Baerveldt implant for secondary glaucoma due to iris melanoma

Annelie N Tan¹, Juliette GMM Hoevenaars¹, Carroll AB Webers¹, Bertil Damato², Henny JM Beckers¹

¹University Eye Clinic, Maastricht, The Netherlands; ²Ocular Oncology Service Royal Liverpool University Hospital, Liverpool, United Kingdom

Background: Proton beam therapy (PBT) is effective in the treatment of iris melanoma. Reported complications after PBT are radiation-induced cataract and raised intraocular pressure (IOP). Filtering glaucoma surgery has generally been avoided because of fears of seeding.

Case report: A 37-year-old man presented with a self-discovered, pigmented lesion on his right iris. Four years later, the pigmented lesion was diagnosed as an iris melanoma, because of documented growth. The patient was treated with PBT but developed secondary glaucoma one month later. The IOP could not be controlled despite maximal medical therapy and selective laser trabeculoplasty (SLT). Finally, Baerveldt implant surgery was performed, resulting in an IOP lowering to 10 mmHg and stabilization of the glaucomatous visual field loss.

Conclusion: Our case demonstrates that Baerveldt implant surgery is a reasonable therapy for glaucoma following successful radiotherapy of iris melanoma.

Keywords: iris melanoma, proton beam therapy, secondary glaucoma, Baerveldt implant surgery