XEN-augmented Baerveldt: A New Surgical Technique for Refractory Glaucoma

Background: Glaucoma drainage devices have traditionally been reserved for patients with refractory glaucoma. However, these devices are prone to various sight-threatening complications. To prevent hypotony after placement of the Baerveldt tube, surgeons traditionally tie the tube with an absorbable suture until encapsulation occurs around the plate. We hypothesized that combining the XEN tube, placing it in the anterior chamber and connecting it to the Baerveldt tube posteriorly, outside the anterior chamber, would minimize 2 main potentially blinding complications: hypotony and corneal disease. Purpose: To describe a new surgical technique for refractory glaucoma, combining both the Baerveldt and the XEN tubes in the same surgery. Surgical Technique: The Baerveldt implant was positioned in the superotemporal quadrant and sutured to the sclera. A scleral flap was executed extending from the anterior margin of the plate for the entire length of the tube to the limbus. The Baerveldt tube was correctly positioned by removing a deeper scleral flap. The XEN tube was then inserted ab externo and inserted into the Baerveldt tube’s lumen. The newly formed double tube was then sutured and covered by the first scleral flap and usual suturing of the conjunctiva was performed. Conclusions: This technique is simple and potentially increases the safety of refractory glaucoma surgeries.