Retrospective analysis of the success and safety of Gold Micro Shunt Implantation in glaucoma

Arno Hueber,Sigrid Roters,Jens F Jordan,Walter Konen

doi:10.1186/1471-2415-13-35

Arno Hueber, Sigrid Roters + Show 2 more

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https://doi.org/10.1186/1471-2415-13-35

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Abstract

BackgroundTo evaluate the success rate and adverse effects of Gold Micro Shunt Plus (GMS+) implantation into the supraciliary space.MethodsThis retrospective study included 31 eyes of 31 patients diagnosed with severe glaucoma and uncontrolled intraocular pressure (IOP) with implantation of a GMS+ by means of a full-thickness scleral flap. The main outcome measures were surgical failure or success, based on the intraocular pressure and adverse effects. Clinical examination data are reported up to 4 years postoperatively.ResultsThirty eyes (97%) met one of our criteria for failure. Within a mean of 7.3 ± 7.7 months another surgery was performed because of elevated IOP in 24 of 31 eyes (77%) and because of adverse effects in 2 (6%). The remaining 4 eyes, that met one of our criteria for failure, had an IOP reduction of less than 20% with comparable medication. Six GMS+’s were explanted; because of IOP elevation, 2; rubeosis iridis, 2; and low grade inflammation, 2.ConclusionsGMS+ implantation is not an effective method to control IOP in patients with glaucoma, when using our surgical technique. The reason for the found signs of chronic low grade inflammation or rubeosis iridis in 4 eyes (13%) remains unknown and has to be further investigated.

Highlights

To evaluate the success rate and adverse effects of Gold Micro Shunt Plus (GMS+) implantation into the supraciliary space
Emi et al [1] found a drop in hydrostatic pressure from the anterior chamber to the suprachoroidal space up to -3.7 ± 0.4 mmHg that increased with experimentally raised intraocular pressure
We included 31 eyes of 31 patients who were female, 15, and male, 16, with an age range from 28 to 82 years, mean age 60.0 ± 15.3 years. They were diagnosed with uncontrolled intraocular pressure (IOP) and with the following types of glaucoma; primary open angle glaucoma (POAG), 17; pseudoexfoliation glaucoma (PEX), 5; secondary glaucoma (Sec), 4; pseudophakic closed-angle glaucoma (CAG), 3; and pigmentary glaucoma (Pigment), 2

Summary

Introduction

To evaluate the success rate and adverse effects of Gold Micro Shunt Plus (GMS+) implantation into the supraciliary space. A recent, alternative approach to treating glaucoma with filtration procedures, such as trabeculectomy, is the drainage of aqueous humor from the anterior chamber (AC) to the suprachoroidal space. This approach avoids the conjunctiva, which is known to be responsible for the failure of trabeculectomies. Another advantage to this shunt route is that the pressure in the suprachoroidal space serves as a natural counter pressure to prevent severe postoperative hypotony. Emi et al [1] found a drop in hydrostatic pressure from the anterior chamber to the suprachoroidal space up to -3.7 ± 0.4 mmHg that increased with experimentally raised intraocular pressure. Aqueous filtration across the sclera may be another possible outflow pathway [2]

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