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Late bleb leak management with trabeculectomy shutdown, Baerveldt glaucoma device implantation, and titratable tube lumen size.
MedLine Citation:
PMID:  20436369     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Garfield Miller; Diamond Y Tam; Iqbal Ike K Ahmed
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of glaucoma     Volume:  20     ISSN:  1536-481X     ISO Abbreviation:  J. Glaucoma     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9300903     Medline TA:  J Glaucoma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  51-6     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology and Vision Sciences Toronto, University of Toronto, Ontario, Canada.
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