Aqueous Shunt Research Articles

Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome.

To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = -3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.

Oculocerebrorenal syndrome of Lowe: Survey of ophthalmic presentations and management.

Lowe syndrome is a rare X-linked disease that is characterized by renal dysfunction, developmental delays, congenital cataracts and glaucoma. Mutations in the oculocerebral renal syndrome of Lowe (OCRL) gene are found in Lowe syndrome patients. Although loss of vision is a major concern for families and physicians who take care of Lowe syndrome children, definitive cause of visual loss is still unclear. Children usually present with bilateral dense cataracts at birth and glaucoma, which occurs in more than half of cases, either concurrently or following cataract surgery. A retrospective review was conducted on the prevalence and characteristics of ocular findings among families of patients with Lowe syndrome with 137 uniquely affected individuals. Of 137 patients, all had bilateral congenital cataracts. Nystagmus was reported in 69.3% of cases, glaucoma in 54.7%, strabismus in 35.0%, and corneal scar in 18.2% of patients. Glaucoma was reported as the most common cause of blindness (46%) followed by corneal scars (41%). Glaucoma occurred in 54.7% of patients and affected both eyes in the majority of cases. Of these patients, 55% underwent surgery for glaucoma, while the remaining patients used medications to control their eye pressure. Timolol and latanoprost were the most commonly used medications. Although trabeculectomy and goniotomy are commonly used for pressure management, aqueous tube shunts had the best outcomes. Ocular manifestations in individuals with Lowe syndrome and carriers with OCRL mutation are reported which may help familiarize clinicians with the ocular manifestations and management of a rare and complex syndrome.

Limbal Stem Cell Deficiency After Glaucoma Surgery.

To characterize the clinical presentation of limbal stem cell deficiency (LSCD) associated with glaucoma surgeries. This is a retrospective cross-sectional study of patients with LSCD and glaucoma who presented to the Stein Eye Institute at the University of California, Los Angeles, between 2009 and 2018. Patients who underwent trabeculectomy and/or aqueous shunt surgery were included. The severity of LSCD was staged using global consensus guidelines and a clinical scoring system, and basal epithelial cell density was measured by in vivo confocal microscopy. Anatomic locations of glaucoma and non-glaucoma surgeries, locations of LSCD, and severity of LSCD were compared. Fifty-one eyes of 41 patients with LSCD associated with glaucoma surgery were included in this study. LSCD in these patients uniquely featured sectoral replacement of corneal epithelium by conjunctival epithelium, without corneal neovascularization or pannus. The sites of glaucoma surgery strongly correlated with the locations of LSCD (P = 0.002). There was a trend toward increased severity of LSCD in eyes with 2 or more glaucoma surgeries as compared to eyes with 1 glaucoma surgery, although the difference did not reach statistical significance (P = 0.3). Use of topical glaucoma medications correlated with LSCD severity, while the impact of antimetabolites did not reach statistical significance. The location of glaucoma drainage surgery is correlated with the location of LSCD. LSCD associated with glaucoma surgery has clinical features distinct from LSCD resulting from other etiologies. Further study is required to delineate the full impact of glaucoma surgery on limbal stem cell function and survival.

Outcomes and risk factor for failure after Aqueous Shunt Implants – annual review of one service results and benchmark

AbstractPurposeReport annual benchmark exercise of aqueous shunt implants (tubes) outcomes and risk factors for failure over 4 years.MethodsRetrospective cases series: Annual reporting of outcomes of tube implants. A total of 332 eyes were included in this study. The main outcomes were intra‐ocular pressure (IOP), loss of visual acuity (VA), number of medications and failure/visually threatening complications at 1‐year follow‐up.ResultsSurgical success rate was 93% at a mean follow‐up of 13.3 months. Compared to preoperative IOP (25.8 ± 7.9 mmHg), the mean postoperative IOP was significantly lower (14.4 ± 5.5 mmHg, p < 0.00001) on significantly fewer ocular hypertensive medications (from 3 ± 1 to 1.4 ± 1.3, p < 0.00001). There were 2 (0.6%) cases of loss of light perception.ConclusionAnnual reporting of tube implant within a service provides an exceptional tool for monitoring outcomes in line with major literature. It allows to monitor safety as well as new trends in surgical technique.

Prevalence of Endophthalmitis after Aqueous Shunt Implants and related procedures in an eye service

AbstractPurposeTo investigate the rate of endophthalmitis, its microorganisms, risk factors and visual outcomes, related to aqueous shunt implant (tube) surgery in the Glaucoma service in 5 years of laboratory electronic database.MethodsThis study was approved by the Clinical Audit Office. All eyes with tube implant or related surgery were reviewed from 2009 to 2013. Development of endophthalmitis was identified from the electronic database and notes reviewed.ResultsA total of 1827 tubes, 893 revisions and 2391 removal of stent suture (RoS) were performed in that period. In total six eyes developed endophthalmitis related to tube surgery, all were following revision/RoS, none were after tube implant only. Time till onset was 8 ± 6.7 days. The rate of endophthalmitis was 0.67% after tube revision and 0.25% after RoS. No microorganisms were identified in any samples.ConclusionEndophthalmitis is a rare complication of tube surgery, its rate in this study was less than reported in literature and was only observed after revision/RoS surgeries.

In Reply: Clinical Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Glaucoma Drainage Devices.

Precis:In this retrospective case series of 85 eyes, 31.8% developed graft failure and graft survival was 50% at 3 years. The presence of an aqueous shunt has a significantly adverse effect on long-term graft survival.Purpose:To report visual outcomes and complications of Descemet stripping endothel

For people with glaucoma, how do aqueous shunts compare with trabeculectomy?

For people with glaucoma, how do aqueous shunts compare with trabeculectomy?

Clinical Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Glaucoma Drainage Devices.

In this retrospective case series of 85 eyes, 31.8% developed graft failure and graft survival was 50% at 3 years. The presence of an aqueous shunt has a significantly adverse effect on long-term graft survival. To report visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with glaucoma drainage devices (GDD). A retrospective chart review was conducted of 122 procedures of 85 eyes of 83 patients who underwent DSEK and had prior or concurrent GDD implantation. Mean follow-up was 36.5±31.4 months. Patients with postoperative follow-up of <3 months were excluded from analysis. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure (IOP), and graft survival. The mean logMAR vision improved to 1.07 postoperatively from 1.43 preoperatively, with 61% of eyes experiencing improved visual acuity. Graft dislocation occurred in 27 (31.8%) eyes and required repeat injection of air in the anterior chamber. Primary graft failure occurred in 2 (2.4%) eyes, whereas secondary graft failure occurred in 27 (31.8%) of eyes, with an average time of 24.3 months for development. Estimated survival rates at 1, 2, and 3 years were 89%, 78%, and 50%, respectively. Escalation of IOP occurred in 21 (24.7%) eyes postoperatively, where 14 eyes underwent medical therapy and 7 eyes required surgical intervention/laser for IOP control. DSEK after GDD is a viable alternative to treat endothelial dysfunction, with the majority of patients achieving visual improvement. However, aqueous shunt implantation has a significantly adverse effect on long-term graft survival and close follow-up is warranted.

Aqueous shunts with mitomycin C versus aqueous shunts alone for glaucoma.

Glaucoma affects more than 70 million people worldwide, with about 10% being bilaterally blind, making it the leading cause of irreversible blindness globally. In patients with advanced glaucoma or those who have failed medical treatment without achieving adequate intraocular pressure (IOP) control, trabeculectomy (glaucoma filtration surgery where an ostium is created into the anterior chamber from underneath a partial thickness scleral flap to allow for aqueous flow out of the anterior chamber intointo the subconjunctival space forming a filtering bleb) and aqueous shunt surgery for more complex and refractory cases remain the mainstay therapies. Proliferation of fibrous tissue around an implanted aqueous shunt may block the diffusion of aqueous humour. Mitomycin C (MMC) is one of two commonly used adjunct antifibrotic agents used during aqueous shunt surgery to prevent proliferation of fibrous tissue. However, the effectiveness and safety of the use of intraoperative MMC during aqueous shunt surgery has not been established. To evaluate the effectiveness and safety of MMC versus no MMC used during aqueous shunt surgery for reducing IOP in primary and secondary glaucoma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 2); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 13 February 2018. We included randomized controlled trials (RCTs) in which one group of participants received MMC during aqueous shunt surgery and another group did not. We did not exclude studies based on outcomes. Two review authors independently reviewed titles and abstracts from the literature searches. We obtained full-text reports of potentially relevant studies and assessed them for inclusion. Two review authors independently extracted data related to study characteristics, risk of bias, and outcomes. We used standard methodological procedures expected by Cochrane. We included five RCTs, with a total of 333 eyes with glaucoma randomized, and identified two ongoing trials. All included trials examined the effect of MMC versus no MMC when used during aqueous shunt surgery for glaucoma. The trials included participants with different types of uncontrolled glaucoma. One study was conducted in China, one in Saudi Arabia, two in the USA, and one study was a multicenter study conducted in Brazil, Canada, Scotland, and USA. We assessed all trials as having overall unclear risk of bias due to incomplete reporting of study methods and outcomes; two of the five trials were reported only as conference abstracts.None of the included trials reported mean decrease from baseline in IOP; however, all five trials reported mean IOP at 12 months post-surgery. At 12 months, the effect of MMC on mean IOP compared with no MMC was unclear based on a meta-analysis of trials (mean difference -0.12 mmHg, 95% CI -2.16 to 2.41; low-certainty evidence). Two trial did not report sufficient information to include in meta-analysis, but reported that mean IOP was lower in the MMC group compared with the no MMC group at 12 months.None of the included trials reported mean change from baseline in visual acuity; however, one trial reported lower mean LogMAR values (better vision) in the MMC group than in the no MMC group at 12 months post-surgery. None of the included studies reported the proportion of participants with stable best-corrected visual acuity. Three trials reported that loss of vision was not significantly different between groups (no data available for meta-analysis).None of the included studies reported the proportion of participants with a postoperative hypertensive phase, which is defined as IOP > 21 mmHg within 3 months after surgery. Two trials reported adverse events (choroidal effusion, corneal edema, flat anterior chamber, and retinal detachment); however, due to small numbers of events and sample sizes, no clear difference between MMC and placebo groups was observed. We found insufficient evidence in this review to suggest MMC provides any postoperative benefit for glaucoma patients who undergo aqueous shunt surgery. Data across all five included trials were sparse and the reporting of study methods required to assess bias was inadequate. Future RCTs of this intervention should report methods in sufficient detail to permit assessment of potential bias and estimate target sample sizes based on clinically meaningful effect sizes.

Tube shunt surgery in pig eyes: a wet lab teaching model

To describe a teaching model for aqueous tube shunt surgery using freshly enucleated pig eyes. A descriptive methods report, containing a small prospective noncomparative interventional case series. Six ophthalmology residents from the University of Alberta program. A descriptive report outlines the materials and methods required for creating a surgical wet lab that teaches aqueous draining device implantation. Residents practiced each step associated with the insertion of plated aqueous tube shunt devices in porcine eyes. The porcine model worked well to demonstrate and perform steps associated with tube implant surgery. Trainee comfort improved in all surgical steps practiced during the session when reassessed at 3-month follow-up: priming and anchoring the drainage device (p = 0.042), inserting the tube into the eye (p = 0.025), creating and securing a scleral patch graft (p = 0.034), and closure of the conjunctiva (p = 0.034). Overall confidence in performing tube shunt surgery also remained above baseline at follow-up (p = 0.042). Implantation of tube shunt devices in the porcine model closely resembles surgery in human eyes. Practicing each step associated with tube shunt surgery on porcine eyes in a supervised wet-lab environment improves trainee confidence in the procedure.

A Case of Pseudomonas Orbital Cellulitis Following Glaucoma Device Implantation

Orbital cellulitis is a rare complication of aqueous tube shunt surgery. Nine cases have been described in the literature, though the microbiologic etiology is rarely reported. Management with intravenous antibiotics and/or explantation has been described. This is a case report and literature review. A 64-year-old woman developed pain, periorbital swelling, limited extraocular motility, proptosis, and conjunctival injection 3 days following implantation of an Ahmed Glaucoma Valve. Computed tomography of the orbits with contrast showed soft tissue fat stranding consistent with orbital inflammation. Initial medical management with topical and intravenous ceftriaxone and vancomycin was unsuccessful. Surgical removal of the implant was performed and intraoperative cultures demonstrated florid Pseudomonas aeruginosa growth. Antibiotic coverage was changed to Piperacillin-Tazobactam for 3 days, with eventual resolution of her orbital symptoms. We report the first case of orbital cellulitis after implantation of a glaucoma device associated with P. aeruginosa. Failure of intravenous and topical antibiotics led to explantation of the valve and targeted intravenous antibiotic therapy with subsequent clinical improvement.

A Composite Model for the Transport of Hydrophilic and Lipophilic Compounds Across the Skin: Steady-State Behavior

A porous pathway feature has been added to an existing skin diffusion model to extend the range of applicability to highly polar solutes that do not readily diffuse across the stratum corneum (SC) lipid/corneocyte matrix. The porous pathway consists of 2 components: Pathway A is appendageal and is implemented as an array of aqueous shunts (the macropores), which themselves have microporous walls with transient aqueous pores (the micropores). Two varieties of shunts are discussed, one representing a terminal hair follicle and the other representing an eccrine sweat duct; however, the focus here is on the hair follicle. Pathway B is transcellular, with lipid-phase transport accomplished through defects or breaks in the bilayer lipid structure. The composite model admits polar solutes into the skin in a size-selective manner with an effective micropore radius of 1.6 nm. Steady-state permeabilities, desorption rates from isolated SC, and SC/water partition coefficients of both polar and lipophilic solutes are effectively explained.

Descemet Membrane Endothelial Keratoplasty for Failed Penetrating Keratoplasty: Visual Outcomes and Graft Survival.

To evaluate outcomes and graft survival of Descemet membrane endothelial keratoplasty (DMEK) for failed penetrating keratoplasty (PK). Ninety-three DMEK procedures performed in 84 eyes of 77 patients with failed PK were retrospectively reviewed. The main outcomes were corrected distance visual acuity and graft survival assessed with Kaplan-Meier survival analysis and proportional hazards modeling taking follow-up into consideration. Sixty-nine eyes had 1 previous failed PK, 13 had 2, 1 had 3, and 1 had 4. Ten eyes had failed Descemet stripping endothelial keratoplasty (DSEK) performed under failed PK. Fourteen cases (15%) had previous glaucoma filtration surgery (9 trabeculectomy alone; 5 trabeculectomy and aqueous shunt). Median follow-up was 21 months (range, 1 month to 7 years). Median Snellen corrected distance visual acuity improved from 20/100 preoperatively (range, 20/30 to count fingers) to 20/30 at 6 months postoperatively (n = 73; range, 20/20-20/200). Rebubbling rates were 53% when the diameter of the DMEK graft was oversized, 27% when same sized, and 33% when undersized relative to that of the previous PK graft. Two grafts (2%) experienced an immunologic rejection episode, and 15 (16%) failed, including 5 primary/early failures and 10 late failures. Previous glaucoma surgery was the only significant risk factor for failure (relative risk, 7.1; 95% confidence interval, 2.1-37.0). The 1-, 2-, and 3-year graft survival rates were 96%, 89%, and 89% without versus 78%, 53%, and 39% with previous glaucoma surgery. Treatment of failed PK with DMEK produced similar 4-year survival (76%) and better visual outcomes than previously reported with Descemet stripping endothelial keratoplasty or an initial PK regraft.

Is Ahmed valve superior to Baerveldt implant as an aqueous shunt for the treatment of glaucoma?

Is Ahmed valve superior to Baerveldt implant as an aqueous shunt for the treatment of glaucoma?

Reporting Harm in Glaucoma Surgical Trials: Systematic Review and a Consensus-Derived New Classification System

To evaluate the standards of harm reporting for glaucoma surgical trials and to develop a classification system for reporting surgical complication severity. Systematic review and Delphi consensus method. Systematic review of glaucoma surgical trials published from January 2010 until July 2017 with a quality assessment against the CONSORT checklist for harm. A Delphi method was employed to generate consensus grading (interquartile range ≤ 2) among international glaucoma experts (n= 43) on severity of glaucoma surgical complications, and specifically for trabeculectomy and aqueous shunt complications, from1(no clinical significance) to 10 (most severe complication). Forty-seven studies were eligible. The items of the CONSORT checklist for harm that were most frequently missing were use of a validated instrument to report severity (0%), withdrawals due to harm, and subgroup analyses, both reported in 3 publications (6.4%). Most glaucoma experts participating in the Delphi process (80%) completed the second round, and consensus was achieved for all but 1 complication. The least severe complications (graded 2) were "transient loss of vision," "early low intraocular pressure," "choroidal detachment anterior to equator," "small layered hyphema < 1mm," and "increased lens opacity not clinically significant." The most severe complications (graded 10) were "endophthalmitis" and "permanent severe loss of vision (hand movements or worse)." Glaucoma surgical randomized controlled trials report frequency of complications, but their severity is rarely reported. The quality of harm reporting is poor. We propose the use of a newly developed system of classification for assessing the severity of surgical complications based on consensus.

Clinical Factors for Early and Late Endothelial Cell Loss After Corneal Transplantation

To consider the relative importance of factors associated with post-keratoplasty endothelial cell loss. Lamellar keratoplasty continues to supplant penetrating keratoplasty. When host endothelium is healthy, retaining it with deep anterior lamellar keratoplasty significantly reduces long-term endothelial cell loss. Endothelial keratoplasty and penetrating keratoplasty differ fundamentally in relative rates of early and late central endothelial cell loss, yet at 10 years, their cumulative cell loss is similarly substantial. The greatest risk factor for post-keratoplasty endothelial decompensation is prior glaucoma filtration surgery, particularly an aqueous shunt. Interestingly, vital dye staining and sophisticated imaging software suggest that the actual viable endothelial cell density of donor corneas is often overestimated by specular microscopy, inflating estimates of early cell loss. Corneal graft longevity is often determined by endothelial cell survival. Adoption of new surgical techniques has improved graft survival, and new imaging techniques allow more accurate preoperative endothelial cell evaluation.

Comparison of surgical outcomes of trabeculectomy, Ahmed shunt, and Baerveldt shunt in uveitic glaucoma

BackgroundUveitis is defined as a collection of syndromes involving intraocular inflammation which can lead to pain, tissue damage, and vision loss. Ophthalmic surgery in uveitis patients can be challenging due to inflammation-induced fibrosis and scarring. Trabeculectomy and implantation of glaucoma drainage devices (aqueous shunts) have been used in surgical management of uveitic glaucoma, however there is a paucity of literature examining the comparative results of these entities in this unique setting. The purpose of this retrospective comparative study is to compare clinical outcomes of trabeculectomy with MMC, Ahmed shunt, and Baerveldt shunt surgery specifically in uveitic glaucoma.ResultsMedian IOP, IOP reduction, glaucoma medication use, and visual acuity at 6- and 12-month follow-up were similar across groups. Postoperative hypotony rate was significantly different across trabeculectomy (53%), Baerveldt (24%), and Ahmed (18%) groups (p = 0.027); other complication rates were similar. Baerveldt eyes had a lower failure rate compared to trabeculectomy (p = 0.0054) and Ahmed (p = 0.0008) eyes.ConclusionsWhile there was no difference in IOP reduction between trabeculectomy, Ahmed, and Baerveldt, Baerveldt eyes had the lowest failure rate.

The Safety and Efficacy of Supraciliary Stenting Following Failed Glaucoma Surgery

To evaluate the safety and efficacy of supraciliary stenting following failed glaucoma surgery. Interventional case series. Setting: Moorfields Eye Hospital, London, United Kingdom. Twenty eyes from 20 patients with glaucoma refractory to prior glaucoma surgery. Ab interno microstent (CyPass Micro-Stent; Alcon, Fort Worth, Texas, USA) implantation into the supraciliary space. Outcome measures included the occurrence of ocular adverse events, mean intraocular pressure (IOP) change, and glaucoma medication use through 12months. Mean baseline IOP was 22.5 ± 8.0mm Hg and number of medications was 2.7 ± 1.0. The majority of patients had undergone either prior trabeculectomy or aqueous shunt surgery. There were no serious intraoperative complications or major adverse events following supraciliary stenting. The most common adverse events included transient hyphema (3/20, 15%), transientIOP> 30mm Hg (4/20, 20%), and transient IOP<6mm Hg (4/20, 20%). At 12months, mean IOP was 14.9 ± 4.3mm Hg-a 33.7% reduction (P=.01). Mean medication usage decreased 56% to 1.2 ± 1.5 at 12months (P= .01). Two patients (10%) required subsequent aqueous shunt insertion. Ab interno supraciliary stenting has a favorable safety profile and provides an effective approach to controlling IOP and reducing medication burden in eyes in which previous glaucoma surgery has failed.

Changing patterns of surgical treatment for glaucoma in the Eye Hospital of Wenzhou Medical University during the past ten years

Objective: To investigate the patterns of surgical treatment for patients with glaucoma in the Eye Hospital of Wenzhou Medical University from 2005 to 2014. Methods: Retrospective case series about 6 781 glaucoma patients (7 751 eyes) who received surgical treatment from January 1, 2005 to December 31, 2014 in the Eye Hospital of Wenzhou Medical University. Among them, 2 869 were males and 3 912 were females, aged (62±14) years. The data of patients' demographic information, diagnosis and surgical procedures [trabeculectomy, aqueous shunts of ExPRESS and Ahmed for extraocular reservoir, cataract extraction with intraocular lens (IOL) implantation, and combined operations for glaucoma and cataract] were collected and the patterns of surgical treatment were evaluated. SPSS 21.0 statistical software was used, mainly for statistical description of the data. Results: The ratio of trabeculectomies increased between 2005 and 2009, from 48.2% (95/197) to 57.7% (488/846), but decreased to 21.1% (220/1 041) in 2014. The ratio of aqueous shunts of ExPRESS and Ahmed increased to 6.1% (63/1 041) and 7.6% (79/1 041) from 2005 to 2014, respectively. The ratio of cataract extraction with IOL implantation increased to 28.4% (294/1 036) in 2012, but decreased to 21.6% (225/1 041) in 2014. The ratio of combined operations for glaucoma and cataract decreased to 6.6% (47/717) from 2005 to 2010, and increased to 36.6% (381/1 041) in 2014. Over the decade, the ratio of cataract extraction with goniosynechialysis increased from 2.4% (15/623) to 17.7% (184/1 041). The rate of iridotectomy decreased to 0.2% (2/1041) in 2014. Conclusions: Trabeculectomy, cataract surgery and combined surgery for glaucoma with cataract were still the mainstream of glaucoma surgery in the Eye Hospital of Wenzhou Medical University from 2005 to 2014. And the ratio of cataract extraction with IOL implantation, aqueous shunts of ExPRESS and Ahmed, and combined operation for glaucoma and cataract rapidly increased, with cataract extraction with goniosynechialysis increasing most rapidly and becoming the mainstream procedure of treatment for glaucoma and cataract. Inversely, the rate of trabeculectomies and iridotectomies decreased dramatically over this period.(Chin J Ophthalmol, 2018, 54: 184-188).

Update on Microinvasive Glaucoma Surgery.

Update on Microinvasive Glaucoma Surgery.