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Simon K. Law, MD; Jeffrey W. Kalenak, MD; Thomas B. Connor, Jr, MD; Jose S. Pulido, MD; Dennis P. Han, MD; William F. Mieler, MD

Arch Ophthalmol. 1996;114(12):1473-1480.

Abstract
Objectives
To assess retinal complications and to identify risk factors for retinal complications following aqueous shunt procedures.

Materials and Methods
Records of 38 consecutive aqueous shunt procedures that were performed on 36 patients at the Eye Institute of the Medical College of Wisconsin, Milwaukee, from June 1993 to March 1995 (minimum follow-up, 6 months) were reviewed. The mean±SD follow-up was 11.4±5.2 months (median, 10.5 months).

Results
Twelve patients (32%) had the following retinal complications: 4 serous choroidal effusions (10%) that required drainage, 3 suprachoroidal hemorrhages (8%), 2 vitreous hemorrhages (5%), 1 rhegmatogenous retinal detachment (3%), 1 endophthalmitis (3%), and 1 scleral buckling extrusion (3%). Surgical procedures for retinal complications were required in 8 (67%) of these 12 patients. Visual acuity decreased 2 lines or more in 9 (75%) of these 12 patients. The median onset of a postoperative retinal complication was 12.5 days, with 10 patients (83%) experiencing complications within 35 days. Serous choroidal effusions developed in 10 other patients (26%), and these effusions resolved spontaneously. Visual acuity decreased 2 lines or more in 2 (20%) of these additional 10 patients. Patients who experienced serious retinal complications were significantly older, had a higher rate of hypertension, and postoperative ocular hypotony. Serious retinal complications were distributed evenly among patients with Krupin valves with discs and Molteno and Baerveldt devices. Experience with the Ahmed glaucoma valve implant was limited.

Conclusion
Aqueous shunt procedures may be associated with significant retinal complications and subsequent visual loss.

Author Affiliations
From the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee. Each author states that he has no proprietary interest in the development or marketing of any device or pharmaceutical product, nor in any competing product, mentioned in this article.

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