Pars plana insertion of glaucoma shunt in eyes with refractory neovascular glaucoma: Case report

RATIONALE: Neovascular glaucoma (NVG) is one of the most aggressive types of glaucoma in clinical practice. The outcomes are unsatisfactory despite the successful trabeculectomy with glaucoma shunt insertion. PATIENT CONCERNS: EX-PRESS Glaucoma Filtration Device (Alcon Laboratories, Fort Worth, TX), which is used in open-angle glaucoma surgery, could minimize the potential injury caused by traditional trabeculectomy. However, no study reported about the posterior segment insertion of this device. This article reports an alternative surgical technique and outcomes of pars plana insertion of glaucoma shunt in a patient with refractory NVG. DIAGNOSES: This research was a retrospective study of a patient with refractory NVG and in whom trabeculectomy with EX-PRESS implantation was performed. However, bleb failure developed three times in four years. INTERVENTIONS: In this patient, the previous EX-PRESS shunt was retrieved and reinserted into the posterior segment through the pars plana 3.5 mm behind the limbus. OUTCOMES: The post-operation intraocular pressure was stable for more than eight months after surgery without any surgical intervention or antiglaucoma medication use. No discomfort nor major complication was observed after this operation. LESSONS: Pars plana insertion of glaucoma shunt may provide an alternative to treat refractory NVG in patients who had received pars plana vitrectomy.