Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology

Don S. Minckler, Brian A. Francis, Elizabeth A. Hodapp, Henry D. Jampel, Shan C. Lin, John R. Samples, Scott D. Smith, Kuldev Singh

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

Objective: To provide an evidence-based summary of commercially available aqueous shunts currently used in substantial numbers (Ahmed [New World Medical, Inc., Rancho Cucamonga, CA], Baerveldt [Advanced Medical Optics, Inc., Santa Ana, CA], Krupin [Eagle Vision, Inc, Memphis, TN], Molteno [Molteno Ophthalmic Ltd., Dunedin, New Zealand]) to control intraocular pressure (IOP) in various glaucomas. Methods: Seventeen previously published randomized trials, 1 prospective nonrandomized comparative trial, 1 retrospective case-control study, 2 comprehensive literature reviews, and published English language, noncomparative case series and case reports were reviewed and graded for methodologic quality. Results: Aqueous shunts are used primarily after failure of medical, laser, and conventional filtering surgery to treat glaucoma and have been successful in controlling IOP in a variety of glaucomas. The principal long-term complication of anterior chamber tubes is corneal endothelial failure. The most shunt-specific delayed complication is erosion of the tube through overlying conjunctiva. There is a low incidence of this occurring with all shunts currently available, and it occurs most frequently within a few millimeters of the corneoscleral junction after anterior chamber insertion. Erosion of the equatorial plate through the conjunctival surface occurs less frequently. Clinical failure of the various devices over time occurs at a rate of approximately 10% per year, which is approximately the same as the failure rate for trabeculectomy. Conclusions: Based on level I evidence, aqueous shunts seem to have benefits (IOP control, duration of benefit) comparable with those of trabeculectomy in the management of complex glaucomas (phakic or pseudophakic eyes after prior failed trabeculectomies). Level I evidence indicates that there are no advantages to the adjunctive use of antifibrotic agents or systemic corticosteroids with currently available shunts. Too few high-quality direct comparisons of various available shunts have been published to assess the relative efficacy or complication rates of specific devices beyond the implication that larger-surface-area explants provide more enduring and better IOP control. Long-term follow-up and comparative studies are encouraged.

Original languageEnglish (US)
Pages (from-to)1089-1098
Number of pages10
JournalOphthalmology
Volume115
Issue number6
DOIs
StatePublished - Jun 2008

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Glaucoma Drainage Implants
Intraocular Pressure
Glaucoma
Trabeculectomy
Anterior Chamber
Limbus Corneae
Equipment Failure
Filtering Surgery
Eagles
Conjunctiva
New Zealand
Case-Control Studies
Adrenal Cortex Hormones
Lasers
Language
Equipment and Supplies
Incidence

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Minckler, D. S., Francis, B. A., Hodapp, E. A., Jampel, H. D., Lin, S. C., Samples, J. R., ... Singh, K. (2008). Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology. Ophthalmology, 115(6), 1089-1098. https://doi.org/10.1016/j.ophtha.2008.03.031

Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology. / Minckler, Don S.; Francis, Brian A.; Hodapp, Elizabeth A.; Jampel, Henry D.; Lin, Shan C.; Samples, John R.; Smith, Scott D.; Singh, Kuldev.

In: Ophthalmology, Vol. 115, No. 6, 06.2008, p. 1089-1098.

Research output: Contribution to journalArticle

Minckler, DS, Francis, BA, Hodapp, EA, Jampel, HD, Lin, SC, Samples, JR, Smith, SD & Singh, K 2008, 'Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology', Ophthalmology, vol. 115, no. 6, pp. 1089-1098. https://doi.org/10.1016/j.ophtha.2008.03.031
Minckler DS, Francis BA, Hodapp EA, Jampel HD, Lin SC, Samples JR et al. Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology. Ophthalmology. 2008 Jun;115(6):1089-1098. https://doi.org/10.1016/j.ophtha.2008.03.031
Minckler, Don S. ; Francis, Brian A. ; Hodapp, Elizabeth A. ; Jampel, Henry D. ; Lin, Shan C. ; Samples, John R. ; Smith, Scott D. ; Singh, Kuldev. / Aqueous Shunts in Glaucoma. A Report by the American Academy of Ophthalmology. In: Ophthalmology. 2008 ; Vol. 115, No. 6. pp. 1089-1098.
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