This is a retrospective study to examine the effect of 0.1ml of sodium intracameral sodium hyaluronate 1.4% (Healon GV – HGV) in patients who had hypotony (IOP<5mmHg) within three months of having a Baerveldt glaucoma implant (BGI) operation. Hypotony is reported to occur in 8-13% of patients after BGI. Hypotony can lead to complications including retinal detachment, maculopathy and corneal endothelial failure. Intraocular pressure was measured using Goldman’s applanation tonometry (GAT). If the pressure was below 5mmHg the patient was treated in clinic with intracameral HGV injection. HGV was injected into a 27 gauge insulin syringe and it was primed to contain only 0.1ml. This could be repeated up to three times at different visits. If the hypotony was not controlled after third injection the tube was tied in theatre. Data were collected before BGI, when presenting with hypotony and post HGV injection at one, two, three, four and six weeks and four months. One hundred and thirty-eight patients (176 eyes) had a BGI and 30 (17%) developed hypotony. Eight (29%) resolved after one HGV injection. Seven (25%) resolved after two injections and 10 (36%) required three injections. Three (11%) had BGI tubes tied. Median IOP was 5, 7, 8, 10, 11 and 13mmHg and best corrected visual acuity was 0.60, 0.50, 0.50, 0.45, 0.40 and 0.40 logMAR at the specified time points. There were no adverse effects. The authors argue that this intervention is preferable to topical steroids for increasing the IOP post hypotony BGI, however, the results of HGV and topical steroids are not compared. The authors conclude that using intracameral HGV is an effective and safe procedure to perform as an outpatient procedure for hypotony post BGI. 

Outcome of fixed volume intracameral sodium hyaluronate 1.4% injection for early postoperative hypotony after Baerveldt glaucoma implant.
Chiam PJ, Chen X, Haque MS, Sung VCT.
CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
2018;46:1035-40.
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Ivan Yip

St Pauls', Royal Liverpool University Hospital, UK.

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