Combined Baerveldt glaucoma drainage implant surgery and surgical bleb revision for preventing a postoperative hypertensive phase
Patient 2 was a 37-year-old man with neovascular glaucoma caused by central retinal vein occlusion. The IOP in his left eye increased markedly to 68 mmHg despite an intravitreal injection of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA, USA) and subsequent panretinal photocoagulation. The BCVA was <20/200. An initial trabeculectomy was performed; however, the bleb failed despite repeated needling. Due to extensive conjunctival scarring and severe iris neovascularization, which is likely to cause hyphema after trabeculectomy, BGI surgery was performed. To avoid the hypertensive phase, the BGI procedure was combined with surgical bleb revision. The surgical procedure was the same as that described for patient 1.\nFor comparison, we present a representative case treated with BGI surgery alone. Patient 3 was a 54-year-old woman with secondary glaucoma caused by ocular sarcoidosis. The IOP increased to 30 mmHg in her right eye. The BCVA was 20/25. She had previously undergone repeated trabeculectomies. Because of the severity of the conjunctival scarring in the superior quadrants, BGI surgery was performed in the inferior quadrant.\nNo signs of tubal obstruction were observed in any of the patients postoperatively. The changes in the postoperative IOP levels of the three patients are shown in . The postoperative IOP was controlled by postoperative bleb management in patients 1 and 2. In patient 3, the postoperative IOP remained relatively high compared to patients 1 and 2.