Skip to main content

Advertisement

SpringerLink
Log in

Histological findings of failed gold micro shunts in primary open-angle glaucoma

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jones E, Clarke J, Khaw PT (2005) Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 16:107–113

    Article  PubMed  Google Scholar 

  2. Hodkin MJ, Goldblatt WS, Burgoyne CF, Ball SF, Insler MS (1995) Early clinical experience with the Baerveldt implant in complicated glaucomas. Am J Ophthalmol 120:32–40

    PubMed  CAS  Google Scholar 

  3. Mermoud A, Salmon JF, Alexander P, Straker C, Murray AD (1993) Molteno tube implantation for neovascular glaucoma. Long-term results and factors influencing the outcome. Ophthalmology 100:897–902

    PubMed  CAS  Google Scholar 

  4. Coleman AL, Hill R, Wilson MR, Choplin N, Kotas-Neumann R, Tam M, Bacharach J, Panek WC (1995) Initial clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol 120:23–31

    PubMed  CAS  Google Scholar 

  5. Benedikt O (1977) The effects of filtering operations. Klin Monatsbl Augenheilkd 170:10

    PubMed  CAS  Google Scholar 

  6. Teng CC, Chi HH, Katzin HM (1959) Histology and mechanism of filtering operations. Am J Ophthalmol 47:16–33

    PubMed  CAS  Google Scholar 

  7. Kee C (2001) Prevention of early postoperative hypotony by partial ligation of silicone tube in Ahmed glaucoma valve implantation. J Glaucoma 110:466–469

    Article  Google Scholar 

  8. Feldman RM, Tabet RR (2008) Needle revision of filtering blebs. J Glaucoma 17:594–600

    Article  PubMed  Google Scholar 

  9. Emi K, Pederson JE, Toris CB (1989) Hydrostatic pressure of the suprachoroidal space. Invest Ophthalmol Vis Sci 30:233–238

    PubMed  CAS  Google Scholar 

  10. Melamed S, Ben Simon GJ, Goldenfeld M, Simon G (2009) Efficacy and safety of gold micro shunt implantation to supraciliary space in patients with glaucoma: a pilot study. Arch Ophthalmol 127:264–269

    Article  PubMed  Google Scholar 

  11. Mastropasqua L, Agnifili L, Ciancaglini M, Nubile M, Carpineto P, Fasanella V, Figus M, Lazzeri S, Nardi M (2010) In vivo analysis of conjunctiva in gold micro shunt implantation for glaucoma. Br J Ophthalmol 94(12):1592–1596, Epub 2010 Aug 30

    Article  PubMed  Google Scholar 

  12. Piattelli A, Scarano A, Quaranta M (1997) High-precision, cost-effective system for producing thin sections of oral tissues containing dental implants. Biomaterials 18:577–579

    Article  PubMed  CAS  Google Scholar 

  13. Ozdamar A, Aras C, Karacorlu M (2003) Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique. J Glaucoma 12:354–359

    Article  PubMed  Google Scholar 

  14. Portney GL (1973) Silicone elastomer implantation cyclodialysis: a negative report. Arch Ophthalmol 89:10–12

    Article  PubMed  CAS  Google Scholar 

  15. Jordan JF, Engels BF, Dinslage S, Dietlein TS, Ayertey HD, Roters S, Esser P, Konen W, Krieglstein GK (2006) A novel approach to suprachoroidal drainage for the surgical treatment of intractable glaucoma. J Glaucoma 15:200–205

    Article  PubMed  Google Scholar 

  16. Tripathi RC, Li J, Chan WA, Tripathi BJ (1994) Aqueous humor in glaucomatous eyes contains an increased level of TGF-β2. Exp Eye Res 59:723–728

    Article  PubMed  CAS  Google Scholar 

  17. Picht G, Welge-Luessen U, Grehn F, Lütjen-Drecoll E (2001) Transforming growth factor beta 2 levels in the aqueous humor in different types of glaucoma and the relation to filtering bleb development. Graefes Arch Clin Exp Ophthalmol 239(3):199–207

    Article  PubMed  CAS  Google Scholar 

  18. Cvenkel B, Kopitar AN, Ihan A (2010) Inflammatory molecules in aqueous humour and on ocular surface and glaucoma surgery outcome. Mediators Inflamm 2010:939602, Epub 2010 May 5

    Article  PubMed  Google Scholar 

  19. Cunliffe IA, Richardson PS, Rees RC, Rennie IG (1995) Effect of TNF, IL-1, and IL-6 on the proliferation of human Tenon’s capsule fibroblasts in tissue culture. Br J Ophthalmol 79(6):590–595

    Article  PubMed  CAS  Google Scholar 

  20. Hu DN, Ritch R, Liebmann J, Liu Y, Cheng B, Hu MS (2002) Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes. J Glaucoma 11(5):406–410

    Article  PubMed  Google Scholar 

  21. Welander M, Abrahamsson I, Berglundh T (2008) The mucosal barrier at implant abutment of different materials. Clin Oral Impl Res 19:635–641

    Google Scholar 

  22. Abrahamsson I, Berglundh T, Glantz PO, Lindhe J (1998) The mucosa attachment at different abutments. An experimental study indogs. J Clin Periodontol 25:721–727

    Article  PubMed  CAS  Google Scholar 

  23. Demann ET, Stein PS, Haubenreich JE (2005) Gold as an implant in medicine and dentistry. J Long Term Eff Med Implants 15(6):687–698

    PubMed  CAS  Google Scholar 

  24. Samuelson TW, Katz LJ, Wells JM, Duh YJ, Giamporcaro JE, US iStent Study Group (2011) Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 118(3):459–467, Epub 2010 Sep 15

    Article  PubMed  Google Scholar 

  25. Fernández-Barrientos Y, García-Feijoó J, Martínez-de-la-Casa JM, Pablo LE, Fernández-Pérez C, García Sánchez J (2010) Fluorophotometric study of the effect of the glaukos trabecular microbypass stent on aqueous humor dynamics. Invest Ophthalmol Vis Sci 51(7):3327–3332, Epub 2010 Mar 5

    Article  PubMed  Google Scholar 

  26. Grieshaber MC, Pienaar A, Olivier J, Stegmann R (2010) Canaloplasty for primary open-angle glaucoma: long-term outcome. Br J Ophthalmol 94:1478–1482

    Article  PubMed  Google Scholar 

  27. Tilden ME, Boney RS, Goldenberg MM, Rosenbaum JT (1990) The effects of topical S(+)-ibuprofen on interleukin-1 induced ocular inflammation in a rabbit model. J Ocul Pharmacol 6(2):131–135

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine and Ageing Science, Ophthalmic Clinic, University of Chieti-Pescara, Via dei Frentani, 114, 66100, Chieti, Italy

    Luca Agnifili

  2. Department for Health Sciences, Ophthalmic Clinic, University of Molise, Campobasso, Italy

    Ciro Costagliola

  3. Department of Neuroscience, Ophthalmology, University of Pisa, Pisa, Italy

    Michele Figus & Marco Nardi

  4. Department of Odontostomalogy Sciences, University of Chieti-Pescara, Chieti, Italy

    Giovanna Iezzi & Adriano Piattelli

  5. Department of Medicine and Ageing Science, Ophthalmic Clinic, University G. d’Annunzio of Chieti-Pescara, Via dei Vestini snc, 66100, Chieti, Italy

    Paolo Carpineto, Rodolfo Mastropasqua & Leonardo Mastropasqua

Authors
  1. Luca Agnifili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ciro Costagliola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Figus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanna Iezzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adriano Piattelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo Carpineto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rodolfo Mastropasqua
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marco Nardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leonardo Mastropasqua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Agnifili.

Additional information

None of the authors have a proprietary interest in the development or marketing of any of the products mentioned in this article. No funding or support has been received for the study.

There was no role of any sponsors or funders in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.

The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Agnifili, L., Costagliola, C., Figus, M. et al. Histological findings of failed gold micro shunts in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 250, 143–149 (2012). https://doi.org/10.1007/s00417-011-1778-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-011-1778-6

Keywords

Search

Navigation