Abstract
Purpose :
We set out to assess the efficacy of a newly available commercial model of the anterior to back (A2B) shunt (AJL, Bilbao, SP) in lowering intraocular pressure (IOP) in pediatric patients.
Methods :
IOP was measured using consistently using either icare TA01i rebound tonometer (icare, Oy, Finland) or Goldmann applanation tonometer (Haag-Streit USA, Mason, Ohio). All patients involved were afflicted by congenital glaucoma. Inclusion: all individuals under the age of 18 who had undergone A2B shunt placement that had previously failed other forms of glaucoma surgery. Change in IOP and number of medications used was assessed using paired t-test.
Results :
8 eyes of 8 patients were assessed (mean age 8 [range: 5mo-17yr]; 4M4F). A mean of 6.1 prior incisional glaucoma procedures had been performed at various centers on each eye without sustained success (3 anti-metabolite filtering procedures, 11 tube shunts, and 7 trans-cameral viscoelastic bleb-expansion tube shunt modifications [range 1-8 such modifications]). Subjects were being administered a mean of 2.7 IOP-lowering drops. At 1, 7, 30, 90, and 180 days after surgery, 85%, 80%, 85%, 66%, and 100% of patients maintained an IOP ≤ 21 mmHg, respectively. At these same time intervals IOP dropped from the baseline value of 36.9 ± 3.3 mmHg to 15.1 ± 3.8 (-21.7mmHg, -40%; p=0.01), 22.6 ± 9.3 (-14.2mmHg, -38%; p=0.38), 17.1 ± 1.2 (-19.7 mmHg, -46%; p=0.001), 19.5 ± 3.4 (-17.3mmHg, -52%; p=0.05), and 18.3 ± 1.3 (-18.54mmHg, 49%; p=0.01) respectively. Change in medication at 30, 90, and 180 days dropped from baseline of 2.75 to 0 at each interval (p<0.0001). (Fig. 1)
Conclusions :
The A2B shunt is a silicone glaucoma device designed by Dr. William E Sponsel. It drains aqueous humor from the anterior chamber into the retrobulbar space by way of a poly-fenestrated large-bore tube. In this study we show the efficacy of this therapy in pediatric patients with congenital glaucoma. Glaucoma surgery in pediatric patients with congenital glaucoma is challenging and the retrobulbar shunt is an efficacious alternative. One of its primary advantages is that it makes use of a compartment with a more ideal healing profile. This study suggests that the use of this kind of shunt in children is as efficacious at lowering IOP after other forms of therapy have failed.
This is a 2020 ARVO Annual Meeting abstract.