Corneal Parameters after Tube-Shunt Implantation through the Ciliary Sulcus

Weiner, Adam J.; Weiner, Yotam; Weiner, Asher

doi:10.1016/j.ogla.2020.07.009

Cited by 4 publications

(10 citation statements)

References 44 publications

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“…49 Recent literature has demonstrated that tube placement in the AC leads to significant endothelial changes compared with tubes placed in the sulcus. [1][2][3] A recent retrospective study evaluated the endothelial cell profiles of 26 glaucoma eyes, which were pseudophakic and had undergone Ahmed GDI (15 eyes had AC-implanted Ahmed GDI and 11 eyes had sulcus-implanted GDI). They reported significant changes in the endothelial cell size and density in the AC-implanted GDI group compared with the sulcus-implanted Ahmed GDI group.…”

Section: Discussionmentioning

confidence: 99%

“…They reported significant changes in the endothelial cell size and density in the AC-implanted GDI group compared with the sulcus-implanted Ahmed GDI group. 2 Another retrospective study by Weiner et al 3 found that sulcus-implanted Baerveldt GDI has a nonsignificant effect on endothelial cell count, morphology, corneal thickness, or corneal failures.…”

Section: Discussionmentioning

confidence: 99%

“…However, endothelial cell changes and corneal decompensation have been reported to occur less frequently in eyes with sulcus-implanted tubes. [1][2][3] Preexisting glaucoma is the strongest risk factor for post-penetrating keratoplasty (PK) glaucoma, 4 with reported rates ranging from 9% to 28%. 5,6 Furthermore, numerous studies have identified preoperative glaucoma as an independent risk factor for graft failure, reporting as high as a 2-fold increase in failure rate compared with eyes without glaucoma.…”

mentioning

confidence: 99%

“…Therefore, encountering patients who have undergone both glaucoma and corneal graft surgery, either combined or staged procedures, is typical. However, endothelial cell changes and corneal decompensation have been reported to occur less frequently in eyes with sulcus-implanted tubes 1–3 …”

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confidence: 99%

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Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty

Chen

Elhusseiny

Khodeiry

et al. 2023

Journal of Glaucoma

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Précis: We evaluated the factors that impacted time from glaucoma drainage implant (GDI) surgery to penetrating keratoplasty (PK) in eyes with previously clear corneas (ie, GDI-first sequence), and that specifically underwent a trabeculectomy before GDI surgery for intraocular pressure (IOP) control.Purpose: To describe through an event-triggered data collection method the clinical course and the long-term outcomes of 2 procedures that are commonly performed sequentially in complex clinical situations: GDI surgery and PK. The study investigates the clinical factors associated with the progression to PK and determines the GDI success rate and graft survival.Methods: A single, tertiary-care center retrospective interventional cases series including patients with a sequential history of trabeculectomy, GDI surgery, and PK from 1999 to 2009. Outcome measures included IOP, visual acuity, graft failure, GDI failure, and time from GDI to PK.Results: Of the eyes, 56% had primary open angle glaucoma. The time from the last trabeculectomy to GDI was 66.5 ± 66.7 months. Of the eyes, 84% received a Baerveldt GDI. Time from GDI to PK was 36.4 ± 28.4 months. IOP at the time of PK was between 5 mm Hg and 21 mm Hg in 90% of eyes. At the last follow-up, 48% of grafts were clear. At 5 years post-PK, 33% of corneal grafts remained clear, whereas 81% of tubes remained functional.Conclusions: Nearly half of the corneal grafts are clear at the last long-term follow-up. Graft failure occurs at a higher rate than tube failure suggesting that IOP control is only one and possibly not the most important factor in graft survival in eyes with prior glaucoma surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty

Chen

Elhusseiny

Khodeiry

et al. 2023

Journal of Glaucoma

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“…With respect to surgical complications, it has previously been shown that AC tubes are associated with higher rates of endothelial cell loss compared to sulcus tubes in pseudophakic patients as measured by specular microscopy [ 9 , 33 ]. Such observations support the theory that sulcus or PP implantation of GDDs may minimize complications stemming from the proximity between the implant and the corneal endothelium.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Anterior Chamber, Sulcus, and Pars Plana Glaucoma Drainage Device Placement in Glaucoma Patients

Samuel

Chang

Gupta

et al. 2022

Journal of Ophthalmology

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Purpose. To assess outcomes of anterior chamber (AC), sulcus, and pars plana (PP) glaucoma drainage device (GDD) placement in glaucoma patients. Patients and Methods. Retrospective evaluation of glaucoma patients who underwent GDD insertion in the AC, sulcus, or PP at Massachusetts Eye and Ear between November 2016 and May 2021. Patients who received AC, sulcus, and pars plana tubes were selected using simple random sampling, and the first 40 patients meeting inclusion criteria were analyzed. Main outcome measures were cumulative success probabilities from Kaplan-Meier (KM) analyses, intraocular pressure (IOP), medication burden, and complication rates. Results. The PP group had a larger proportion of Ahmed GDDs and was younger on average with less severe glaucoma compared to patients with AC or sulcus tubes. The PP group had a higher proportion of mixed-mechanism glaucoma and lower proportion of primary open-angle glaucoma. With success defined as IOP reduction ≥20% and 5 < IOP ≤ 21 mm Hg, the Kaplan-Meier cumulative success probabilities for all three GDD locations were not significantly different. No significant differences were found in complication rates between all groups after 3 months. Patients with PP GDD had significantly lower medication burden than those with AC or sulcus GDDs up to 1.5 years postoperatively (1.7 ± 1.1, 3.0 ± 1.4, and 2.8 ± 1.2 for PP, AC, and sulcus, respectively; P = 0.017 ). Conclusion. PP GDDs may be more effective in lowering medication burden than AC or sulcus tubes without compromising long-term safety.

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Sulcus Tube Internal Needle Guidewire Technique for Glaucoma Drainage Device Placement: Improving Surgical Ease and Precision

Shao,

Gharabagi,

King

et al. 2023

Ophthalmol Ther

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Introduction Despite the rise of micro-invasive glaucoma surgery (MIGS), glaucoma drainage device implantation continues to be a mainstay among glaucoma surgical treatment options. Anterior chamber tube placement, while effective in reducing intraocular pressure (IOP), poses corneal endothelial risks. Ciliary sulcus tube placement shows promise in reduced corneal endothelial cell loss, but proper sulcus placement can be challenging. Our study describes the initial safety and effectiveness results using a novel sulcus tube internal needle guidewire (STING) technique for glaucoma drainage device insertion into the ciliary sulcus. Methods We retrospectively reviewed the charts of all consecutive patients who underwent the STING technique using the Ahmed ClearPath, Ahmed Glaucoma Valve, or Baerveldt glaucoma implant with at least 6 months of follow-up. Demographic characteristics, type of glaucoma, previous medical and surgical treatment, pre- and postoperative IOP, pre- and postoperative medications, complications, and success rates were recorded. Results Out of nine eyes, seven resulted in qualified success (77.8%). Preoperative mean IOP was 23.8 ± 6.3 mmHg, and postoperative IOP decreased significantly to 14.9 ± 3.7 mmHg ( p = 0.008). The average number of preoperative medications per patient was 4.4 ± 0.7, while the average number of postoperative medications per patient was reduced significantly to 3.6 ± 1.0 ( p = 0.039). Conclusion The STING technique is a novel method for placing a glaucoma drainage device into the ciliary sulcus, leading to IOP lowering with minimal complications. The STING technique is designed to improve surgical ease and increase anatomical precision of sulcus tube placement. Video available for this article. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-023-00848-0.

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Corneal Parameters after Tube-Shunt Implantation through the Ciliary Sulcus

Cited by 4 publications

References 44 publications

Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty

Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty

Outcomes of Anterior Chamber, Sulcus, and Pars Plana Glaucoma Drainage Device Placement in Glaucoma Patients

Sulcus Tube Internal Needle Guidewire Technique for Glaucoma Drainage Device Placement: Improving Surgical Ease and Precision

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