Gillmann Kevin, Mansouri Kaweh, Bravetti Giorgio E, Mermoud André
Department of Ophthalmology, Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
J Curr Glaucoma Pract. 2019 Sep-Dec;13(3):110-112. doi: 10.5005/jp-journals-10078-1257.
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, Baerveldt-Baerveldt Apposition: A New Surgical Technique to Salvage Obstructed Glaucoma Drainage Tubes. J Curr Glaucoma Pract 2019;13(3):110-112.
青光眼引流装置（GDD）故障通常通过更换整个装置或使用延长管来纠正，这两种方法都与术后并发症相关。为了将这些风险降至最低，我们开发了一种技术，在保留滤过板原位的情况下更换引流管的故障部分，且无需使用延长夹。
我们描述了一名69岁男性的病例，其左眼外伤性青光眼最初采用XEN增强的Baerveldt手术治疗。在反复出现阻塞后，对Baerveldt引流管的扭结部分进行了分段并更换。
在将引流管的阻塞部分分段后，将一根新的Baerveldt引流管插入前房。移除其滤过板，将新引流管的后端连接到现有装置的前端，使两个管腔连续。用两根8-0尼龙缝线穿过引流管壁将相邻的引流管相互缝合。在引流管上覆盖同种异体移植物补片，并关闭结膜穹窿。术后眼压（IOP）立即恢复正常，并在6个月内保持稳定。
这种手术方法提供了一种新的方法来挽救故障的Baerveldt引流管，而无需更换滤过板、重复完整手术或使用延长夹潜在地损害结膜。引流管连接处的最小残余间隙似乎提供了与有时进行的“排气缝”相同的额外降眼压效果，以在不引起低眼压的情况下最小化初始高血压期。
本报告说明了一种简单而有效的技术，用于更换GDD的故障部分或延长短GDD，而无需更换整个装置或使用延长夹，从而将并发症风险降至最低。
吉尔曼K，曼苏里K，布拉韦蒂GE，Baerveldt-Baerveldt对接：一种挽救阻塞性青光眼引流管的新手术技术。《当代青光眼实践杂志》2019年；13（3）：110-112。
