Posted 1/2/25
Q: We have a patient who has a Baerveldt drainage device. Is this safe to treat, are there any contraindications?
A:
Thank you for your question. The UHMS HBO2 Safety Committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the Hyperbaric Medical Director (HMD) and Hyperbaric Safety Director/Coordinator (HSD/C) of your facility.
This device is similar in design to the Ahmed Glaucoma valve, an item reviewed by the UHMS Safety Committee in 2020:
Undersea and Hyperbaric Medical Society, MEDFAQ Response, “Ahmed Glaucoma Valve,” Accessed 12/13/2024, UHMS MEDFAQ LINK
The safety committee understands this item to be surgically attached to the sclera of the eye and free of air. Therefore, it is reasonable to consider that pressure would have no effect on the functionality of the device if it has been properly installed and primed. The valve is designed to keep intraocular pressure balanced. However, we suggest that a risk assessment be performed by the hyperbaric physician aided by the patient’s ophthalmologist to ensure that the device is functioning normally.
The Committee did reach out to the manufacturer, Johnson & Johnson, and received the following response:
“My R&D colleague reports that the Baerveldt Implant has not been tested under the specified condition (3 atm), so we unfortunately cannot substantiate efficacy under these conditions for this particular patient. The Baerveldt Implant functions in conjunction with the patient’s response to the encapsulation of the silicone plate, and this combined system determines the intraocular pressure (IOP). It is unknown whether HBOT will affect the relative difference between eye chamber pressure and bleb pressure (aqueous pressure at encapsulated plate) or if individual patient factors can affect this differential.
With that being said, I did a quick literature search on the effects of hyperbaric oxygen on intraocular pressure or glaucoma. There is not much data given that this is not a standard treatment used in our field, but it seems that hyperbaric oxygen will, at least, likely not induce elevated IOP. If anything, there have been reports of decreased IOP (Gallin-Cohen PF, Podos SM, Yablonski ME. Oxygen lowers intraocular pressure. Invest Ophthalmol Vis Sci. 1980;19(1):43-48) or improved visual function in glaucoma patients without a lowering of IOP (Bojić L, Kovacević H, Andrić D, Romanović D, Petri NM. Hyperbaric oxygen dose of choice in the treatment of glaucoma. Arh Hig Rada Toksikol. 1993;44(3):239-247). Ultimately, IOP control and optic nerve health is what we want to monitor for these patients, and I highly recommend close monitoring with the patient’s eye care provider around time of treatment.”
These additional references may assist you in completing the risk assessment and determining the proper course of action for your particular case. Again, The Safety Committee suggests consulting the patient’s ophthalmologist prior to the decision to proceed with hyperbaric oxygen therapy:
Ersanli D, Akin T, “The effect of hyperbaric oxygen on intraocular pressure,” Vol 33, No.1 : Journal of the Undersea and Hyperbaric Medical Society, 2006
McMonnies CW, “Hyperbaric oxygen therapy and the possibility of ocular complications or contraindications” Journal of clinical and experimental optometry, 2015, Volume 98, Issue 2, Pages 122-125
Respectfully,
UHMS HBO2 Safety Committee
DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet. If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility. Information provided on this forum is for general educational purposes only. It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.
