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Results of the retrobulbar shunt in glaucoma management

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First Author: F.March De Ribot SPAIN

Co Author(s):    W. Sponsel   M. Montelongo   L. Chu   V. Saka   R. Chitedze   R. Craven     

Abstract Details

Purpose:

To examine the efficacy and safety of a commercial model of the retrobulbar shunt  Anterior chamber to Back of the eye (A2B) in lowering intraocular pressure (IOP) and medication requirement after the failure of all other IOP-lowering therapies (including trabeculectomy with antimetabolites and tube shunt procedures).

Setting:

Ophthalmology Department, University Hospital

Methods:

This is a single-site, prospective, nonrandomized study. Individuals who had failed all other IOP-lowering therapies were considered candidates for A2B shunt implantation. Shunts that were consecutively implanted from Jan. 2019-Feb 2020 were included in this analysis. Prespecified outcome measures include IOP control with and without supplemental medication, success rate, medication use, and adverse events.

Results:

26 eyes of 23 patients wereassessed (mean age 43.9 ± 5.1) received the A2B shunt, after a mean of 2.2 prior incisional glaucomasurgeries without sustained success. 92% of the eyes had previously failed tubeshunt surgeries, after the failure of other surgeries. The mean IOP (mmHg ± SEM) dropped from a baseline of 34.6 ± 2.6 to 9.5 ± 1.5(-25.1 mmHg, -72%), 16.2 ± 2.7(-18.4 mmHg, -53%), 15.5 ± 1.5 (-19.1 mmHg, -55%), 16.7 ± 1.5 (-17.9 mmHg, -51%), 18.2 ± 1.0 (-16.4 mmHg, -47%), and 16 ± 2.12 (-18.6 mmHg, -53%) at 1, 7, 30, 90, 180, and 365 days after surgery, respectively(p < 0.001). The mean number of glaucoma medications (± SEM) at 30, 90, 180, and 365 days dropped from baseline of 2.3 ± 0.3 to 0.24 ± 0.13, 0.26 ± 0.14, 0.33 ±0.18, and 0.2 ± 0.2 respectively (p<0.0001). There were no complicationsincluding leaks, infections, migrations, erosions, persistent corneal edema, orserious long-term adverse events.

Conclusions:

Conclusions: TheA2B shunt is an effective rescue therapy in patients that have manifestly failed other IOP-lowering procedures.  Discussion: The surgery redirects aqueous humor into the retrobulbar space resulting in a highly effective method to lower IOP, with no significant fibrosis reaction, ending in less surgical failure. The operation is similar to traditional tube shunts but requires only a fraction of the time, in part because it omits the scleral fixation of a plate. The risk of aqueous leakage or tube/tutoplast exposure is limited because of the intrinsic properties of retrobulbar fat prompts it to create a one-way valve system.

Financial Disclosure:

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