Journal of Current Glaucoma Practice

Register      Login

VOLUME 9 , ISSUE 3 ( September-December, 2015 ) > List of Articles

RESEARCH ARTICLE

Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush

Kelsi L Greider

Keywords : Bleb fibrosis, Glaucoma surgery, Glaucoma tube shunt, Intraocular pressure, Modification/revision of glaucoma tube shunt, Ocular hypertension, Viscoelastic

Citation Information : Greider KL. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015; 9 (3):73-76.

DOI: 10.5005/jp-journals-10008-1188

License: CC BY-NC 4.0

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs. Design: Case series. Subjects and participants: Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb. Main outcome measures: Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months. Results: Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20). Conclusion: Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period.


PDF Share
  1. Minckler DS, Francis BA, Hodapp EA, et al. Aqueous shunts in glaucoma: a report by the American Academy of Ophthalmology. Ophthalmol 2008;115(6):1089-1098.
  2. Price FW Jr, Wellemeyer M. Long-term results of Molteno implants. Ophthalmic Surg 1995;26(2):130-135.
  3. Sarkisian SR Jr. Tube shunt complications and their prevention. Curr Opin Ophthalmol 2009;20(2):126-130.
  4. Gedde SJ, Schiffman JC, Feuer WJ, et al. Tube versus trabeculectomy study group. Treatment outcomes in the tube versus trabeculectomy study after five years of follow-up. Am J Ophthalmol 2012;153(5):789-803.
  5. Arosemena A, Ayyala RS. Steps for saving failing blebs after trabeculectomy: needling can be successful in early and late cases of bleb revision. Ocular Surgery News US Edition; 2004 February.
  6. Bayer A, Wilson RR, Eagle RC Jr. Tube occlusion from the external ostium after implantation of an aqueous shunt. Ophthalmic Surg Lasers 2002;33(6):493-496.
  7. Singh K, Eid TE, Katz LJ, et al. Evaluation of Nd: YAG laser membranectomy in blocked tubes after glaucoma tube-shunt surgery. Am J Ophthalmol 1997;124(6):781-786.
  8. Tessler Z, Jluchoded S, Rosenthal G. Nd: YAG laser for Ahmed tube shunt occlusion by the posterior capsule. Ophthalmic Surg Lasers 1997;28(1):69-70.
  9. Gomez LI, Gutierrez DE, Montero RM, et al. Glaucoma drainage device obstruction. Arch Soc Esp Oftalmol 2004; 79(7):341-346.
  10. Francis BA, Kawji AS, Vo NT, et al. Endoscopic cyclophotocoagulation in the management of uncontrolled glaucoma with prior aqueous tube shunt. J Glaucoma 2011;20(8):523-527.
  11. Sood S, Becker AD. Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma. J AAPOS 2009; 13(4):379-383.
  12. Paris G, Zhao M, Sponsel WE. Operative revision of nonfunctioning filtering blebs with 5-fluorouracil to regain intraocular pressure control. Clin Experiment Ophthalmol 2004;32(4):378-382.
  13. Tsui I, Airiani S, Wen A, et al. Intravitreal injection of tissue plasminogen activator as treatment for an occluded pars plana glaucoma tube. Clin Ophthalmol 2009;3:91-93.
  14. Odrich S, Wald K, Sperber L. Ab interno management of blocked Ahmed valve in the posterior segment. J Glaucoma 2013;22(5):9-10.
  15. Burgoyne JK, WuDunn D, Lakhani V, et al. Outcomes of sequential tube shunts in complicated glaucoma. Ophthalmol 2000;107(2):309-314.
  16. Tsai JC, Grajewski AL, Parrish RK. Surgical revision of glaucoma shunt implants. Ophthalmol Surg Lasers 1999; 30(1):41-46.
  17. Batlle OR, Sponsel WE, Swann FB, et al. Retrobulbar diversion of aqueous humor: laboratory studies. J Glaucoma 2014;23(9):624-627.
  18. Sponsel WE, Groth SL, Ayyala RS. Retrobulbar diversion of aqueous humor: clinical feasibility studies. J Glaucoma 2014;23(9):628-632.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.