Case Report: Temporary management of delayed postoperative hypotony with Baerveldt tube: Ab Interno stenting using 3-0 nylon suture

Abstract

Background To describe the management of delayed postoperative hypotony and choroidal detachment in a 79-year-old female patient with advanced pseudoexfoliative open-angle glaucoma. Case The patient, refractory to maximal medical therapy, underwent Baerveldt tube implantation with a ripcord using a 4-0 nylon suture. Ripcord removal and the reintroduction of antiglaucoma medication were initiated in response to a hypertensive phase. Delayed postoperative hypotony and choroidal effusions were managed through ab interno stenting of the tube, employing a 3-0 nylon suture. Ab interno stenting of the tube, employing a short segment of 3-0 nylon suture, initially addressed delayed postoperative hypotony and choroidal effusions. However, recurrence of hypotony and choroidal detachment occurred as the short stent descended into the anterior chamber. To manage the recurrent hypotony, Baerveldt tube truncation was performed, along with re-stenting of the tube using a longer 3-0 Nylon ripcord. Conclusions While ab interno occlusion with a short segment of 3-0 nylon suture may offer temporary hypotony control, the risk of segment descent warranted the use of a longer ripcord to enhance efficacy and stability.