title: Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush.
abstract: OBJECTIVE
  To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb.
  
  
  METHODS
  Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months.
  
  
  RESULTS
  Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20).
  
  
  CONCLUSIONS
  Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period. How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76.
authors.affiliation: Resident, Department of Ophthalmology, University of North Carolina Chapel Hill, North Carolina, USA.
authors.forename: Sylvia L
authors.initials: SL
authors.lastname: Groth
authors.affiliation: Resident Physician, Chicago Medical School, Chicago, Illinois, USA.
authors.forename: Kelsi L
authors.initials: KL
authors.lastname: Greider
authors.affiliation: Director and Professor, WESMD Professional Association, Baptist Medical Center Biomedical Engineering, University of Texas, Texas and Vision Sciences, University of the Incarnate Word, San Antonio, Texas USA.
authors.forename: William Eric
authors.initials: WE
authors.lastname: Sponsel
keywords: Bleb fibrosis; Glaucoma surgery; Glaucoma tube shunt; Intraocular pressure; Modification/revision of glaucoma tube shunt; Ocular hypertension; Viscoelastic.