Outcome of fixed volume intracameral sodium hyaluronate 1.4% injection for early postoperative hypotony after Baerveldt glaucoma implant

Importance Using an ophthalmic viscoelastic device to manage early postoperative hypotony after Baerveldt glaucoma implant (BGI). Background To determine the outcome of intracameral sodium hyaluronate injection for early postoperative hypotony treatment after BGI. Design A retrospective study. Participants One‐hundred‐and‐thirty‐eight patients (176 eyes) had BGI from January 2012 to November 2015. Those who had hypotony within 3 months postoperatively were studied. Methods Hypotonous eyes were injected with 0.1 mL sodium hyaluronate 1.4% intracameral on the slit‐lamp. The patients were followed up weekly and the injection repeated up to 3 times if hypotony persisted. The tube was tied surgically as a last resort. Main Outcome Measures The intraocular pressure and best‐corrected visual acuity at week 1, 2, 3, 4, 6 and month 4 were assessed. Results Thirty (17.0%) out of 176 eyes developed early postoperative hypotony. The median intraocular pressure and median best‐corrected visual acuity when hypotony first presented were 3 mmHg and 0.8 logMAR. Two eyes were excluded as they had more than 0.1 mL injection. Eight (29%) of the 28 hypotonous eyes resolved after one injection, seven (25%) required two and 10 (36%) needed three injections. Three (11%) eyes had surgical tube tie. The median intraocular pressures were 5, 7, 8, 10, 11 and 13 mmHg at week 1, 2, 3, 4, 6 and month 4 post‐injection. The median best‐corrected visual acuity were 0.60, 0.50, 0.50, 0.45, 0.40 and 0.40 logMAR for the same period. Conclusions and Relevance Standardised intracameral 0.1 mL sodium hyaluronate 1.4% is an effective and safe way to manage early postoperative hypotony after BGI.