Retinal complications after aqueous shunt surgical procedures for glaucoma
S. K. Law, J. W. Kalenak, T. B. Connor Jr, J. S. Pulido, D. P. Han and W. F. Mieler
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA.
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.
