4-0 Prolene for Occlusion of an Overfiltering Baerveldt Tube

Dr. Rishi Gupta and colleagues perform surgery on an 83-year-old patient with light perception vision 6 weeks following a combined Baerveldt tube shunt and cataract surgery. The anterior chamber was shallow, the eye hypotonous and large choroidal detachments were observed on B-scan ultrasonography. During her previous surgery, zonular weakness was encountered due to pseudoexfoliation syndrome and the posterior capsule had ruptured. The surgeon had placed a sulcus IOL and tied off the valveless Baerveldt tube with an 7-0 polyglactin (Vicryl) suture. Suture hydrolysis occurred at 6 weeks and hypotony ensued, resulting in the development of choroidals, shallowing of the anterior chamber and anterior dislocation of the IOL. 

After placing anterior chamber infusion, a 23-gauge trocar was inserted at a relatively steep angle in a quadrant where the choroidals were at their largest height to drain the serous fluid—a technique previously described by Rezende et al (2012). This was followed by amputating capsule–iris attachments, vitrectomy, removing the dislocated 3-piece IOL and positioning an anterior chamber IOL. Partial occlusion of the tube was performed using an ab interno approach with 4-0 polypropylene suture passed into the lumen of the tube, as first described by Feinstein et al (2018). Postoperatively, the patient’s vision improved to 20/60 and IOP was 10 mm Hg with no recurrence of choroidals. 

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