Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome1Historical image☆,
Section snippets
Materials and methods
We reviewed the charts of ten patients with ICE syndrome-related glaucoma who underwent aqueous shunt surgery by a member of the Glaucoma Service of Wills Eye Hospital between 1987 and 1996.
Complete success was defined as a postoperative intraocular pressure (IOP) of 21 mmHg or lower, with or without glaucoma medications, for the entire course of available follow-up. Qualified success was defined as IOP of 21 mmHg or lower, with or without medications, at most recent follow-up in eyes that had
Results
The clinical characteristics of the ten patients are summarized in Table 1. All ten patients were female. The mean age, mean preoperative IOP, and median number of preoperative glaucoma medications were 44.2 ± 13.3 years, 37.1 ± 11.5 mmHg, and 2.6 ± 0.7 medications, respectively. Baseline visual acuity ranged from 20/20 to hand motion (median = 20/65). All eyes were phakic. Eight of the ten eyes had undergone previous trabeculectomy, six of which were supplemented with 5-fluorouracil (5-FU).
Discussion
Aqueous shunt surgery is usually performed when conventional filtration surgeries fail or are expected to fail. Patients with ICE syndrome undergoing filtering procedures are believed to have a lower success rate than do patients with most other types of glaucoma.11 Laganowski et al5 reported that glaucoma occurred in 33 (50%) of 66 patients with the ICE syndrome. Of the 25 patients with glaucoma whose detailed records were reviewed, 22 required surgical intervention. Twenty of 22 patients had
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Cited by (43)
Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome
2023, American Journal of Ophthalmology Case ReportsEye-on-a-chip
2023, Principles of Human Organs-on-ChipsAchieving Inner Aqueous Drain in Glaucoma Secondary to Iridocorneal Endothelial Syndrome: One Year Results of Penetrating Canaloplasty: Bleb Independent Anti-Glaucoma Surgery in ICE
2022, American Journal of OphthalmologyCitation Excerpt :Doe and associates reported a cumulative survival of 73%, 44%, and 29% for antifibrotic augmented trabeculectomy and 71%, 71%, and 53% for GDI in GS-ICE at 1, 3, and 5 years, respectively.9 In the study by Kim and associates, the aqueous shunt survival at 1, 3, and 5 years was 70%, 40%, and 40%.11 Most recently, Gebremichael and associates23 and Mao and associates24 reported higher GDI survival in 2 independent studies (92.3 ± 7.4%, 66.1 ± 11.0%, and 50.5% ± 17.3% at 1, 3, and 4 years, respectively and 94.4%, 88.1%, and 73.5% at 1, 2, and 3 years, respectively).
Graft failure and intraocular pressure control after keratoplasty in iridocorneal endothelial syndrome
2015, American Journal of OphthalmologyCitation Excerpt :There are a few small published studies on outcomes of secondary glaucoma in ICE patients since the introduction of antifibrotic agents and GDD surgery. These studies found reasonable success rates for trabeculectomy with antifibrotic agent application40,41 and GDD in cases that have failed medical treatment or conventional filtration surgery.42 Although essential iris atrophy has been reported to develop a more severe form of glaucoma compared to those with Chandler syndrome,9 there was no difference in the need for additional IOP-lowering therapy between these 2 subgroups in our study.
The iridocorneal endothelial syndrome
2018, Survey of OphthalmologyCitation Excerpt :In pseudophakic eyes, we advocate for tube insertion through the ciliary sulcus, which decreases the risk of corneal decompensation by tube-cornea touch (especially in eyes with compromised corneal endothelium, which is quite common in ICE syndrome) and also decreases the risk of iris damage or iris dialysis in eyes with important PAS (also common in ICE syndrome, especially PIA or CRS). Placement of the tube behind the iris could also potentially prevent obstruction of the lumen by ICE membrane migrating from the iridocorneal angle, which has been previously reported.54 We trim the tube bevel down to decrease the risk of obstruction of the lumen by the posterior surface of the iris whether the tip stays ideally beyond the pupillary margin, or right behind it.
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Supported in part by the Glaucoma Service Foundation to Prevent Blindness, Philadelphia, Pennsylvania.
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The authors have no proprietary interest in any of the materials used in this study.