Shunt implantation efficacious for management of uveitic glaucoma

Take Home

The outcomes for shunt implantation show promise as an option for the management of uveitic glaucoma. In a retrospective chart review, 73% of patients had a decrease of at least 20% in IOP 6 months postoperatively.

Dr. Dhanireddy

By Nancy Groves; Reviewed by Swetha Dhanireddy, MD

Cambridge, MA-Implantation of a shunt (Ex-Press Glaucoma Filtration Device, Alcon Laboratories) has been found to be an effective surgical intervention for the management of patients with uveitic glaucoma in a small retrospective study, according to Swetha Dhanireddy, MD.

“Patients with uncontrollable glaucoma or uveitic glaucoma who are on the maximum number of tolerable medications are usually considered candidates for surgery, and having something like the (shunt) can be an option that may bring their IOP to a lower level than other surgical devices could,” said Dr. Dhanireddy, a recent medical school graduate who is working with C. Stephen Foster, MD, at the Massachusetts Eye Research and Surgery Institution (MERSI) in Cambridge before applying for a 2015 residency.

More in Special Report: Novel use of endoscope helps to visualize hyphema

Dr. Foster, Dr. Dhanireddy, and Ninani C. Kombo, MD (also at MERSI) were apparently the first to conduct research on use of the shunt in uveitic glaucoma.

The shunt, which is smaller than a device such as the Ahmed valve, may be more comfortable for patients. Also, if the shunt is not effective at lowering IOP, another form of glaucoma surgery could then be tried.

In eight of 11 eyes (72.7%), IOP decreased 20% or more at 6 months follow-up, and eight eyes also had a decrease in anti-glaucoma medications postoperatively.

These findings are encouraging, since adequate management of uveitic glaucoma can be challenging compared with other glaucomas due to existing damage from ocular inflammation and the complexity of mechanisms involved in its pathogenesis, Dr. Dhanireddy noted.

NEXT: Examining the research

Examining the research

The investigators conducted a retrospective chart review of all patients with uveitic glaucoma and the shunt implantation between June 2011 and May 2013 at MERSI, excluding patients with less than 6 months of follow-up or active uveitis prior to surgery.

The review identified 10 patients (11 eyes) and used two factors in the analysis of outcomes:

• IOP pre- and 6 months postoperatively.

• A quality-of life-measure, the number of anti-glaucoma medications patients were using before and after surgery.

Either a decrease in IOP of 20% or greater or a reduction in anti-glaucoma medications occurred in all eyes postoperatively. The mean preoperative IOP was 18.7 mm Hg, which dropped to a mean of 12.2 mm Hg 6 months postoperatively. Before shunt implantation, the mean number of anti-glaucoma medications taken was 3, while at 6 months follow-up it was 1.2. Six eyes (54.5%) had no anti-glaucoma medication at follow-up.

The researchers plan to follow-up on these findings by continuing to monitor the original group of subjects out to at least 1 year as well as evaluating postoperative complications and new factors such as visual acuity pre- and postoperatively. 

Swetha Dhanireddy, MD

E: swetha.dhanireddy87@gmail.com

Dr. Dhanireddy did not report any financial disclosures.