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Aqueous shunt exposure repair: outcomes and risk factors for recurrence

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Abstract

Objective

To investigate the outcomes of aqueous shunt exposure repair and to identify risk factors for recurrent exposure after surgical repair.

Methods

This is a retrospective interventional case series of consecutive patients who underwent repair of an exposed aqueous shunt. Demographic and clinical data were extracted from the patients’ records and survival analysis was employed to determine the probability of survival of the repair without further exposure. Cox proportional regression analysis was utilised to identify potential risk factors for failure of the repair surgery.

Results

Seventy-six eyes of 76 patients were included in the study. The probability of survival without further exposure was 76.2% (CI 66.9–86.8%), 72.7% (CI 62.8–84.1%) and 54.7% (40.5–73.7%) at 1,2 and 4 years, respectively. No eye in which the tube was repositioned in the anterior chamber or in the sulcus (n = 9; 11.8%) developed a recurrence of the exposure. A shorter interval from the time of tube insertion to the repair surgery (HR 2.87 [CI 1.11–7.39]; p = 0.03; reference longer interval), a history of previous surgical revision (HR 3.06 [1.15–8.12]; p = 0.02; reference no prior revision) and the use of a human pericardial donor patch at the time of revision (HR 3.43 [1.16–10.13]; p = 0.03; reference other than pericardium) was associated with an increased risk of exposure recurrence.

Conclusion

Aqueous shunt exposure revision is associated with reasonable mid and long term success. A shorter interval from tube insertion to exposure revision, previous revisions and the use of a human pericardium patch were associated with increased risk of failure.

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Data availability

The data that support the findings of this study are located in Moorfields Eye Hospital and are available from the authors upon reasonable request.

References

  1. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Tube versus trabeculectomy study group. treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789–803.e2. https://doi.org/10.1016/j.ajo.2011.10.026.

    Article  PubMed Central  Google Scholar 

  2. Budenz DL, Feuer WJ, Barton K, Schiffman J, Costa VP, Godfrey DG, et al. Ahmed baerveldt comparison study group. postoperative complications in the Ahmed baerveldt comparison study during five years of follow-up. Am J Ophthalmol. 2016;163:75–82.e3. https://doi.org/10.1016/j.ajo.2015.11.023.

    Article  Google Scholar 

  3. Christakis PG, Kalenak JW, Tsai JC, Zurakowski D, Kammer JA, Harasymowycz PJ, et al. The Ahmed versus baerveldt study: five-year treatment outcomes. Ophthalmology. 2016;123:2093–102. https://doi.org/10.1016/j.ophtha.2016.06.035.

    Article  Google Scholar 

  4. Gedde SJ, Feuer WJ, Lim KS, Barton K, Goyal S, Ahmed II, et al. Primary tube versus trabeculectomy study group. postoperative complications in the primary tube versus trabeculectomy study during 5 years of follow-up. Ophthalmology. 2022;129:1357–67. https://doi.org/10.1016/j.ophtha.2022.07.004.

    Article  Google Scholar 

  5. Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of various glaucoma surgeries and procedures in medicare beneficiaries from 1994 to 2012. Ophthalmology. 2015;122:1615–24. https://doi.org/10.1016/j.ophtha.2015.04.015.

    Article  Google Scholar 

  6. Gedde SJ, Scott IU, Tabandeh H, Luu KK, Budenz DL, Greenfield DS, et al. Late endophthalmitis associated with glaucoma drainage implants. Ophthalmology. 2001;108:1323–7. https://doi.org/10.1016/s0161-6420(01)00598-x.

    Article  CAS  Google Scholar 

  7. Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC. Tube versus trabeculectomy study group. postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804–814.e1. https://doi.org/10.1016/j.ajo.2011.10.024.

    Article  PubMed Central  Google Scholar 

  8. Bains U, Hoguet A. Aqueous drainage device erosion: a review of rates, risks, prevention, and repair. Semin Ophthalmol. 2018;33:1–10. https://doi.org/10.1080/08820538.2017.1353805.

    Article  Google Scholar 

  9. Muir KW, Lim A, Stinnett S, Kuo A, Tseng H, Walsh MM. Risk factors for exposure of laucoma drainage devices: a retrospective observational study. BMJ Open. 2014;4:e004560. https://doi.org/10.1136/bmjopen-2013-004560.

    Article  PubMed Central  Google Scholar 

  10. Trubnik V, Zangalli C, Moster MR, Chia T, Ali M, Martinez P, et al. Evaluation of risk factors for glaucoma drainage device-related erosions: a retrospective case-control study. J Glaucoma. 2015;24:498–502. https://doi.org/10.1097/IJG.0000000000000034.

    Article  Google Scholar 

  11. Koval MS, El Sayyad FF, Bell NP, Chuang AZ, Lee DA, Hypes SM, et al. Risk factors for tube shunt exposure: a matched case-control study. J Ophthalmol. 2013;2013:196215. https://doi.org/10.1155/2013/196215.

    Article  PubMed Central  Google Scholar 

  12. Van Hoefen Wijsard M, Haan M, Rietveld E, van Rijn LJ. Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture. Acta Ophthalmol. 2018;96:692–8. https://doi.org/10.1111/aos.13721.

    Article  PubMed Central  Google Scholar 

  13. Al-Beishri AS, Malik R, Freidi A, Ahmad S. Risk factors for glaucoma drainage device exposure in a middle-eastern population. J Glaucoma. 2019;28:529–34. https://doi.org/10.1097/IJG.0000000000001220.

    Article  Google Scholar 

  14. Godfrey DG, Merritt JH, Fellman RL, Starita RJ. Interpolated conjunctival pedicle flaps for the treatment of exposed glaucoma drainage devices. Arch Ophthalmol. 2003;121:1772–5. https://doi.org/10.1001/archopht.121.12.1772.

    Article  Google Scholar 

  15. Grover DS, Merritt J, Godfrey DG, Fellman RL. Forniceal conjunctival pedicle flap for the treatment of complex glaucoma drainage device tube erosion. JAMA Ophthalmol. 2013;131:662–6. https://doi.org/10.1001/jamaophthalmol.2013.2315.

    Article  Google Scholar 

  16. Guajardo JM, Lim KS. Long-term safety and efficacy of conjunctival pedicle graft revision combined with repeated pericardium allograft for exposed glaucoma drainage devices. J Glaucoma. 2018;27:910–3. https://doi.org/10.1097/IJG.0000000000001060.

    Article  Google Scholar 

  17. Einan-Lifshitz A, Belkin A, Mathew D, Sorkin N, Chan CC, Buys YM, et al. Repair of exposed ahmed glaucoma valve tubes: long-term outcomes. J Glaucoma. 2018;27:532–6. https://doi.org/10.1097/IJG.0000000000000951.

    Article  Google Scholar 

  18. Ainsworth G, Rotchford A, Dua HS, King AJ. A novel use of amniotic membrane in the management of tube exposure following glaucoma tube shunt surgery. Br J Ophthalmol. 2006;90:417–9. https://doi.org/10.1136/bjo.2005.084905.

    Article  CAS  PubMed Central  Google Scholar 

  19. Huddleston SM, Feldman RM, Budenz DL, Bell NP, Lee DA, Chuang AZ, et al. Aqueous shunt exposure: a retrospective review of repair outcome. J Glaucoma. 2013;22:433–8. https://doi.org/10.1097/IJG.0b013e3181f3e5b4.

    Article  Google Scholar 

  20. Thompson AC, Manjunath V, Muir KW. Risk factors for earlier reexposure of glaucoma drainage devices. J Glaucoma. 2017;26:1155–60. https://doi.org/10.1097/IJG.0000000000000821.

    Article  Google Scholar 

  21. Sheha H, Tello C, Al-Aswad LA, Sayed MS, Lee RK. Outcomes of the shunt tube exposure prevention study: a randomized clinical trial. Ophthalmol Glaucoma. 2019;2:392–401. https://doi.org/10.1016/j.ogla.2019.08.003.

    Article  PubMed Central  Google Scholar 

  22. Lankaranian D, Reis R, Henderer JD, Choe S, Moster MR. Comparison of single thickness and double thickness processed pericardium patch graft in glaucoma drainage device surgery: a single surgeon comparison of outcome. J Glaucoma. 2008;17:48–51. https://doi.org/10.1097/IJG.0b013e318133fc49.

    Article  Google Scholar 

  23. Weinreb S, Cardakli N, Jefferys J, Quigley H. Long-term functional outcomes of glaucoma tube shunt revision surgery. Ophthalmol Glaucoma. 2019;2:383–91. https://doi.org/10.1016/j.ogla.2019.08.002.

    Article  Google Scholar 

  24. Bouris E, de Gainza A, Barsegian A, Caprioli J. The success rate of glaucoma drainage device revision. J Glaucoma. 2023;32:489–96. https://doi.org/10.1097/IJG.0000000000002217.

    Article  Google Scholar 

  25. Low SA, Rootman DB, Rootman DS, Trope GE. Repair of eroded glaucoma drainage devices: mid-term outcomes. J Glaucoma. 2012;21:619–22. https://doi.org/10.1097/IJG.0b013e3182447d83.

    Article  Google Scholar 

  26. Liu KC, Gomez-Caraballo M, Challa P, Asrani SG. Recurrent tube erosions with anti-vascular endothelial growth factor therapy in patients with age-related macular degeneration. Ophthalmol Glaucoma. 2020;3:295–300. https://doi.org/10.1016/j.ogla.2020.04.005.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Ospedale Morgagni-Pierantoni, Forlì, Italy

    Corrado Gizzi

  2. Ospedale degli Infermi, Faenza, Italy

    Corrado Gizzi

  3. Moorfields Eye Hospital NHS Trust, London, UK

    Poornima Rai & Keith Barton

  4. UCL Institute of Ophthalmology, London, UK

    Keith Barton

Authors
  1. Corrado Gizzi
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  2. Poornima Rai
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  3. Keith Barton
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All the authors have made substantial contribution to the design, drafting, revision and final approval of the work. CG acquired and analysed the data for the work.

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Correspondence to Corrado Gizzi.

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Gizzi, C., Rai, P. & Barton, K. Aqueous shunt exposure repair: outcomes and risk factors for recurrence. Eye (2024). https://doi.org/10.1038/s41433-024-03219-6

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