FEB 23, 2022
Baerveldt Exchange With Autologous Capsular Patch Graft
AAO2021 Video Program
The patient is a 85-year-old man with bilateral primary open-angle glaucoma. The right eye was pseudophakic with a superior trabeculectomy, superotemporal Baerveldt 350 in the anterior chamber (AC), inferonasal Baerveldt 350 in the AC and micropulse cyclophotocoagulation. The inferonasal tube was chafing the iris root, causing recurrent anterior uveitis, and had become recurrently eroded (exacerbated by the anterior plate position 6 mm behind the limbus). The IOP was controlled on three meds, and he elected for a tube exchange with the primary goal of managing the erosion and secondary goal of repositioning the tube to the sulcus. To achieve both goals, the inferonasal Baerveldt 350 was removed, capsular autograft tissue was harvested while avoiding the rectus muscles, a new Baerveldt 350 was ligated and affixed to the bare sclera in the same inferonasal quadrant with tube tip in the inferior sulcus, and the excised Baerveldt capsule tissue was used as a patch graft for the new Baerveldt 350. An autologous conjunctival free graft from the superonasal quadrant was used to close the inferonasal conjunctiva without tension. By postoperative week 8, there was excellent cosmesis and no erosion.