Glaucoma Tube Shunt Implantation Through the Ciliary Sulcus in Pseudophakic Eyes With High Risk of Corneal Decompensation

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PurposeTo summarize our clinical experience with implanting Baerveldt glaucoma tube shunts through the ciliary sulcus in eyes with a posterior chamber intraocular lens and shallow anterior chambers, corneal transplants, guttata or edema.Patients and MethodsA retrospective interventional nonrandomized noncomparative case series. Main outcome measure was postoperative corneal status. Secondary outcome measures included postoperative intraocular pressure (IOP), visual acuity and complications.ResultsThirty-six eyes of 32 patients were identified through chart review. Follow-up period was 21.8±16.6 months (mean±standard deviation, range: 4.0 to 58.5 mo). At final visit, all 23 preoperative clear native corneas and 6 of 7 corneal transplants remained clear. Thus, of the 30 preoperative clear corneas, only 1 decompensated. Preoperative IOP was 27.9±11.8 mm Hg (range: 12 to 59 mm Hg), reduced postoperatively to 10.1±3.9 mm Hg (range: 2 to 21 mm Hg, P=0.0001), a reduction of 58.2%±19.3% (range: 5.0% to 95.4%). Final IOP was ≥5 and ≤21 mm Hg in 33 of 36 eyes (91.7%). It was lowered by 30% or more in 34 of 36 eyes (94.4%).ConclusionsAlthough previously published studies demonstrated a significant risk of corneal decompensation after angle or pars plana tube implantation, our clinical experience suggests that ciliary sulcus tube implantation in eyes with a posterior chamber intraocular lens is a safe and effective procedure even in eyes with high risk of corneal decompensation.

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