Sutureless scleral pocket implantation of the Baerveldt glaucoma device in refractory glaucoma: a retrospective case series.

PURPOSE

To evaluate the efficacy and safety of a Baerveldt valve implant technique without creating a scleral flap and without using a scleral patch in refractory cases of secondary glaucoma.

METHODS

This is a retrospective, interventional, consecutive case series. We included 52 eyes affected by refractory glaucoma that were recruited for Baerveldt tube implant. Surgery is reserved for cases of refractory glaucoma and is performed under locoregional anaesthesia with peribulbar anesthesia. Before the implant, a valve is prepared using a 5-0 Prolene® is used as a stenting suture and the tube is ligated with 7-0 Vicryl. The valve is positioned in the supero-temporal quadrant. We create a belt in the scleral thickness near the outlet of the tube and then create a pocket in the scleral thickness starting from 7 mm away from the limbus. Finally, with a 22-gauge needle, we enter the anterior chamber and position the tube. The primary outcomes were the percentage of tube erosion and the proportion of surgical success at 12 months post-operatively. Complete success and qualified success were distinguished.

RESULTS

There were 28 eyes (53.84%) that showed an increase in intraocular pressure (IOP) after 3 months of follow-up, which underwent Prolene suture removal to increase Baerveldt filtration. Of these 28 eyes, 16 (57.14%) reached a stable final IOP, and 12 eyes (42.85%) needed extra medical or surgical therapy. There were 6 cases (11.53%) that showed opacity in the cornea, possibly due to a pre-existing corneal condition and endothelial cell loss for elevated IOP. No case showed complications related to tube exposure or the scleral pocket in 12 months of follow-up.

CONCLUSIONS

The Baerveldt valve scleral pocket implant technique is safe and effective, the learning curve is not particularly steep, and the incidence of tube complications was comparable with the literature.