Gold Shunt in the treatment of refractory glaucoma

Abstract

When medical therapy fails to control intraocular pressure, the standard surgical approaches for treating glaucoma are trabeculectomy and aqueous shunt implantation. However, alternative surgical techniques and devices are being investigated in an effort to avoid the potentially serious complications associated with filtering procedures. In patients who have previously undergone incisional glaucoma surgery, surgical options may be particularly limited because of conjunctival scarring. One novel device that has gained significant interest is the Gold Shunt, a non-valved flat-plate drainage implant that diverts aqueous humor from the anterior chamber into the suprachoroidal space. Ideally, this ‘blebless’ procedure is less prone to the postoperative complications that can lead to failure in standard glaucoma surgeries and does not rely on conjunctival manipulation or integrity to form a bleb. This device profile reviews the current literature and evidence for Gold Shunt implantation in refractory glaucoma.

Keywords::

• glaucoma
• glaucoma surgery
• Gold Shunt
• intraocular pressure
• refractory
• suprachoroidal
• transscleral

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The Gold Shunt is a non-valved flat-plate drainage device that diverts aqueous humor from the anterior chamber to the suprachoroidal space.

• The mechanism of intraocular pressure reduction is not fully understood, but proposed mechanisms include direct resorption of aqueous humor in the choriocapillary circulation and trans-scleral diffusion.

• Initial studies were promising, reporting a success rate of 79% at 1 year, but subsequent studies have demonstrated a varied response with failure rates as high as 97% at 4 years.

• Failure of the devices is likely related to connective tissue infiltration and fibrosis surrounding the ends of the implant.

• There is inconclusive data supporting the widespread use of the Gold Shunt implant for refractory glaucoma, and further studies evaluating the long-term efficacy and safety of the Gold Shunt are needed.

Notes