BACKGROUND: To describe the histological features of failed gold micro shunts (GMS) in unsuccessful implantations for refractory primary open-angle glaucoma (POAG). METHODS: This was an interventional case series study. Five eyes of five glaucomatous patients with unsuccessful GMS implantation underwent shunt removal. Each device was sectioned into three portions: proximal or anterior chamber (AC) portion, middle or scleral portion and distal or suprachoroidal (SC) portion. The histological analysis was performed throughout the whole extent of the shunt, describing both the inner spaces and the outer surface. RESULTS: At the moment of removal all devices were correctly located into the SC space and in AC, with the exception of a case presenting corneal endothelial contact. The mean intra-ocular pressure before GMS removal was 30.4 ± 5.3 mmHg, and the mean time of GMS removal after implantation was 6.8 ± 2.5 months. No significant histological differences were documented among the five analyzed devices. The main feature was the presence of a thick connective capsule-like reaction surrounding both the proximal and distal ends and invading the posterior and anterior grid holes, whereas a more loosely arranged connective tissue was observed within the inner channels. Signs of surface fibrosis of the middle-scleral portion and inflammatory cell infiltration of the device were not documented in any of the cases. CONCLUSIONS: Failed GMS implantations presented connective tissue filling all the inner spaces and creating a thick fibrotic capsule surrounding the ends of the device. This modification isolated the GMS from the AC and SC space, impeding aqueous flows throughout the shunt.
BACKGROUND: To describe the histological features of failed gold micro shunts (GMS) in unsuccessful implantations for refractory primary open-angle glaucoma (POAG). METHODS: This was an interventional case series study. Five eyes of five glaucomatouspatients with unsuccessful GMS implantation underwent shunt removal. Each device was sectioned into three portions: proximal or anterior chamber (AC) portion, middle or scleral portion and distal or suprachoroidal (SC) portion. The histological analysis was performed throughout the whole extent of the shunt, describing both the inner spaces and the outer surface. RESULTS: At the moment of removal all devices were correctly located into the SC space and in AC, with the exception of a case presenting corneal endothelial contact. The mean intra-ocular pressure before GMS removal was 30.4 ± 5.3 mmHg, and the mean time of GMS removal after implantation was 6.8 ± 2.5 months. No significant histological differences were documented among the five analyzed devices. The main feature was the presence of a thick connective capsule-like reaction surrounding both the proximal and distal ends and invading the posterior and anterior grid holes, whereas a more loosely arranged connective tissue was observed within the inner channels. Signs of surface fibrosis of the middle-scleral portion and inflammatory cell infiltration of the device were not documented in any of the cases. CONCLUSIONS: Failed GMS implantations presented connective tissue filling all the inner spaces and creating a thick fibrotic capsule surrounding the ends of the device. This modification isolated the GMS from the AC and SC space, impeding aqueous flows throughout the shunt.
Authors: Thomas W Samuelson; L Jay Katz; Jeffrey M Wells; Yi-Jing Duh; Jane Ellen Giamporcaro Journal: Ophthalmology Date: 2010-09-15 Impact factor: 12.079
Authors: A L Coleman; R Hill; M R Wilson; N Choplin; R Kotas-Neumann; M Tam; J Bacharach; W C Panek Journal: Am J Ophthalmol Date: 1995-07 Impact factor: 5.258
Authors: Marina Hovakimyan; Stefan Siewert; Wolfram Schmidt; Katrin Sternberg; Thomas Reske; Oliver Stachs; Rudolf Guthoff; Andreas Wree; Martin Witt; Klaus-Peter Schmitz; Reto Allemann Journal: Transl Vis Sci Technol Date: 2015-06-30 Impact factor: 3.283