Suprachoroidal devices in glaucoma surgery

Abstract

While conventional glaucoma filtration surgery provides excellent intraocular pressure (IOP) lowering effect, this comes at the expense of significant risks. As the physiology of the suprachoroidal space has become better understood, its potential as a source for aqueous drainage has generated significant interest. This has resulted in the creation of several suprachoroidal glaucoma devices with excellent IOP lowering ability and a much more favorable side effect profile.

Keywords: CyPass; Glaucoma; SOLX; Shunt; Suprachoroidal; Surgery.

Figure 1

The CyPass micro-shunt is inserted into the suprachoroidal space in a transcameral fashion through a clear corneal incision (image courtesy of Ravi Pamnani, Transcend Medical, Inc.)

Figure 2

The CyPass micro-shunt creates and maintains a localized cyclodialysis cleft with the body of the stent while the proximal collar remains positioned in the anterior chamber as the inflow site (image courtesy of Ravi Pamnani, Transcend Medical, Inc.)

Figure 3

This is a three-dimensional representation of the correct positioning of the gold shunt within a pillow of collagen in the suprachoroidal space (image courtesy of Gabriel Simon, M.D.)

Figure 4

The iStent Supra is a heparin-coated, slightly curved polyethersulfone stent that is designed to create and maintain a lumen within the suprachoroidal space (image courtesy of Chris Calcaterra, Glaukos)

Figure 5

The Aquashunt is a 10 × 0.75 × 0.75 mm polypropylene shunt with a tapered leading edge (image courtesy of M. Bruce Shields)

Figure 6

The STARflo device is composed of a single continuous sheet of porous silicon STAR scaffold that is implanted in the supraciliary space and provides a controlled fluid path for aqueous egress (image courtesy of Cecile Roy Ph.D., iStar Medical)