Glaucoma drainage device erosion rescued with upper eyelid forniceal conjunctival pedicle flap

Corneal graft survival and intraocular pressure control after penetrating keratoplasty and glaucoma drainage device implantation

The Boston Keratoprosthesis: Highs and Lows of Intraocular Pressure and Outcomes

Excessive fibrosis is the primary factor for the failure of glaucoma drainage device (GDD) implantation. Thus, strategies to suppress scar formation in GDD implantation are crucial. Although it is known that in implanted medical devices, microscale modification of the implant surface can modulate cell behavior and reduce the incidence of fibrosis, in the field of ophthalmic implants, especially the modification and effects of hydrogel micropatterns have rarely been reported. Here, we designed the patterned gelatin/acrylamide double network hydrogel and developed an innovative GDD with micropattern to suppress inflammatory and fibroblast activation after GDD implantation. Pattern topography suppressed F-actin expression and mitigated actin-dependent nuclear migration of myocardin-related transcription factor A (MRTF-A) during the proliferative phase after GDD implantation. Ultimately, the expression of α-smooth muscle actin (α-SMA), a key fibrosis-related gene product, was suppressed. Moreover, the modified GDD effectively controlled intraocular pressure (IOP), mitigated fibrous formation, and remodeled extracellular matrix (ECM) collagen distribution invivo. Therefore, the novel GDD with surface patterning interventions provides a promising strategy to inhibit scar formation after GDD implantation and raise the efficacy of GDD implantation.

PurposeTo assess and compare the risk for development of cystoid macula edema (CME) after glaucoma drainage device (GDD) implantation versus conventional trabeculectomy with mitomycin (trab) for glaucoma.MethodsRetrospective review of consecutive patients receiving trab or GDD implantation between 2016 and 2018. Inclusion criteria were availability of pre- and postoperative spectral domain optical coherence tomography (SD-OCT) of the macula. SD-OCT images were evaluated for presence of CME qualitatively, central subfield thickness (CST) and macular volume (MV).Results73 eyes could be included, 42 received trab and 31 GDD surgery. Eyes receiving trab on average had 0.8 ± 0.8 previous intraocular operations, while eyes with GDD implantation had 3.1 ± 1.9 (p < 0.001). Occurrence of postoperative CME was significantly more frequent after GDD implantation (6 out of 31 (19.4%)) than after trab (2 out of 42 eyes = 4.8%), (p = 0.049). Mean preoperative CST as well as MV was comparable in both groups (CST before trab: 282.7 ± 23.0 µm, CST before GDD 284.2 ± 27.3 µm, p = 0.287; MV before trab: 7.8 ± 1.1 mm3, MV before GDD: 8.0 ± 0.8mm3, p = 0.305). Mean postoperative CST and MV were significantly higher after GDD (CST 338.5 ± 129.3 µm, MV 8.8 ± 2.6 mm3) than after trabeculectomy (CST 290.6 ± 60.2 µm, p = 0.038; MV 7.8 ± 1.2mm3, p = 0.039).ConclusionsIn real-life conditions, GDD surgery seems to be associated with a higher risk to develop CME when compared to conventional trabeculectomy. This information may be helpful for glaucoma surgeons to advise the patients on postoperative risks of surgery.

PurposeOrbital cellulitis (OC) is a rare postoperative complication of glaucoma drainage device (GDD) implantation. To date, there have only been 10 reported cases of OC following GDD implantation.Case ReportHere, we report a case of OC in a 57-year-old man who developed pain, proptosis, and limited extraocular motility two days after uneventful Ahmed FP7 implantation in the right eye. Contrast-enhanced computed tomography of the orbits demonstrated fat stranding and a small fluid collection, consistent with OC. He had minimal improvement with intravenous antibiotics and ultimately underwent GDD explantation. A systematic review of the literature showed that the development of OC following GDD implantation can occur in the early or late postoperative period. Immediate hospitalization with intravenous administration of broad-spectrum antibiotics is recommended. Explantation of the infected GDD is often required for source control.ConclusionOC is a rare postoperative complication of GDD implantation. Prompt evaluation and treatment are required, often combined with GDD explantation.

Dynamic regulation of thermal-responsive fibers for mitomycin C-controlled delivery on glaucoma drainage device implantation.

To examine the results of Ahmed glaucoma drainage device (GDD) implantation in patients with a preoperative intraocular pressure (IOP) of 20 mm Hg or less. Noncomparative retrospective case series. Sixty-six surgeries in 63 patients were analyzed. Mean follow-up was 51 months. The mean drop in IOP was 3.8 mm Hg (23.3%, P<0.0001) at 12 months and 3.9 mm Hg (24.0%, P<0.0001) at final follow-up. The number of glaucoma medications used postoperatively was significantly less than preoperatively. Although the mean visual acuity was poorer postoperatively this did not reach statistical significance. Surgical success was defined as IOP > or =5 mm Hg and 20% lower than preoperatively with or without hypotensive therapy, visual acuity perception of light or better and no further glaucoma surgery. About 57.6% and 53.0% of patients were considered a success at 12 months and final follow-up, respectively. Fourteen patients (21.2%) underwent additional glaucoma surgery, 8 of which had a second Ahmed GDD inserted whereas 6 had cyclodestruction. All failures were due to inadequate IOP control or further glaucoma surgery, with no cases considered failures due to vision loss or hypotony. Perioperative complications developed in 6 cases (9.1%) whereas long-term problems related to surgery occurred in 8 cases (12.1%). In patients with IOPs of 20 mm Hg or less who require IOPs in the low teens and below Ahmed GDD surgery does seem to be an effective option. The success rates of surgery, however, must be balanced against the risk of complications. In addition, the relative merits of Ahmed GDD implantation versus mitomycin trabeculectomy and/or nonvalved GDDs requires further investigation.

IntroductionThis study aimed to compare the surgical outcomes of trabeculectomy and glaucoma drainage device (GDD) implantation in patients with congenital aniridia.MethodsEligible studies were retrieved from Embase, MEDLINE (via PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 15, 2024. Studies were included if they reported clinical outcomes following trabeculectomy or GDD implantation in individuals with aniridic glaucoma. Outcomes of interest included success rates, best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), use of glaucoma medications, and postoperative complications.Data extraction and synthesis were conducted according to the Cochrane Handbook. Meta-analyses were performed using a random-effects model. Heterogeneity among studies was evaluated using the Q test and I2 statistic.ResultsTwenty-two of the 1039 screened studies were included in the meta-analysis. Pooled complete success rates were not significantly different between trabeculectomy and GDD treatments (p = 0.88). However, the qualified success rate was significantly higher following GDDs compared to trabeculectomy (p < 0.001) in patients with aniridia. Cox frailty regression analysis of individual success data showed similar results: the hazard ratio of failure was significantly higher after trabeculectomy than after GDD (HR 5.684 from 1.46 to 22.14, p = 0.012). No significant differences were observed between the two procedures in terms of IOP reduction (p = 0.53), percentage change in IOP (p = 0.24), or reduction in glaucoma medications (p = 0.56) at final follow-up. Additionally, there was no significant difference in the change in BSCVA between the two groups (p = 0.72).ConclusionRegarding complete success rates, trabeculectomy does not seem to provide a significant benefit over GDDs in treating aniridic glaucoma. However, the qualified success rate is greater with GDD implantation than with trabeculectomy. Both surgical approaches show similar effectiveness in lowering intraocular pressure, reducing the need for glaucoma medications, and maintaining visual acuity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-025-01215-x.

This retrospective cohort compared the cumulative probability of success for glaucoma drainage device (GDD) implantation in pediatric and adult patients. This retrospective study enrolled adult and pediatric patients who had received a GDD between January 1, 1985 and December 31, 2017. Kaplan-Meier method was used to estimate the cumulative probability of success in the pediatric and adult patients. Successful intraocular pressure (IOP) control was defined as (i) a 20% reduction from baseline and (ii) IOP>6 and <18. Inadequate IOP control and failure were defined as a violation of these two criteria over two consecutive visits. Cox proportional hazards models enabled assessing the influence of sex, GDD location, and GDD type on IOP control. A total of 425 adult eyes from 372 individuals and 41 pediatric eyes from 28 individuals were included. The median follow-up time was 55 months for adults and 87 months for children. Superior temporal GDD placement was most employed for both (p=0.16). Adults were more likely to receive a Baerveldt 350 (p=0.04) and children were more likely to receive an Ahmed S2 (p<0.001). Adults and children had a median survival time of 2.99 and 0.82, respectively, and did not have a statistically significant difference in GDD failure rate (p=0.18). Additionally, sex, GDD location, and GDD type did not affect the success rate. Children and adults had a similar cumulative probability of success following GDD implantation. This study found that GDD type, GDD location, and glaucoma type did not influence the probability of successful IOP control.

Background: Uveitis is broadly defined as inflammation of the uvea. Glaucoma is the third most common complication of uveitis. Uveitic Glaucoma (UG) is known to be refractory, and multiple surgeries are often required for proper treatment. The purpose of this study is to determine the effectiveness of Glaucoma Drainage Device (GDD) implantation as a surgical procedure in UG patients.Method: We conducted a systematic search of electronic databases from PubMed, Science Direct, and SpringerLink using a combination of relevant keywords was performed by 5 independent reviewers. Various search terms, including 'glaucoma drainage device', 'glaucoma drainage implants', 'glaucoma filtration implants', 'aqueous shunts', 'uveitic glaucoma', 'inflammatory glaucoma'.Result: A total of 143 articles were retrieved, but only 14 articles were eligible for data extraction. There are 631 eyes from 583 patients who had UG, 442 eyes underwent GDD implantation. Overall, intraocular pressure and the use of glaucoma medication were reduced. Mean IOP preoperative is 31.57 mmHg, and IOP postoperative is 14.48 mmHg. There is a reduction in IOP of an average of 17.09 mmHg. The number of glaucoma medications has decreased from 3.24 to 1.29 postoperatively.Conclusion: UG has been shown to be managed successfully by GDD implantation. GDD implantation may be considered a long-term effective surgical option for patients with UG.

Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population

To investigate the refractive outcome of combined cataract surgery and glaucoma drainage device (GDD) implantation compared with trabeculectomy and cataract surgery. Department of Ophthalmology, National University Health System, Singapore. Retrospective cohort study. 206 eyes were enrolled for analysis: 50 had combined cataract surgery and trabeculectomy (trabeculectomy group), 50 had combined cataract surgery and GDD implantation (GDD group), and 106 had cataract surgery alone (control group). Refractive prediction error and absolute prediction error of each glaucoma surgery group were compared with the control group. Subgroup analysis was performed in the following axial length (AL) subgroups: short (<22.5 mm), medium (≥22.5 to <25.5 mm), and long (≥25.5 mm). In total, 206 eyes were examined. There was no statistically significant difference in the overall refractive prediction error between the GDD (0.00 ± 0.54 diopters [D]) and the control group (0.10 ± 0.53 D, P = .58). There was significant myopic refractive prediction error in the trabeculectomy group (-0.18 ± 0.88 D, P = .020). In eyes with short AL, a greater absolute prediction error was observed in the GDD group (-0.75 ± 0.43 D, P = .039). Apart from a significant deviation in short AL eyes, combined cataract surgery and GDD implantation demonstrated no significant postoperative refractive prediction error.

Glaucoma, an irreversible ocular disease with a risk of blindness, is often treated with glaucoma drainage device (GDD) implantation as a last resort. The study on the impact of passive valve GDD implantation on aqueous humor (AH) dynamics is of great significance for supplementing numerical simulation methods for GDDs and exploring novel glaucoma treatment approaches. Therefore, this study employed a porous region method to simulate the regulatory role of the trabecular meshwork in intraocular pressure (IOP), establishing a glaucoma model. Based on this, a multi-outlet, passive valve GDD was designed and virtually implanted, with the post-implantation flow field simulated using mesh deformation, overset mesh, and fluid–structure interaction methods. Results indicate that by adjusting the structural parameters of the GDD, IOP can be maintained within an acceptable range. The thickness (h) of the upper component has a more significant impact on the IOP and outlet flow distribution ratio than the distance (d) between the drainage tube's central axis and the drainage groove. Both increases in h and d lead to increased IOP, gradually approaching pre-implantation levels. The fissure region formed by the deformation of the upper component and the trabecular meshwork region work together to regulate IOP in the simulation. However, the fissure region shows a greater height near the center of the shunting tube, potentially imposing additional mechanical stress on ocular tissues, reaching up to 5.8 μm for a GDD with h = 10 and d = 160 μm. Additionally, wall shear stress on the iris near the shunting tube inlet is relatively high, reaching values of 6.24 × 10−4 Pa under the same conditions. In conclusion, the designed GDD effectively controls postoperative IOP. Studying AH regulation performance after GDD implantation provides a foundation for the personalized customization of passive valve-type GDDs.

Risk factors for strabismus following glaucoma drainage device implantation for refractory childhood glaucoma

Purpose: To report the management of exposed glaucoma drainage device (GDD) tube using periosteal graft.Methods: A case report of patient from ophthalmology outpatient clinic in Dr. Saiful Anwar general Hospital.Results: A 26‐year‐old male with history of steroid induced glaucoma came to ophthalmology clinic. Patient already underwent several procedures to control his intraocular pressure (IOP), including trabeculectomy and implantation of GDD. Implantation of GDD is widely used to control IOP in glaucoma patients. One month after implantation, patient experienced exposed GDD tube. Exposed GDD tube is one of the most common complications. The incidence is about 12% and tend to happen in eyes that already underwent many surgeries previously. This condition needs a further operative procedure such as adding patch graft on exposed area, in this case patient underwent conjunctival and pericardial graft. One month after additional patch graft procedure, patient felt uncomfortable sensation and redness on his right eye, even though IOP was 12 mmHg. During anterior segment examination, tube expose was found again. Patient underwent periosteal graft from his right tibial bone and conjunctival pedicle flap. After 2 months of evaluation, the graft is attached and IOP controlled at 14 mmHg.Conclusions: Periosteal graft and conjunctival pedicle flap could be one of the appropriate choices to cover re‐exposed GDD tube.