One-year outcomes of stand-alone ab externo SIBS microshunt implantation in refractory glaucoma.

BACKGROUND/AIMS

Determine the efficacy of stand-alone implantation of the ab externo SIBS or poly(styrene-block-isobutylene-block-styrene) microshunt with mitomycin C in glaucomatous eyes, refractory to previous subconjunctival filtering surgery, over 1 year of follow-up.

METHODS

Consecutive retrospective cohort of patients with intraocular pressure (IOP) above target and previous subconjunctival filtering surgery, who received the microshunt between July 2015 and April 2019. Primary outcome was a complete success, with failure defined as IOP <6 mm Hg with vision loss, >17 mm Hg or <20% reduction in IOP without medications. Secondary outcomes included thresholds of 6 to 14 mm Hg and 6 to 21 mm Hg for both complete (no medications) and qualified (with medications) success as well as qualified success for thresholds of 6 to 17 mm Hg. Risk factors for failure, IOP, medications and complications were also assessed.

RESULTS

85 eyes of 79 patients with a preoperative median IOP of 22.0 mm Hg (IQR 18.0-29.0) on four (IQR 3-4) medications were included. Postoperative median IOP was 13.0 mm Hg (IQR 10.0-17.0) on zero (IQR 0-2) medication at 1 year. 61.0% achieved complete success and 79.7% achieved qualified success. Mild-to-moderate disease was associated with failure (adjusted HR 2.37; 95% CI 1.23 to 4.59). Needling was performed in 11.8%, and 8.2% underwent anterior chamber reformation. Complications were transient, consisting of hyphaema, choroidal detachment and hypotony maculopathy, with 7.1% of patients undergoing reoperation.

CONCLUSIONS

In a group of high-risk eyes that had already failed at least one subconjunctival filtering surgery, the SIBS microshunt demonstrates reasonable surgical success over 1-year follow-up, with relatively few complications.

Informations de copyright

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: GMD: honoraria from, and consultant to, Alcon (Fort Worth, Texas, USA); honoraria from, and consultant to, Allergan (Irvine, California, USA), honoraria from, and consultant to Bausch and Lomb (Rochester, New York, USA), honoraria from, and consultant to, Glaukos (San Clemente, California, USA); honoraria from Novartis (Basel, Switzerland); honoraria from Thea-Labtician (Oakville, Ontario, Canada); honoraria from MicroSurgical Technology (Redmond, Washington, USA); honoraria from, and consultant to Santen Pharmaceutical Co, (Kita-ku, Osaka, Japan); honoraria from Sight Sciences (Menlo Park, California, USA). MBS: Honoraria from, and consultant to, Alcon (Fort Worth, Texas, USA); honoraria from, and consultant to, Allergan (Irvine, California, USA); consultant to Light Matter Interaction (Toronto, Ontario, Canada); consultant to Santen Pharmaceutical Co (Kita-ku, Osaka, Japan); honoraria from Aequus (Vancouver, British Columbia, Canada); honoraria from Johnson & Johnson (Jacksonville, Florida, USA); honoraria from Thea-Labtician (Oakville, Ontario, Canada). SS: No financial disclosures. IKA: speaker’s honoraria and research support from, and consultant to, Abbott Medical Optics (Abbott Park, Illinois, USA); consultant to Acucela (Seattle, Washington, USA); research support from, and consultant to, Aerie Pharmaceuticals (Durham, North Carolina, USA); speaker’s honoraria and research grant support from, and consultant to, Alcon (Fort Worth, Texas, USA); speaker’s honoraria and research support from, and consultant to, Allergan (Irvine, California, USA); consultant to ArcScan (Golden, Colorado, USA); consultant to Bausch and Lomb (Rochester, New York, USA); speaker’s honoraria and research support from, and consultant to, Carl Zeiss Meditec (Jena, Germany); consultant to Centervue (Padova, Italy); consultant to Clarity Medical Systems (Pleasanton, California, USA); consultant to ElutiMed (New Orleans, Louisiana, USA); consultant to Envisia Therapeutics (Morrisville, North Carolina, USA); consultant to Equinox (Newport Beach, California, USA); consultant to Eyelight (Funo, Italy); consultant to ForSight Labs (Menlo Park, California, USA); research support from, and consultant to, Glaukos (San Clemente, California, USA); consultant to Gore (Newark, Delaware, USA); consultant to InjectSense (Emeryville, California, USA); consultant to Iridex (Mountain View, California, USA); consultant to iStar (Wavre, Belgium); research support from, and consultant to, Ivantis (Irvine, California, USA); consultant to KeLoTec (Orange County, California, USA); consultant to LayerBio (Medford, Massachusetts, USA); consultant to Leica Microsystems (Wetzlar, Germany); research support from, and consultant to, New World Medical (Rancho Cucamonga, California, USA); consultant to Omega Ophthalmics (Lexington, Kentucky, USA); consultant to Ono Pharma (Chuo-ku, Osaka, Japan) consultant to PolyActiva (Melbourne, VIC, Australia); consultant to Sanoculis (Kiryat Ono, Israel); consultant to Santen Pharmaceutical Co (Kita-ku, Osaka, Japan); consultant to Science Based Health (Spring, Texas, USA); consultant to SOLX (Waltham, Massachusetts, USA); consultant to Stroma (Irvine, California, USA); consultant to TrueVision (Santa Barbara, California, USA).