After the insertion of a drainage tube, the risk of a delayed supra-choroidal haemorrhage can be reduced by avoiding post-operative hypotony

The Science behind the Tip

One of the most serious post-operative complications of tube-shunt surgery is a delayed supra-choroidal haemorrhage, which has been reported to occur in up to 8% of patients undergoing this surgery. (1) The condition is characterised by sudden severe pain and decreased vision, associated with an acute rise in IOP and shallowing in the anterior chamber several days after surgery.

Risk factors include advanced age, systemic hypertension, high pre-operative IOP, aphakia and previous vitrectomy. It usually follows a period of post-operative hypotony and choroidal effusion. (2) (3)

To reduce the risk of supra-choroidal haemmorhage make sure that the tube is adequately occluded at the time of surgery. If hypotony develops, consider the injection of high viscosity viscoelastic solution into the anterior chamber and repeat if necessary. If the hypotony persists, deal with the cause of the hypotony surgically. (4)

Contributor: John Salmon, Oxford, UK

References

1. Gedde SJ, Herndon, LW, Brandt JD et al. Surgical complications in the Tube versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007; 143: 23-31

2. Nguyen QH, Budenz DL, Parrish RK Complications of Baerveldt glaucoma drainage implants. Arch Ophthalmol 1998; 116: 571-575.

3. Tuli SS, Wu Dunn D Ciulla TA et al. Delayed suprachoroidal haemorrhage after glaucoma filtration procedures. Ophthalmology 2001; 108: 1808-1811.

4. Wu Dunn D, Ryser D, Cantor LB. Surgical drainage of choroidal effusions following glaucoma surgery. J Glaucoma 2005; 14: 103-108.

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand