Where Plates and Fluidics Meet

Novel subconjunctival drainage devices are designed to minimize postoperative hypotony.

Stephanie Wey, MD, and Eydie Miller-Ellis, MD

Glaucoma Today

Key Takeaways Innovating on the mechanical scaffolding provided by existing technology, several new devices have been developed that build on the plate or tube design of glaucoma drainage devices. The newer technologies incorporate features such as titratable valves, multiple outflow channels, and a decreased tube lumen caliber to minimize postoperative hypotony and maximize efficacy. The long-standing goal of incisional glaucoma surgery is to achieve a steady and sufficient reduction in IOP, especially in eyes with severe, progressive disease. Hypotony, numerically defined as an IOP of less than 5 to 6 mm Hg, remains a feared sequela of surgery. Clinically, hypotony raises the risks of choroidal effusion, a shallow anterior chamber, and maculopathy—complications that can require additional surgery and lead to further vision loss. Achieving the target IOP while minimizing the risk of hypotony can be a challenge. Tube shunts have risen in popularity thanks to their lower risk of postoperative complications compared to trabeculectomy. This is especially true of the Ahmed Glaucoma Valve (AGV; New World Medical), which is the only valved drainage device available in the United States. In the Ahmed Baerveldt Comparison (ABC) Study, the risk of postoperative hypotony was much lower with the AGV than the Baerveldt Glaucoma Implant (BGI; Johnson & Johnson Vision), but the BGI was associated with a greater IOP reduction.1 The reason that the BGI presents a higher risk of postoperative hypotony than the AGV is that the former lacks a valve and the plate must be encapsulated to a certain extent before the tube is opened to allow aqueous outflow. Various techniques involving the use of ligatures around the BGI’s tube, a ripcord within the tube lumen, and fenestrations and wicks through the tube have been developed to facilitate an IOP reduction while preventing overfiltration and related complications postoperatively.

Preparing Pre-Presbyopic Patients: Marketing Gold

Consider these five strategies to ready patients to embrace this change and, therefore, its treatment options.

Jade Coats, OD, FAAO

Modern Optometry

PRIMA Retinal Implant Launched in EU

Eyetube

A retinal implant system allowing patients with GA to regain some functional central vision vison is approved in Europe; Bausch + Lomb launches a new preloaded IOL delivery system in the US; and we review recent advancements and milestones in the development of novel ophthalmic treatments. Learn more about your ad choices. Visit megaphone.fm/adchoices