Posterior repositioning of glaucoma implants for anterior segment complications

Abstract

Objective To assess the efficacy of repositioning Baerveldt aqueous implant tubes from the anterior chamber into the vitreous cavity in the management of anterior chamber tube–related complications. Design Noncomparative case series. Participants Nine eyes of eight consecutive subjects with anterior segment problems (corneal decompensation with a shallow anterior chamber or recurrent tube erosion unresponsive to conventional revision). Intervention Baerveldt implant tubes were repositioned from the anterior chamber into the vitreous cavity after pars plana vitrectomy. Main outcome measures Preservation of visual acuity, maintenance of intraocular pressure (IOP) control, and resolution of the anterior segment problem. Results Nine eyes of eight subjects were collaboratively managed by the operating glaucoma and vitreoretinal surgeons and followed postoperatively for an average time of 17 months (range, 2–42 months). Visual acuity remained stable or improved in seven of the nine eyes. IOP remained controlled in all eyes, with an average IOP of 14.3 ± 3.0 standard deviation mmHg (range, 10–18 mmHg). Progression of the anterior segment problem, which dictated the revision, was halted in three of five eyes with corneal decompensation and shallow anterior chambers and in all eyes with recurrent tube erosion. Postoperative complications included one successfully repaired retinal detachment occurring 9 months postoperatively. Conclusions Repositioning of an anterior chamber Baerveldt shunt tube into the vitreous cavity is a viable option for resolving recalcitrant tube-related anterior segment complications.