నైరూప్య

PEDI (Pullout Exteriorized Drainage Implant) suture: Case report of an improved ripcord technique in glaucoma drainage implant devices

Khin P Kilgore, Khaled Moumneh, Oluwatosin U Smith, Ronald L Fellman, Arsham Sheybani, Davinder S Grover

Background: To describe the PEDI (Pullout Exteriorized Drainage Implant) suture technique, an improvement on the ripcord technique that can be removed in the office setting under topical anesthesia.

Case presentation: A 5-year-old girl with congenital ectropion uvea and bilateral glaucoma had poor intraocular pressure (IOP) control on maximal medical therapy. She received a Baerveldt 350 glaucoma drainage device in each eye using the PEDI suture technique and tube fenestrations. The PEDI suture technique involves the classic ripcord technique of inserting a 4-0 nylon suture into the proximal end of the tube and burying the distal tip under the conjunctiva. However, as the distal nylon ripcord is tunneled towards the adjacent inferior quadrant, the needle is exteriorized near the fornix for a very short course then brought back under the conjunctiva. Patient’s IOPs improved post-operatively from low-30s to mid-teens until the fenestrations closed. IOP then increased to low-30s in the right eye and low-20s in the left eye 4-5 months postoperatively, so the PEDI suture ripcord was removed from the right eye in clinic under topical anesthesia. The ripcord in left eye was similarly removed 9 months post-operatively, and the IOPs have remained controlled in the mid-teens with 3 IOP-lowering medications in both eyes.

Conclusion: The PEDI suture technique is a practical modification to the standard ripcord technique that allows for easier and safer removal in clinic without requiring sedation, conjunctival incision or a return to the operating room with its attendant anesthesia exposure for pediatric patients.