Clinical experience with urgent tube shunt implantation through the ciliary sulcus in phakic eyes

  • Adam J. Weiner
  • Yotam Weiner
  • Melissa L. Severson
  • Asher Weiner
Original Paper
  • 17 Downloads

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Tube shunt implantation Ciliary sulcus Glaucoma surgery Intraocular pressure Phakic Crystalline lens Cataract 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

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.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beaumont Eye InstituteOakland University William Beaumont School of MedicineRoyal OakUSA
  2. 2.Oakland University William Beaumont School of MedicineRochester HillsUSA
  3. 3.Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo/State University of New York (SUNY)BuffaloUSA

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