Clinical experience with urgent tube shunt implantation through the ciliary sulcus in phakic eyes
- 33 Downloads
To review the clinical course and outcomes of 3 phakic, ischemic, and inflamed eyes in which we performed urgent tube shunt implantation through the ciliary sulcus without lensectomy.
This is a retrospective interventional case series. Three eyes of 3 diabetic patients with uncontrolled severe neovascular glaucoma, shallow anterior chambers with closed angles and poor view to the posterior segment, where concomitant lensectomy was not recommended due to uncontrolled uveitis and ischemia, underwent tube shunt implantation through the ciliary sulcus. Main outcome measures were surgical complications, especially injury to the crystalline lens, and postoperative intraocular pressure (IOP).
No surgical complications, including injury to the crystalline lens, have occurred. We used surgical modifications to allow sufficient visualization of the sulcus area to avoid injury to the crystalline lens during scleral tunneling and tube insertion through the ciliary sulcus. Postoperatively, the uveitis, ischemia, and vision have improved and IOP was controlled throughout follow-up. Cataract surgery with pupilloplasty was performed in one eye a year later with no complications and no interruption to IOP control.
Based on our small and limited retrospective study, and under unusual circumstances, urgent tube shunt implantation through the ciliary sulcus may be considered in phakic eyes with severely uncontrolled IOP, shallow anterior chambers and poor view to the posterior segment, and when concomitant lensectomy is not recommended. We advise the use of appropriate surgical modifications by experienced glaucoma surgeons to prevent intraoperative complications. Further and larger studies are needed to evaluate the safety of this surgical option.
KeywordsTube shunt implantation Ciliary sulcus Glaucoma surgery Intraocular pressure Phakic Crystalline lens Cataract
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB), St. Peter’s Hospital, Albany, New York, approved this study.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Since this study is retrospective and does not reveal any identifiable information on any of the patients studied, no informed consent was required or obtained.
- 23.Baker CW, Almukhtar T, Bressler NM, Glassman AR, Grover S, Kim SJ, Murtha TJ, Rauser ME, Stockdale C, Diabetic Retinopathy Clinical Research Network Authors/Writing Committee (2013) Macular edema after cataract surgery in eyes without preoperative central-involved diabetic macular edema. JAMA Ophthalmol 131:870–879CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Wang S, Xu Q, Du Y, Wu X (2016) Does phacoemulsification speed the progression of diabetic retinopathy? A meta-analysis. Int J Clin Exp Med 9:8874–8882Google Scholar
- 38.Bloom PA, Clement CI, King A, Noureddin B, Sharma K, Hitchings RA, Khaw PT (2013) A comparison between tube surgery, Nd:Yag laser and diode laser cyclophotocoagulation in the management of refractory glaucoma. BioMed Res Int. https://doi.org/10.1155/2013/371951 (Article ID 371951) PubMedPubMedCentralGoogle Scholar