J Glaucoma. 2022 Jul 20. doi: 10.1097/IJG.0000000000002080. Online ahead of print.
PURPOSE: Early hypotony after non-valved glaucoma drainage device (GDD) implantation for complex glaucomatous eyes with labile aqueous production can lead to significant visual morbidity. We therefore sought to report the early post-operative outcomes of a novel surgical technique that allows atraumatic insertion of non-valved GDDs through a much smaller 25-gauge scleral track, to minimise entry site leakage and improve safety.
METHODS: Retrospective case series of fifteen consecutive cases undergoing non-valved GDD insertion into the anterior chamber using a previously unreported technique.
RESULTS: All eyes underwent successful GDD insertion using our novel technique, with no intra-operative complications. Mean intraocular pressures (IOP) pre-operatively, at day 1, week 1 and week 3 were 31.4, 22.4, 23.7 and 25.6 mmHg respectively. A statistically significant IOP reduction was achieved at day 1, week 1 and week 3 post-operatively (P<0.05) without any observed leakage at the scleral entry site. One eye (6.7%) with complex panuveitic glaucoma developed early hypotony (5 mmHg) with shallow choroidal detachments on day 1. This was successfully managed with one intracameral ophthalmic viscoelastic device injection given at the slit-lamp and no further intervention.
CONCLUSIONS: This novel single needle-docking intra-ocular insertion manoeuvre is an easily adoptable technique to make GDD insertion through a smaller 25-gauge water-tight scleral track more efficient and less traumatic. The technique reduces scleral distortion and therefore improves surgical safety particularly in eyes with complex secondary glaucoma.