July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Novel Retrobulbar Extension Shunt to Rescue Eyes with Fibrotic Encapsulated Blebs and Uncontrolled Ocular Hypertension
Author Affiliations & Notes
  • William Eric Sponsel
    Madison Square Bldg Ste 306, WESMDPA, San Antonio, Texas, United States
    Biomedical Engineering, UTSA, San Antonio, Texas, United States
  • Madeleine Puig
    UTHSCSA School of Medicine, Texas, United States
  • Hannia Ramos
    Universidad Autónoma de Guadalajara School of Medicine, Guatemala
  • Sylvia Groth
    Vanderbilt University, Tennessee, United States
  • Francesc March de Ribot
    Barcelona University Hospital, Spain
  • Footnotes
    Commercial Relationships   William Sponsel, AJL (P), New World Medical (P); Madeleine Puig, None; Hannia Ramos, None; Sylvia Groth, None; Francesc March de Ribot, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3742. doi:
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      William Eric Sponsel, Madeleine Puig, Hannia Ramos, Sylvia Groth, Francesc March de Ribot; Novel Retrobulbar Extension Shunt to Rescue Eyes with Fibrotic Encapsulated Blebs and Uncontrolled Ocular Hypertension. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3742.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Retrobulbar glaucoma shunts are large-bore fenestrated silicone stents that redirect aqueous humor into the retrobulbar space. They were designed to rescue failed standard tube shunts with fibrotic encapsulation in patients with intractable ocular hypertension. This article evaluates longer-term outcomes of a larger population undergoing retrobulbar aqueous redirection.

Methods : Outcomes of all retrobulbar shunts placed among this progressive-entry surgical population over an 8-year interval. Implants were produced by New World Medical (NWM) in Rancho Cucamonga, California and AJLin Bilbao, Spain. Mean and percentage IOP reduction and medications required were evaluated at annual intervals, along with pre-operative and final visual acuity. Significance of change was assessed by 2-tailed paired t-test. Failure was designated as any eye requiring placement of another shunt or diode-cyclophotocoagulation. All data are included in this analysis regardless of outcome.

Results : Thirty-five retrobulbar shunts were implanted (18M,17F; mean 54.3yrs; mean follow-up 32.5mo). Short-term AJL shunt performance was comparable to that of the 26 NWM shunts, for which there was longer-termfollow-up. Three shunts (9%) failed: two eyes required diode at 6mo, one another standard shunt after >2yrs. Preoperatively medications averaged 2.6, reduced to 0.4-0.75 medications at each annual assessment (P<0.0001). IOP was substantially reduced (by 53-57% from mean baseline 29.9-32.5mmHg to 16.4-18.4mmHg; P<0.0008) at every annual follow-up. Visual acuity remained stable (baseline mean VA 0.27, final VA 0.30;P=0.68).

Conclusions : Retrobulbar extension shunts can convert tube shunt failures, with high success rate, to eyes with IOP
control comparable to successful primary filtration surgery.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

The current European model (AJL; Bilbao, Spain) retrobulbar glaucoma tube shunts, shown with the posterior aspect of the implant oriented to the left. 2a. Is the continuous large-bore B2B ‘bleb-to-back’ fenestrated surgical silicone implant designed to direct aqueous from a fibrotic encapsulated bleb into the retrobulbar space. 2b. Is the graduated A2B ‘anterior-to-back’ implant for directing aqueous into the retrobulbar space directly from the anterior chamber in a bleb-free system.

The current European model (AJL; Bilbao, Spain) retrobulbar glaucoma tube shunts, shown with the posterior aspect of the implant oriented to the left. 2a. Is the continuous large-bore B2B ‘bleb-to-back’ fenestrated surgical silicone implant designed to direct aqueous from a fibrotic encapsulated bleb into the retrobulbar space. 2b. Is the graduated A2B ‘anterior-to-back’ implant for directing aqueous into the retrobulbar space directly from the anterior chamber in a bleb-free system.

 

Mean pre- and post-operative intraocular pressures in eyes undergoing retrobulbar shunt placement.

Mean pre- and post-operative intraocular pressures in eyes undergoing retrobulbar shunt placement.

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