A Novel Approach to Suprachoroidal Drainage for the Surgical Treatment of Intractable Glaucoma

Abstract

This novel surgical approach and the placement of the silicone tube described here have several advantages. Its intrascleral course minimizes the risk of conjunctival erosion and associated infections. No cyclodialysis is performed. Connection to the suprachoroidal space exploits the resorptive capability of the choroid. It guarantees drainage but also provides a natural counterpressure, avoiding severe postoperative hypotony. The suprachoroidal shunt presented here achieves good follow-up results in terms of IOP control. No serious complications have been observed. This new method promises to be an effective surgical technique and presents a new therapeutic option in intractable glaucoma. Fibroblast reaction obstructing the posterior lumen, seemed to be the only factor limiting drainage. Further studies and experiments will be needed to elucidate the exact physiologic mechanisms underlying the draining, the capacity and duration of the draining effect, and the histologic background of suprachoroidal scarring.

Histological findings of failed gold micro shunts in primary open-angle glaucoma

“…In a rabbit model of the suprachoroidal shunt [15], massive formation of scar tissue was observed as early as 2 weeks after surgery, with the histologic examination revealing fibrosis with similarities to proliferative vitreoretinopathy specimens. The authors suggested that scar tissue derives from fibroblasts transformed from retinal pigment epithelial cells of suprachoroid, as a consequence of the surgical trauma.…”

Suprachoroidal implant surgery in intractable glaucoma

“…As described by Jordan et al [5], we first made a fornixbased conjunctival flap, then prepared 4 9 4-mm superficial and 3 9 3-mm deep posterior limbus-based scleral flaps (Fig. 1).…”

“…The virtual space between the external surface of the choroid and the internal surface of the sclera does not clinically manifest under physiological conditions. However, this suprachoroidal space is reported to be used to achieve glaucoma shunting in eyes with cicatrized conjunctiva [1,5].…”

Modern concepts in antiglaucomatous implant surgery

“…Another approach using a tube implant for suprachoroidal drainage has been described by Jordan and coworkers [41]. Using a standard trabeculectomy approach, a silicone tube was inserted to connect the anterior chamber with the suprachoroidal space via an intrascleral route, to avoid conjunctival erosion or infection.…”