Insertion of an intraluminal ripcord suture to prevent early post operative hypotony
January 15, 2025

Insertion of an intraluminal ripcord suture to prevent early post operative hypotony

Hypotony is a common complication associated with the implantation of various unvalved glaucoma drainage devices. To reduce the risk of this potentially vision-threatening complications, it is advisable to partially occlude the device during surgery. For example, 3-0 supramid and 6-0 prolene ripcords are typically used during Baerveldt and Paul Glaucoma implant surgeries, respectively.[1,2] Interestingly, a similar technique can be applied with the Preserflo MicroShunt, utilizing a 9-0 prolene or 10-0 nylon suture. By looping the distalend of the suture in a limbal corneal groove, the suture can be easily removed at the slit lamp. A recent study has shown that this approach significantly reduces adverse hypotony and could be considered as a valid option.[3]
(Note: Adverse hypotony was defined as an IOP less or equal to five mmHg with severe choroidal effusion and/or anterior chamber shallowing or the presence of macular folds in OCT imaging.)


References

  1. Gan YK, Birapadian SM, Abdul Jalal MI, Din NM. Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series. Int J Ophthalmol. 2024 Feb 18;17(2):265-271. doi: 10.18240/ijo.2024.02.06. PMID: 38371250; PMCID: PMC10827610.
  2. Vallabh NA, Mason F, Yu JTS, Yau K, Fenerty CH, Mercieca K, Spencer AF, Au L. Surgical technique, perioperative management and early outcome data of the PAUL® glaucoma drainage device. Eye (Lond). 2022 Oct;36(10):1905-1910. doi: 10.1038/s41433-021-01737-1. Epub 2021 Sep 20. PMID: 34545206; PMCID: PMC8450714.
  3. Verma-Fuehring R, Dakroub M, Bamousa A, Kann G, Hillenkamp J, Kampik D. The use of intraluminal PRESERFLO stenting in avoiding early postoperative hypotony. Graefes Arch Clin Exp Ophthalmol. 2024 Dec;262(12):3925-3932. doi: 10.1007/s00417-024-06567-x. Epub 2024 Jul 6. PMID: 38969777; PMCID: PMC11608340.


Contributor: Liat Mendel-Veig, MD, Tel Aviv, Israel

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