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Artificial Suprachoroidal Shunt without Cyclodialysis to Regulate Uncontrollable Glaucoma
Engels B. F., Konen W.,
Universität zu Köln, Zentrum für Augenheilkunde (Köln)
Background: It is a well-known fact that in some glaucoma patients filtering glaucoma surgery has to be repeated because of decrease or even loss of the drainage effect over time. In glaucoma surgery several techniques with different drainage systems exist. In our study we present a technique of glaucoma surgery using an artificial shunt to the suprachoroidal space without cyclodialysis.
Patients and methods: 31 eyes of 31 patients with uncontrollable refractory glaucoma were involved in this study. All patients have a history of two or more glaucoma surgeries. The new surgical strategy presented here is based on the resorptive capability of the suprachoroidal space. We implanted a silicon tube as a connection between the anterior chamber and the suprachoroidal space. To prevent early hypotony the tube was closed either with Healon® or an resorptive suture. Because of this procedure the early postoperative pressure is comparable to other glaucoma surgeries.
Results: Normal intraocular pressure (12,88 ± 5.17 mmHg; p<0.0005) could be measured in 70% of all patients after 30 weeks and in 60% of all patients 52 weeks post surgical. No topical medication was used during this period of time. In two patients despite normal intraocular pressure the tube had to be explanted because of contact between the tube and the corneal endothelium. Removal of the tube and additive glaucoma surgery in consequence of deregulated intraocular pressure also had to be performed in some patients. With increasing time the number of failure was rising.
Conclusions: The artificial suprachoroidal shunt without cyclodialsysis shows good results and is in its extend of filtration comparable to standard techniques in glaucoma surgery. At present the duration of the drainage effects and reduction of the intraocular pressure is still unknown.