Baerveldt-350 with 3-0 Prolene Ripcord to Minimize Hypotony-Associated Complications after Spontaneous Ligature Dissolution.

PURPOSE: To describe the technique and demonstrate the utility and outcomes of using a thick 3-0 Prolene ripcord in the lumen of Baerveldt-350 aqueous shunt until after the ligature suture dissolves.

DESIGN: Single-center, non-controlled, retrospective case series.

PARTICIPANTS: A total of 50 eyes from 50 patients with glaucoma undergoing placement of Baerveldt-350 aqueous shunts with 3-0 Prolene ripcord.

METHODS: A retrospective chart review was performed for all eyes of adult patients that had undergone a Baerveldt-350 aqueous shunt placement by a single surgeon at a single academic center between 10/1/2019 - 6/30/2022.

MAIN OUTCOMES: Data collected included demographic and clinical characteristics of the patients, preoperative and postoperative clinical data including IOP and glaucoma medications, postoperative timepoints of ligature suture dissolution, and timepoints of 3-0 Prolene ripcord removal or whether they were permanently left in place.

RESULTS: In total, 50 eyes from 50 patients were included; mean age was 69.5 years, 54.0% of patients were female, 92% of patients were Black, 66% of eyes had primary open angle glaucoma. 26/50 (52%) eyes had ripcord removal at the soonest postoperative visit after spontaneous ligature dissolution, 19/50 (38%) eyes had delayed ripcord removal, and 5/50 (10%) eye had no ripcord removal. There were no cases of hypotony-associated complications (shallow AC, hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage) in this sub-group of eyes which underwent no ripcord removal.

CONCLUSIONS: Our results demonstrate that routine use of a 3-0 Prolene ripcord to partially occlude the lumen of Baerveldt-350s is a safe and effective strategy to minimize sudden hypotony-associated complications when the ligature suture dissolves. This strategy allows for a more controlled postoperative course and a safe two-step decrease in IOP (1: when the ligature dissolves, and 2: when the ripcord is removed).