Diane C. Lundy

Pars Plana Baerveldt Tube Insertion With Vitrectomy in Glaucomas Associated With Pseudophakia and Aphakia

PURPOSE We reviewed the course of intraocular pressure, visual acuity, and complications in patients with shallow anterior chambers or vitreous prolapse who underwent insertion of glaucoma drainage tubes through the pars plana (after a complete posterior vitrectomy). METHODS Thirteen patients (13 eyes) with uncontrolled glaucoma associated with shallow anterior chamber or vitreous prolapse and aphakia or pseudophakia underwent pars plana Baerveldt tube insertion after vitrectomy. RESULTS In 11 eyes the intraocular pressure was less than or equal to 15 mm Hg at a minimum follow-up of one year; the other two eyes underwent additional glaucoma surgery. Two of the 11 eyes with controlled intraocular pressure had limitation of ocular motility postoperatively. No retinal complications had occurred in any of the 13 eyes. CONCLUSION This technique of combined pars plana vitrectomy and pars plana insertion of a Baerveldt tube provides intraocular pressure control in eyes with shallow anterior chamber or vitreous prolapse and glaucoma associated with pseudophakia or aphakia.

Fascia Laxa Patch Graft in Glaucoma Tube Surgery

PURPOSE To determine if using human cadaveric fascia lata grafts to cover glaucoma implant tubes is safe and effective. METHODS All patients who underwent glaucoma implant surgery at the Doheny Eye Institute between July 1993 and September 1993 received a fascia lata patch graft to cover the subconjunctival portion of the tube. These patients were followed prospectively for clinical signs of conjunctival breakdown, graft melt, tube erosion, graft-related inflammation, infection, and graft-related complications. RESULTS Twenty-two eyes of 21 patients were followed for a mean of 19 months. All eyes tolerated the fascia lata grafts well without clinical evidence of graft-related conjunctival, scleral, or intraocular inflammation. No tube erosion or melting of the graft was observed in the study group. CONCLUSION Preserved donor fascia lata was well tolerated as a grafting material in glaucoma implant surgery. No clinical signs of graft rejection, foreign body reaction, tube erosion, or graft melt were observed in the study group during the follow-up period.

Tissue plasminogen activator and glaucoma drainage implants.

PurposeThe tube lumen of a glaucoma drainage implant is prone to occlusion by a blood or fibrin clot due to its small caliber, relatively low flow rate, and the plasmoid nature of the aqueous humor passing through it in the early postoperative period. The use of tissue plasminogen activator in the management of drainage tube obstruction is described herein. MethodsTwo cases of drainage tube obstruction in patients with neovascular glaucoma treated with an intracameral injection of tissue plasminogen activator are reported. ResultsResolution of tube obstruction following tissue plasminogen activator administration with spontaneous lowering of the intraocular pressure and bleb formation was achieved in both cases. Differentiation of tube obstruction from other causes of elevated intraocular pressure following installation of glaucoma drainage devices is discussed. ConclusionThe intracameral injection of tissue plasminogen activator may relieve drainage tube obstruction secondary to a blood or fibrin clot, even in the absence of any visible clot covering the proximal tube ostium or within the anterior chamber portion of the tube. This approach should be considered, in selected cases, prior to more invasive surgical revision.