Long-term outcome of supraciliary gold micro shunt in refractory glaucoma

Abstract

Purpose: To evaluate the 10-year follow-up efficacy and safety of gold micro shunt (GMS) in patients with refractory glaucoma, and the potential risk factors for failure.

Methods: Retrospective data analyses based on medical records from 55 patients who underwent GMS implant for refractory glaucoma between March 2007 and April 2008. The primary outcome measure was the cumulative probability of success defined as intraocular pressure (IOP) below 21 mmHg together with a 33% lowering of the baseline IOP with (qualified) or without (complete) topical medications, no reoperation for glaucoma or loss of light perception.

Results: Mean IOP 10 years after the GMS implantation was 21.6 ± 5.1 mmHg with 2.7 ± 0.7 drugs. Qualified success was achieved in 8/55 patients (14.5%) with a mean of 2.9 ± 0.8 drugs at 5 years and in 2/55 patients (3.6%) with a mean of 2.7 ± 1.0 drugs at 10 years. None of the patients reached complete success at five years from surgery. The cumulative probability of complete success was 14%, 9% and 0% at 1, 2 and 5 years, respectively, and 72%, 67%, 36% and 3.6% at 1, 2, 5 and 10 years, respectively, for qualified success criterion. Baseline IOP for complete success, number of baseline medication for qualified success and age at the time of GMS implantation for both criteria were risk factors significantly associated with failure.

Conclusion: A very low long-term survival rate of GMS in refractory glaucoma was found. Most patients did not reach the IOP success criteria of the study, even with the re-introduction of medications, leading to the need for further surgical procedures.

Keywords: gold micro shunt; long-term follow-up; refractory glaucoma; supraciliary shunt.

Fig. 1

Kaplan–Meier survival estimates for criterion. Kaplan–Meier survival curve showing the survival probability of gold micro shunt in refractory glaucoma. Complete success: IOP below 21 mmHg together with a reduction of at least 33% of the baseline IOP without any topical medications; qualified success: IOP below 21 mmHg together with a reduction of at least 33% of the baseline IOP with or without topical medications. IOP = intraocular pressure.