Tube Shunt Related Complications of the Retina and Vitreous

Abstract

Tube shunt complications of the retina and vitreous can threaten vision. It is important to understand how to recognize, prevent, and manage these complications. While many retrospective studies regarding retinal complications of tube shunts are in the literature, there are now 2 major prospective studies that can be looked to for the incidence of retinal complications. In the Tube Versus Trabeculectomy (TVT) Study, at 3 years of follow-up, 4 eyes out of 107 total eyes (4%) with tube shunts had required pars plana vitrectomies due to a retinal complication (e.g., vitreous occlusion of the tube, retinal detachment, choroidal detachment). Drainage of a choroidal effusion was performed in 2 patients. Early postoperative retinal complications (onset at 1 month or less after tube shunt implantation) included choroidal effusion (15 eyes; 14%), suprachoroidal hemorrhage (2 eyes; 2%), and vitreous hemorrhage (1 eye; 1%). Late postoperative retinal complications (onset more than 1 month after tube shunt implantation) included choroidal effusion (2 eyes; 2%) and retinal detachment (1 eye; 1%). In the Ahmed Baerveldt Comparison (ABC) Study, at one year of follow-up, one eye of 276 total eyes (0.4%) required a pars plana vitrectomy to clear a postoperative hemorrhage and one eye (0.4%) required reoperation for drainage of a suprachoroidal hemorrhage. Early postoperative retinal complications (3 months of less after implantation of the tube shunt) reported included choroidal effusion (34 eyes; 12%), suprachoroidal hemorrhage (2 eyes; 1%), endophthalmitis (1 eye; 0.4%), and vitreous hemorrhage (5 eyes; 2%). Late retinal postoperative complications (more than 3 months after tube shunt implantation) included choroidal effusion (3 eyes; 1%), endophthalmitis (2 eyes; 1%), vitreous hemorrhage (3 eyes; 1%), and retinal detachment (2 eyes; 1%). Both of these studies indicate a similar incidence of retinal complications after tube shunt implantation. Tube shunt surgery is performed in cases of uncontrolled glaucoma where medications are inadequate. A pars plana tube is most often indicated for anatomic reasons, such as a small eye, or an eye that already has coexisting corneal disease.