Avoid premature removal of the intraluminal suture in glaucoma drainage devices to minimize the risk of hypotony

While prolene suture removal is an effective method for reducing IOP at the slit-lamp, removing it too early can lead to postoperative hypotony and severe complications such as suprachoroidal hemorrhage, choroidal detachments, and macular folds, potentially resulting in permanent vision loss. [1-3]. It should not be removed before 8 to 12 weeks after surgery. In the weeks following GDD surgery, a hypertensive phase may occur, causing elevated IOP, which usually resolves within weeks as IOP decreases naturally. Pressure-lowering therapy can help manage this period [4]. However, if high IOP is due to inadequate outflow, early prolene suture removal may be needed to restore flow, promote bleb formation, and maintain IOP control. Sonographic imaging can assess flow and bleb formation to determine if suture removal is necessary or if other factors are causing the elevated IOP [5].

References

1. Goerdt, L., et al., [Suprachoroidal hemorrhage after Paul™ tube stent removal in high myopia]. Ophthalmologie, 2024. 121(5): p. 407-409.
2. Vallabh, N.A., et al., The PAUL® glaucoma implant: 1-year results of a novel glaucoma drainage device in a paediatric cohort. Graefes Arch Clin Exp Ophthalmol, 2023. 261(8): p. 2351-2358.
3. Tan, M.C.J., et al., Three-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma. J Glaucoma, 2024. 33(7): p. 478-485.
4. Fargione, R.A., et al., Etiology and management of the hypertensive phase in glaucoma drainage-device surgery. Surv Ophthalmol, 2019. 64(2): p. 217-224.
5. Weber, C., et al., Sonographic bleb visualisation after PAUL glaucoma implant surgery. Br J Ophthalmol, 2024.

Contributor: Constance Weber, MD, Bonn, Germany

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