Aqueous shunts for glaucoma

The Ahmed Versus Baerveldt Study

“…Given the advanced and refractory nature of disease, we set our IOP target to 18 mmHg, which is more stringent than previous studies comparing these devices. 8 This was based on evidence that an IOP target of 21 mmHg may be insufficient to prevent disease progression in patients with advanced glaucoma. 25 Our patients required on average a 40% reduction in IOP from baseline to achieve their target pressure.…”

“…34 Antimetabolites have been trialed in aqueous drainage device implantation to prevent encapsulation but failed to show improved IOP and had a higher incidence of hypotony and graft melt. 5,8,32 Bleb histology has been cited as an important factor in the long-term success of aqueous drainage devices, with encapsulation reducing filtration and increasing the need for medications. 12 In our study, the medication requirement of the Ahmed group increased steadily beginning at 4 weeks, in contrast to the Baerveldt group, whose requirement for medications decreased over time.…”

“…4e7 A Cochrane review in 2006 comparing trabeculectomy with various aqueous drainage devices found no evidence of superiority of one procedure over another. 8 More recently, however, the Tube Versus Trabeculectomy Study found the Baerveldt implant to have a higher success rate than trabeculectomy with mitomycin C at 5 years, with fewer early postoperative complications. 1,3 This has initiated discussion as to the role of aqueous drainage devices as a first-line surgical treatment for glaucoma, and the Primary Tube Versus Trabeculectomy Study is under way to explore this question.…”

Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma

“…[1][2][3] Unfortunately, traditional ab externo glaucoma surgical procedures (eg, trabeculectomy, tubes, deep sclerectomy) are associated with significant risks and complications, including infection, corneal decompensation, choroidal hemorrhage, hypotony, diplopia, and vision loss. [1][2][3][4][5][6][7] Thus, despite their effective control of IOP, they should not be considered benign operations.…”

Delayed suprachoroidal hemorrhage after pediatric glaucoma surgery

“…14 Unlike adjunctive mitomycin-C use for trabeculectomy, adjunctive mitomycin-C use for Ahmed valve implantation does not improve intraocular pressure outcomes and thus should probably not be used, especially if it may increase complications. 18,19 Although historically Sturge-Weber syndrome has been considered a risk factor for choriodal effusion and hemorrhage during glaucoma surgery, 11,20,21 the literature review did not reveal any pediatric Sturge-Weber glaucoma surgical cases that met our definition of delayed suprachoroidal hemorrhage. Postoperative choroidal effusions that did not progress to hemorrhage certainly may have occurred.…”