Complications of Glaucoma Drainage Device Surgery: A Review

Giovingo, Michael

doi:10.3109/08820538.2014.959199

Cited by 37 publications

(31 citation statements)

References 29 publications

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“…Grafts also carry the risk of virus transmission, corneal dellen formation, scleral melting, and high financial burden [7, 8]. Thus, there is no perfect surgical technique to prevent AGV tube exposure [9]. …”

Section: Introductionmentioning

confidence: 99%

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

et al. 2018

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BackgroundTo describe a new technique and present its long-term outcome for prevention of Ahmed glaucoma valve (AGV) tube exposure in patients with refractory glaucoma.MethodsTwenty-seven eyes of 24 patients (mean age, 50 years; age range, 16–78 years; 8 females, 16 males) with refractory glaucoma who had the AGV implant were retrospectively reviewed. For AGV implantation, a long scleral flap combined with Tenon advancement and duplication was used. In this technique, a long scleral flap is created to completely cover the extraocular part of valve’s tube, and the flap surface is covered with duplicated Tenon’s tissue. The average follow-up after AGV implantation was 21.7 months (range, 12–36 months).ResultsThe mean intraocular pressure before the operation, which was 44.1 mmHg (range, 26–62 mmHg), decreased to 14.2 mmHg (range, 8–20 mmHg) at the last follow-up visit, showing 67% reduction with AGV implantation. The mean number of antiglaucomatous medications was 4.1 before the AGV implantation and decreased to 0.9 after the operation, showing 88% reduction. In 14 eyes (51.9%), there was no change in the best corrected visual acuity (BCVA), and in 11 eyes (40.7%), the BCVA increased by 2 lines on the Snellen chart postoperatively. No patient developed postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, or tube/plate migration.ConclusionsThe long scleral flap augmented with Tenon advancement and duplication is an effective and safe surgical technique for the implantation of AGV and preventing tube exposure in cases of refractory glaucoma.

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Section: Introductionmentioning

confidence: 99%

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

et al. 2018

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“…The formation of a low-permeability fibrous capsule around the device often leads to obstructed drainage channels and/or an encapsulated filtration bleb. Together, these events may impair the drainage function of devices at both the mid-or long-term intervals [18][19][20][21][22][23]. These foreign body-related limitations point to the need to develop biologically inert biomaterials to improve performance in reaching long-term IOP reduction.…”

Section: Introductionmentioning

confidence: 99%

A novel suprachoroidal microinvasive glaucoma implant: in vivo biocompatibility and biointegration

Grierson

Minckler

Rippy³

et al. 2020

BMC biomed eng

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Background A major challenge for any glaucoma implant is their ability to provide long-term intraocular pressure lowering efficacy. The formation of a low-permeability fibrous capsule around the device often leads to obstructed drainage channels, which may impair the drainage function of devices. These foreign body-related limitations point to the need to develop biologically inert biomaterials to improve performance in reaching long-term intraocular pressure reduction. The aim of this study was to evaluate in vivo (in rabbits) the ocular biocompatibility and tissue integration of a novel suprachoroidal microinvasive glaucoma implant, MINIject™ (iSTAR Medical, Wavre, Belgium). Results In two rabbit studies, no biocompatibility issue was induced by the suprachoroidal, ab-externo implantation of the MINIject™ device. Clinical evaluation throughout the 6 post-operative months between the sham and test groups were similar, suggesting most reactions were related to the ab-externo surgical technique used for rabbits, rather than the implant material itself. Histological analysis of ocular tissues at post-operative months 1, 3 and 6 revealed that the implant was well-tolerated and induced only minimal fibroplasia and thus minimal encapsulation around the implant. The microporous structure of the device became rapidly colonized by cells, mostly by macrophages through cell migration, which do not, by their nature, impede the flow of aqueous humor through the device. Time-course analysis showed that once established, pore colonization was stable over time. No fibrosis nor dense connective tissue development were observed within any implant at any time point. The presence of pore colonization may be the process by which encapsulation around the implant is minimized, thus preserving the permeability of the surrounding tissues. No degradation nor structural changes of the implant occurred during the course of both studies. Conclusions The novel MINIject™ microinvasive glaucoma implant was well-tolerated in ocular tissues of rabbits, with observance of biointegration, and no biocompatibility issues. Minimal fibrous encapsulation and stable cellular pore colonization provided evidence of preserved drainage properties over time, suggesting that the implant may produce a long-term ability to enhance aqueous outflow.

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“…Conventional glaucoma surgeries such as trabeculectomy and tube shunt implantation can effectively reduce the IOP and the use of glaucoma medications but also have significant complications. [ 7 8 ] In recent decades, minimally invasive glaucoma surgeries have shown comparable IOP-lowering effects when compared with conventional glaucoma surgeries, but with a better safety profile, thus becoming the first-line treatment for glaucoma patients with the maximum tolerance of medication. [ 9 ] Invented and patented by George Baerveldt and Roy Chunk in 2002,[ 10 ] the Trabectome (NeoMedix, Tustin, CA, USA) is a United States Food and Drug Administration-approved minimally invasive glaucoma surgery designed to remove the trabecular meshwork (TM) using a high-frequency bipolar electrode.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficiency of Trabectome-mediated Trabecular Meshwork Ablation for Chinese Glaucoma Patients

Dang

Cen

Hong

et al. 2018

Chinese Medical Journal

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Background:The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients.Methods:This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percentages, and complications. Success was defined as an IOP <21 mmHg and at least a 20% IOP reduction from baseline after 3 months for any two consecutive visits, without additional glaucoma surgery. The data were processed using the R Stats Package version 3.0.0. The Wilcoxon test was used to compare the postoperative IOP and the number of glaucoma medications with baselines. The Kaplan–Meier test was used to calculate the 2-year success percentage. The risk factors related to Trabectome failure were determined by logistic regression.Results:A total of 120 glaucoma patients were enrolled. The Trabectome efficiently reduced the IOP from a baseline of 22.8 ± 1.34 mmHg to 17.6 ± 0.96 mmHg, and the use of glaucoma medications from 2.2 ± 0.17 mmHg to 1.4 ± 0.21 in a 2-year follow-up (both, P < 0.01). The overall success percentage was 80%. No risk factor related to Trabectome failure was identified. No vision-threatening complication was observed. Ten patients, who required secondary glaucoma surgery, all reached the target IOP.Conclusions:In a 2-year follow-up, Trabectome was an efficient and safe procedure for Chinese glaucoma patients.

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Complications of Glaucoma Drainage Device Surgery: A Review

Cited by 37 publications

References 29 publications

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication

A novel suprachoroidal microinvasive glaucoma implant: in vivo biocompatibility and biointegration

Safety and Efficiency of Trabectome-mediated Trabecular Meshwork Ablation for Chinese Glaucoma Patients

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