Ultrasound biomicroscopy and management of late posterior migration of a ripcord suture after glaucoma drainage implant surgery.

Three years after receiving a Baerveldt tube implant for neovascular glaucoma, a 50-year-old man presented to the Wills Eye Hospital Glaucoma Service with pain and decreased vision in his left eye. On examination, a 4-0 nylon ripcord suture was seen to have migrated posteriorly through the pupil and in front of the intraocular lens. The distal end of the suture was not seen on dilated indirect ophthalmoscopic examination or by standard B-scan ultrasonography. Ultrasound biomicroscopy examination was performed, and the distal end of the suture was found to lie just anterior to the pars plana. Careful removal of the suture was performed intraoperatively through two paracentesis incisions using Kelman forceps. Posterior ripcord migration is a rare complication after glaucoma drainage implant surgery, and ultrasound biomicroscopy imaging may be helpful in determining its proper management.