Glaucomatous Progression
A patient with a past ocular history of open angle glaucoma presented to glaucoma clinic after being lost to follow-up for 3 years. There was concern for glaucomatous progression on his optical coherence tomography of the retinal nerve fiber layer and visual field. The decision was made to complete 180 degrees of selective laser trabeculoplasty (SLT). Following SLT, the intraocular pressure (IOP) elevated to over 40 mm Hg and was refractory to maximal medical therapy. The decision was made to place a Baerveldt 350 tube shunt. Following the tube shunt placement, the patient developed a hyphema with elevated IOPs refractory to medical therapy. There was concern for occlusion of the tube shunt and fenestrations. The decision was made to inject intracameral tPA to lyse the blood occluding the tube. However, the IOP remained elevated and the vision was light perception in their better seeing eye due to a complete hyphema. An emergent anterior chamber washout and placement of a pediatric Ahmed tube shunt (FP8) was performed to reduce the IOP until the Baerveldt opened. Following surgery, the IOP improved and their hyphema had resolved. Post-operative month 2, their IOP was 14 mm Hg on dorzolamide-timolol and latanoprost. Their vision was 20/70 and limited by a cataract.
Presentation Date: 05/01/2025
Issue Date: 04/17/2026
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