[Implantation of a silicone tube in therapy refractory glaucoma]

Hemorrhagic and neovascular glaucomas are difficult to treat. Trabeculectomy often fails. Cyclophotocoagulation or cyclocryotherapy are destructive procedures and are frequently followed by further visual loss. Fistulizing operations with silicone implants appear more promising in regulating the intraocular pressure (IOP) while preserving vision. Results of a modified implantation technique are compared with previously published studies.

A von Denffer silicone tube was implanted in 53 eyes of 50 patients with untreatable glaucomas. The follow-up was at least 6 months. The surgical procedure consisted of an oblique scleral stab incision into the anterior chamber without preparation of a scleral flap. The tapered silicone tube was inserted into the tunnel and fixed with 3 episcleral 9-0 prolene sutures. The conjunctiva was adapted watertight at the limbus.

The IOP was regulated in 71% eyes (< 21 mm Hg). 30% of the eyes needed additional antiglaucomatous measures. Postoperative visual acuity remained stable or improved in 58% of the eyes.

The described technique of a fistulizing operation with a von Denffer silicone tube was proven to be a valuable alternative for the treatment of refractory hemorrhagic or neovascular secondary glaucomas.