Glaucoma Tube Shunt Implantation Through the Ciliary Sulcus in Pseudophakic Eyes With High Risk of Corneal Decompensation

Abstract

Although previously published studies demonstrated a significant risk of corneal decompensation after angle or pars plana tube implantation, our clinical experience suggests that ciliary sulcus tube implantation in eyes with a posterior chamber intraocular lens is a safe and effective procedure even in eyes with high risk of corneal decompensation.

Glaucoma in Cases of Penetrating Keratoplasty, Lamellar Procedures and Keratoprosthesis

“…These were not observed in a series of patients that underwent this procedure. [26][27][28] The corneal grafts remained clear for years of follow-up and the glaucoma was controlled following this procedure. Placement of the shunt tube into the posterior chamber through the ciliary sulcus is contraindicated in phakic eyes because it may endanger the integrity of the crystalline lens.…”

Scleral fixation of Ahmed glaucoma valve tube tip for adjustment of cornea-touching malposition

“…1,[3][4][5][6] Patients who have a shallow anterior chamber, corneal guttata, corneal edema, or who have Eye previously received corneal transplant may be more prone to corneal touch by the AGV tip. 2 Many different approaches to address the problem of corneal touch have been reported. Conventional treatment of corneal touch after AGV implantation through the anterior chamber involves cutting the long tube or repositioning the tube through a new sclera pathway, ciliary sulcus, 2 or pars plana.…”

“…This method is easy to learn and the surgical procedures are less invasive to the globe of the eye than previous reported methods. 1,2,6 As shown in Figure 1, this method involves making an incision right above the tube entering the anterior chamber and 'flipping' out the tube end using a Sinskey. The rest of the procedure for sclera fixation is the same as in previously described surgical techniques.…”

“…1,2 However, there are some cases in which IOP control through the use of eye drop is not sufficient, and surgery is needed. Ahmed glaucoma valve (AGV) implantation is one available option for glaucoma surgery; however, tube touching of the corneal endothelium can occur in some cases.…”

Extension of a retracted ciliary sulcus tube of Ahmed glaucoma implant with angiocatheter segment

“…The frequency of corneal complications after Ahmed TM glaucoma valve (AGV) implant surgery has been reported to be between 7 and 27 % [1][2][3]. Ciliary sulcus placement of GDDs is an alternative to AC or pars plana placement in pseudophakic/aphakic patients at higher risk for corneal decompensation or in patients with peripheral anterior synechiae [4][5][6].…”