation with an eyeWatch adjunction to the BGI. Postoperatively, the IOP was successfully controlled through fine adjustments of the eyeWatch opening position, until the last visit 8 months after the rescue, with complete resolution of the choroidal detachment and without any medications. This demonstrates that the eyeWatch may offer an answer not only to the immediate postoperative hypotonic phase of the GDD surgery but also to the later cystic bleb hypertonic phase.

journal_name

J Glaucoma

journal_title

Journal of glaucoma

authors

Elahi S,Bravetti GE,Gillmann K,Villamarin A,Meeus L,Stergiopoulos N,Mansouri K,Mermoud A

doi

10.1097/IJG.0000000000001417

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

e7-e10

issue

eissn

1057-0829

issn

1536-481X

journal_volume

pub_type

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EyeWatch Rescue of Refractory Hypotony After Baerveldt Drainage Device Implantation: Description of a New Technique.