Reactivation of Shunts in Glaucoma Surgery

Abstract

Objective: to present the main methods of reactivation and maintaining the activity of shunt systems (Ahmed valve drainage, PRESERFLO shunts) in cases of reducing the effectiveness of their work in the early or late postoperative follow-up due to proliferative changes in the filtration zone.
Methods: an experimental study involving, n = 10 eyes (10 patients). After PRESERFLO implantation: patients underwent needling with dexamethasone injection into the area of the filtration bleb in 2 cases, open plastic surgery of the filtration bleb with cleaning of the distal end of the tube from fibrous tissue and treatment of the filtration area with mitomycin in 3 cases, and reimplantation of the shunt into another sector of the eye in 2 cases. In the case of the Ahmed shunt, in all 3 cases, an open plastic surgery of filtration bleb was performed with excision of a dense fibrovascular membrane around the shunt body.
Results. As a result of surgical reactivation of the shunts, compensation of IOP in the early postoperative period was achieved in all cases.
Conclusion. The use of shunts made of modern polymers to create an alternative drainage system has reduced the problem of tissue proliferation response on newly created aqueous humor outflow paths, but has not completely solved it. Reactivation of shunts is a routine type of surgical treatment for glaucoma. This article presents the main methods to reactivate and prevent malfunction of the Ahmed and PRESERFLO shunts.