The efficacy of Ex-PRESS glaucoma drainage device implantation in the treatment of open-angle glaucoma

Purpose: To introduce a new technique of short tunnel small flap graft-free glaucoma drainage device implantation and report our early experience. Methods: In a retrospective study, patients with uncontrolled primary open-angle glaucoma underwent short tunnel small flap graft-free Ahmed glaucoma valve implantation. In this technique, plate is sutured 8–10 mm posterior to the limbus and a partial thickness flap is made at 1 or 11 o’clock position, 1 mm posterior the limbus. Tube was passed through a tunnel immediately anterior to the plate into the proximal edge of the flap and then inserted into the anterior chamber via a route underneath the flap. Flap then covered the distal end of the tube and conjunctiva was sutured. Patients were followed for a minimum of 12 months for any sign of tube exposure and rise of intraocular pressure. Results: A total of 16 consecutive patients with refractory primary open-angle glaucoma and uncontrolled intraocular pressure were included in this study. Mean age of participants was 59 ± 8.3 years and nine (56%) were male. Mean intraocular pressure at the time of presentation was 26 ± 6.2 mm Hg, which dropped to 16 ± 4.5 at 12 months postoperative follow-up. The number of medications at baseline was 3 ± 1 eye drops, which was decreased to 1 ± 1.2 at 12 months. There were no conjunctival and flap-related complications or any sign of tube exposure during 1-year postoperative period. Conclusion: Short tunnel small flap graft-free glaucoma drainage device implantation technique combines advantages of both tunneling and flap techniques. Also, it may result in better tube positioning and more favorable cosmetic outcomes.

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Outcomes of Glaucoma Drainage Device Implantation and Trabeculectomy with Mitomycin C in Glaucoma Secondary to Aniridia

American Journal of Ophthalmology ◽

10.1016/j.ajo.2021.03.008 ◽

2021 ◽

Author(s):

Indira Durai ◽

Srilekha Pallamparthy ◽

George Varghese Puthuran ◽

Hiruni Kaushalya Wijesinghe ◽

Mohammed Sithiq Uduman ◽

...

Keyword(s):

Mitomycin C ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Device Implantation

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Outcomes and lessons learned from two decades’ experience with glaucoma drainage device implantation for refractory Sturge Weber–associated childhood glaucoma

Journal of American Association for Pediatric Ophthalmology and Strabismus ◽

10.1016/j.jaapos.2021.05.019 ◽

2021 ◽

Author(s):

Tanya S. Glaser ◽

Landon C. Meekins ◽

Sharon F. Freedman

Keyword(s):

Lessons Learned ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Device Implantation

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Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Journal of Ophthalmology ◽

10.1155/2020/4796548 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Aitor Fernández-García ◽

Ying Zhou ◽

Mercedes García-Alonso ◽

Henry D. Andrango ◽

Francisco Poyales ◽

...

Keyword(s):

Observational Study ◽

Clinical Outcomes ◽

Surgical Procedures ◽

Primary Open Angle Glaucoma ◽

Treatment Approach ◽

Open Angle Glaucoma ◽

Open Angle ◽

Medium Term ◽

Device Implantation ◽

The Mean

Purpose. To evaluate medium-term clinical outcomes with XEN® 45 or XEN® 63 Gel Stent (Allergan, Dublin, Ireland) for treatment of primary open angle glaucoma (POAG). Materials and Methods. Retrospective, descriptive, and observational study involving 40 patients implanted with a XEN® 45 Gel Stent and 34 implanted with a XEN® 63 Gel Stent who had undergone POAG surgery and had been followed up and controlled between 12 and 36 months. Results. IOP dropped from 18.02 ± 5.23 mmHg preop to 13.81 ± 1.88, 14.80 ± 2.23, and 14.62 ± 1.90 at 1, 2, and 3 years after surgery (p<0.001) consecutively with XEN® 45 and from 19.00 ± 6.11 mmHg preop to 15.47 ± 2.45, 14.66 ± 2.45, and 15.46 ± 2.48 at 1, 2, and 3 years after surgery (p<0.001) with XEN® 63. The number of drugs used by patients to treat their glaucoma decreased after undergoing surgery in both groups. Within the XEN® 45 group, mean changes at 1 year, 2 years, and 3 years amounted to 70%, 74.3%, and 37.5%, respectively, whereas within the XEN® 63 group, the mean reduction was 75%, 79.8%, and 71.9%. When comparing the outcomes for two groups, the differences did not prove to be statistically significant. More than 90% of the procedures included in the study (using either gel-stent device) were completed without any noteworthy complications. Conclusion. POAG surgical procedures with either XEN® 45 or XEN® 63 Gel Stent implantation could be a safe and effective treatment approach.

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Treatment Outcomes Following Resident Performed Nonvalved (Baerveldt 350) Glaucoma Drainage Device Implantation

Journal of Glaucoma ◽

10.1097/ijg.0000000000001354 ◽

2019 ◽

Vol 28 (11) ◽

pp. 958-964

Author(s):

Adam L. Rothman ◽

Jullia A. Rosdahl ◽

Thomas G. Hunter ◽

Pratap Challa ◽

Kelly W. Muir

Keyword(s):

Treatment Outcomes ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Device Implantation

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Ocular motility disturbances after glaucoma drainage device implantation for paediatric glaucoma: a cross-sectional study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317356 ◽

2020 ◽

pp. bjophthalmol-2020-317356

Author(s):

Kate Elspeth Leahy ◽

Katelyn MacNeill ◽

Jeff Locke ◽

Stephanie Sobey ◽

Stephen P Kraft ◽

...

Keyword(s):

Mass Effect ◽

Paediatric Population ◽

Cross Sectional Study ◽

Glaucoma Drainage Device ◽

Ocular Motility ◽

Sectional Study ◽

Cross Sectional ◽

Drainage Device ◽

Device Implantation ◽

Mean Time

AimTo grade extraocular motility in the field of action of each extraocular muscle following superotemporal glaucoma drainage device (GDD) implantation in a paediatric population and to investigate which drainage device (Ahmed vs Baerveldt) yields less extraocular motility disturbance.MethodsCross-sectional study of children with a GDD implanted consecutively by a single surgeon who underwent ocular motility examination by two masked orthoptists. Ductions in the cardinal positions were graded. Ocular alignment, visual acuity, binocularity, stereopsis and intraocular pressure were also measured, and patient charts were reviewed.ResultsThirty children each had one eye included. Twenty-one eyes had an Ahmed GDD and 9 had a Baerveldt GDD. Mean time between GDD insertion and ocular motility exam was 68 months in the Ahmed group and 19 months in the Baerveldt group. Exotropia was present in 46% and vertical heterotropia in 46% of children post-GDD insertion. Thirty-three percent of eyes had a moderate or severe limitation of elevation in abduction, 30% of elevation in adduction, 10% of abduction and 10% of adduction. There was a trend towards more eyes in the Ahmed group (62%) having at least a moderate limitation in ocular motility (−2 or worse; scale −1 to −4) compared with the Baerveldt group (22%).ConclusionStrabismus is common in children with GDDs. Our motility and alignment findings are consistent with either a mass effect of the device and bleb and/or scarring beneath the plate in the quadrant of the GDD causing dysmotility, most commonly limitation towards the GDD.

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Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-block-styrene) surgical device for the treatment of primary open-angle glaucoma: a review

Eye and Vision ◽

10.1186/s40662-019-0162-1 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Omar Sadruddin ◽

Leonard Pinchuk ◽

Raymund Angeles ◽

Paul Palmberg

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Glaucoma Surgery ◽

Operative Management ◽

Glaucoma Drainage Device ◽

Outer Diameter ◽

Open Angle ◽

Less Invasive ◽

Randomized Clinical Study ◽

Suture Tension

AbstractTrabeculectomy remains the ‘gold standard’ intraocular pressure (IOP)-lowering procedure for moderate-to-severe glaucoma; however, this approach is associated with the need for substantial post-operative management. Micro-invasive glaucoma surgery (MIGS) procedures aim to reduce the need for intra- and post-operative management and provide a less invasive means of lowering IOP. Generally, MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma, highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma. The PRESERFLO® MicroShunt (formerly known as InnFocus MicroShunt) is an 8.5 mm-long (outer diameter 350 μm; internal lumen diameter 70 μm) glaucoma drainage device made from a highly biocompatible, bioinert material called poly (styrene-block-isobutylene-block-styrene), or SIBS. The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided, but large enough to avoid being blocked by sloughed cells or pigment. The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule. The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive (relative to incisional surgery) surgical procedure, enabling precise control of placement without the need for gonioscopy, suture tension control, or suture lysis. The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure. The MicroShunt received Conformité Européenne (CE) marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery. Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed; a Phase 3 multicenter, randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway. In preliminary studies, the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation, with an acceptable safety profile. This article summarizes current literature on the unique properties of the MicroShunt, the preliminary efficacy and safety findings, and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.

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Hyaluronidase injection for improved tissue dissection in Baerveldt tube surgery

European Journal of Ophthalmology ◽

10.5301/ejo.5001065 ◽

2017 ◽

Vol 28 (3) ◽

pp. 339-340

Author(s):

Alon Zahavi ◽

John R. Grigg

Keyword(s):

Postoperative Complications ◽

Glaucoma Drainage Device ◽

Ocular Surgery ◽

Novel Technique ◽

Drainage Device ◽

Early Stages ◽

Device Implantation ◽

Tissue Dissection ◽

Tissue Trauma ◽

Baerveldt Tube

Purpose: To describe a novel technique for tissue dissection during Baerveldt tube surgery. Methods: We present a technique for posterior dissection of conjunctiva and Tenon tissue for the placement of a glaucoma drainage device. Hyaluronidase is used in the early stages of surgery in order to minimize tissue trauma and facilitate easy dissection even through existing adhesions and conjunctival scarring. Results: The technique facilitates convenient dissection through tissues. We did not experience any intraoperative or postoperative complications. Conclusions: The described technique has substantial advantages for Baerveldt tube surgery, specifically in cases of previous ocular surgery and subsequent conjunctival scarring. It is safe and easy to perform, and should be considered in cases of glaucoma drainage device implantation surgeries.

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Baerveldt Scleral Patch Graft Abscess Secondary to Coagulase-Negative Staphylococcus

Case Reports in Ophthalmology ◽

10.1159/000484918 ◽

2017 ◽

Vol 8 (3) ◽

pp. 521-526

Author(s):

Van Nguyen ◽

Mason Schmutz ◽

Sarah Farukhi ◽

Sameh Mosaed

Keyword(s):

Open Angle Glaucoma ◽

Staphylococcal Infection ◽

Glaucoma Drainage Device ◽

Coagulase Negative Staphylococcus ◽

Drainage Device ◽

Implant Placement ◽

First Case ◽

Severe Stage ◽

Device Placement ◽

Patch Graft

We report the case of a 69-year-old female who underwent a Baerveldt implant placement for severe-stage primary open-angle glaucoma and developed a bacterial infection of the conjunctiva and abscess of the scleral patch graft with subsequent tube exposure. The infection was identified 3 weeks postoperatively and a topical antibiotic was immediately initiated. A concurrent systemic staphylococcal infection was discovered by an outside physician and oral cephalexin was initiated. Despite antibiotic treatment, the conjunctival erosion progressed, and tube revision was required. Culture of the abscess revealed coagulase-negative Staphylococcus. As alluded to above, the patient also had multiple abscesses on the skin that cultured positive for Staphylococcus aureus. To our knowledge, this is the first case in the literature of coagulase-negative Staphylococcus causing an early postoperative abscess of the scleral patch graft following glaucoma drainage device placement.

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