glaucoma drainage implants


Summary: Devices, usually incorporating unidirectional valves, which are surgically inserted in the sclera to maintain normal intraocular pressure.

Top Publications

  1. Souza C, Tran D, Loman J, Law S, Coleman A, Caprioli J. Long-term outcomes of Ahmed glaucoma valve implantation in refractory glaucomas. Am J Ophthalmol. 2007;144:893-900 pubmed
    ..001). Approximately 50% of single-plate AGV implantations in refractory glaucoma were considered successful after five years of follow-up. Prior glaucoma surgery was a statistically significant risk factor for failure. ..
  2. Parihar J, Vats D, Maggon R, Mathur V, Singh A, Mishra S. The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes. Indian J Ophthalmol. 2009;57:345-50 pubmed publisher
    ..None of the eyes had failure to maintain IOP control following AGV. The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up. ..
  3. Schmidt W, Kastner C, Sternberg K, Allemann R, Löbler M, Guthoff R, et al. New concepts for glaucoma implants--controlled aqueous humor drainage, encapsulation prevention and local drug delivery. Curr Pharm Biotechnol. 2013;14:98-111 pubmed
    ..Furthermore, current approaches to local drug delivery in glaucoma implant technology are briefly summarized. ..
  4. Desai M, Gedde S, Feuer W, Shi W, Chen P, Parrish R. Practice preferences for glaucoma surgery: a survey of the American Glaucoma Society in 2008. Ophthalmic Surg Lasers Imaging. 2011;42:202-8 pubmed publisher
    ..The use of a GDD has progressively increased, and the popularity of trabeculectomy decreased between 1996 and 2008. Mitomycin C remains the most frequently selected antifibrotic agent used as an adjunct to trabeculectomy. ..
  5. Sarkisian S, Netland P. Tube extender for revision of glaucoma drainage implants. J Glaucoma. 2007;16:637-9 pubmed
    ..The Tube Extender is a useful device when the tubes of glaucoma drainage implants from different manufacturers require lengthening.
  6. Budenz D, Barton K, Feuer W, Schiffman J, Costa V, Godfrey D, et al. Treatment outcomes in the Ahmed Baerveldt Comparison Study after 1 year of follow-up. Ophthalmology. 2011;118:443-52 pubmed publisher
    ..014). Although the average IOP after 1 year was slightly higher in patients who received an AGV, there were fewer early and serious postoperative complications associated with the use of the AGV than the BGI. ..
  7. De Feo F, Jacobson S, Nyska A, Pagani P, Traverso C. Histological biocompatibility of a stainless steel miniature glaucoma drainage device in humans: a case report. Toxicol Pathol. 2009;37:512-6 pubmed publisher
    ..No inflammatory cells occurred within the fibrous capsule. No material or blockage was noted within the lumen. Our results support the biological inertness of the device...
  8. Marzette L, Herndon L. A comparison of the Ex-PRESS™ mini glaucoma shunt with standard trabeculectomy in the surgical treatment of glaucoma. Ophthalmic Surg Lasers Imaging. 2011;42:453-9 pubmed publisher
    ..The data further suggest that the Ex-PRESS device results in an overall greater percentage reduction in IOP than with trabeculectomy, although this did not reach statistical significance. ..
  9. Christakis P, Kalenak J, Zurakowski D, Tsai J, Kammer J, Harasymowycz P, et al. The Ahmed Versus Baerveldt study: one-year treatment outcomes. Ophthalmology. 2011;118:2180-9 pubmed publisher
    ..To report the 1-year treatment outcomes of the Ahmed Versus Baerveldt (AVB) Study...

More Information


  1. Minckler D, Francis B, Hodapp E, Jampel H, Lin S, Samples J, et al. Aqueous shunts in glaucoma: a report by the American Academy of Ophthalmology. Ophthalmology. 2008;115:1089-98 pubmed publisher
    ..Long-term follow-up and comparative studies are encouraged. ..
  2. Thieme H, Choritz L, Hofmann Rummelt C, Schloetzer Schrehardt U, Kottler U. Histopathologic findings in early encapsulated blebs of young patients treated with the ahmed glaucoma valve. J Glaucoma. 2011;20:246-51 pubmed publisher
    ..The valve mechanism is blocked by contracted scar tissue, but the device itself is not affected by the encapsulation. Surgical excision of the capsule immediately leads to an aqueous flow and drop of intraocular pressure. ..
  3. Gedde S, Parrish R, Budenz D, Heuer D. Update on aqueous shunts. Exp Eye Res. 2011;93:284-90 pubmed publisher
    ..Several modifications in surgical technique have been directed toward improving surgical success, reducing complications, and optimizing efficiency and cost. ..
  4. Aziz H, Fantes F, Dubovy S. Histopathology of the Ex-PRESS Shunt. Ophthalmic Surg Lasers Imaging. 2011;42 Online:e94-6 pubmed publisher
    ..Histopathologic evaluation of the specimen showed a thin layer of fibrotic tissue surrounding the implant. In this case, the Ex-PRESS shunt was relatively well tolerated in the human eye. ..
  5. De Feo F, Bagnis A, Bricola G, Scotto R, Traverso C. Efficacy and safety of a steel drainage device implanted under a scleral flap. Can J Ophthalmol. 2009;44:457-62 pubmed publisher
    ..To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS X200) implanted under a scleral flap for the surgical treatment of primary open-angle glaucoma (POAG)...
  6. Hendrick A, Kahook M. Ex-PRESS mini glaucoma shunt: surgical technique and review of clinical experience. Expert Rev Med Devices. 2008;5:673-7 pubmed publisher
    ..We summarize pertinent literature and expand on the future role of this device in glaucoma surgery. ..
  7. Kim C, Yim J, Lee E, Lee N. Changes in corneal endothelial cell density and morphology after Ahmed glaucoma valve implantation during the first year of follow up. Clin Exp Ophthalmol. 2008;36:142-7 pubmed publisher
    ..These findings indicate that particular care should be taken during intraoperative and postoperative management of AGV implantation patients in order to minimize damage to the endothelium. ..
  8. Ramulu P, Corcoran K, Corcoran S, Robin A. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology. 2007;114:2265-70 pubmed
    ..After a decline in use between 1995 and 2001, laser trabeculoplasty increased substantially from 2001 to 2004. Fistulization procedures other than trabeculectomy and surgical iridectomy have become very uncommon. ..
  9. Alvarado J, Hollander D, Juster R, Lee L. Ahmed valve implantation with adjunctive mitomycin C and 5-fluorouracil: long-term outcomes. Am J Ophthalmol. 2008;146:276-284 pubmed publisher
    ..The adjunctive use of both intraoperative MMC and postoperative 5-FU with Ahmed valve implantation results in high success rates. IOP was well controlled in the majority of patients within the six-year postoperative period. ..
  10. Dietlein T, Jordan J, Lueke C, Krieglstein G. Modern concepts in antiglaucomatous implant surgery. Graefes Arch Clin Exp Ophthalmol. 2008;246:1653-64 pubmed publisher
    ..Although valid data on clinical application of the new glaucoma implants are not available as yet, profound knowledge about their theoretical concept and their practical management is obligatory for all glaucoma clinicians. ..
  11. Barton K, Heuer D. Modern aqueous shunt implantation: future challenges. Prog Brain Res. 2008;173:263-76 pubmed publisher
    ..At present, the main barrier to wider use of shunts in less-complicated glaucomas will probably be the unknown long-term effect on corneal endothelium, an issue that has not yet been properly addressed. ..
  12. Agnifili L, Costagliola C, Figus M, Iezzi G, Piattelli A, Carpineto P, et al. Histological findings of failed gold micro shunts in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2012;250:143-9 pubmed publisher
    ..This modification isolated the GMS from the AC and SC space, impeding aqueous flows throughout the shunt. ..
  13. Gallego Pinazo R, Lopez Sanchez E, Marín Montiel J. [Postoperative outcomes after combined glaucoma surgery. Comparison of ex-press miniature implant with standard trabeculectomy]. Arch Soc Esp Oftalmol. 2009;84:293-7 pubmed
    ..The Ex-PRESS implant is an effective and safe alternative to standard trabeculectomy in selected cases which makes possible to reduce remarkably the classic early postoperative complications associated with trabeculectomy. ..
  14. Merrill K, Suhr A, Lim M. Long-term success in the correction of exposed glaucoma drainage tubes with a tube extender. Am J Ophthalmol. 2007;144:136-7 pubmed
    ..A tube extender can provide long-term correction of an exposed GDD tube by bypassing weakened tissue, thus avoiding or delaying a second implant surgery. ..
  15. Zeppa L, Romano M, Capasso L, Tortori A, Majorana M, Costagliola C. Sutureless human sclera donor patch graft for Ahmed glaucoma valve. Eur J Ophthalmol. 2010;20:546-51 pubmed
    ..To report the safety and effectiveness of a sutureless human sclera donor patch graft covering the subconjunctival portion of glaucoma drainage implant tube to prevent its erosion throughout the overlying conjunctiva...
  16. Barton K, Gedde S, Budenz D, Feuer W, Schiffman J. The Ahmed Baerveldt Comparison Study methodology, baseline patient characteristics, and intraoperative complications. Ophthalmology. 2011;118:435-42 pubmed publisher
  17. Law S, Song B, Yu F, Kurbanyan K, Yang T, Caprioli J. Hemorrhagic complications from glaucoma surgery in patients on anticoagulation therapy or antiplatelet therapy. Am J Ophthalmol. 2008;145:736-746 pubmed publisher
  18. Riaz K, Sugar J, Tu E, Edward D, Wilensky J, Namavari A, et al. Early results of Descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma drainage devices. Cornea. 2009;28:959-62 pubmed publisher
    ..These early outcomes support the use of DSAEK as an alternative to penetrating keratoplasty in this patient population. ..
  19. Mokbel T, Khalaf M, El Khouly S, El Metwally N. Flexible Ahmed valve for selected cases of refractory glaucoma. Eur J Ophthalmol. 2012;22:83-9 pubmed publisher
    b>Glaucoma drainage implants are a useful alternative in treating glaucomas that are resistant to medical therapy and conventional glaucoma filtration surgery...
  20. Melamed S, Ben Simon G, Goldenfeld M, Simon G. Efficacy and safety of gold micro shunt implantation to the supraciliary space in patients with glaucoma: a pilot study. Arch Ophthalmol. 2009;127:264-9 pubmed publisher
    ..Use of the GMS resulted in a significant decrease in IOP. The GMS could be an alternative surgical device to standard trabeculectomy. ..
  21. Hau S, Barton K. Corneal complications of glaucoma surgery. Curr Opin Ophthalmol. 2009;20:131-6 pubmed publisher
    ..Corneal complications are commonest in patients with aqueous shunts, and long-term prospective studies of endothelial cell density are required to elucidate the factors that predispose to corneal endothelial cell loss. ..
  22. Dahan E, Ben Simon G, Lafuma A. Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study. Eye (Lond). 2012;26:703-10 pubmed publisher
    ..Trabeculectomy and Ex-PRESS implantation provided similar IOP control, but the Ex-PRESS group had a lower rate of complications, fewer postoperative interventions, and needed less glaucoma medications. ..
  23. Seider M, Rofagha S, Lin S, Stamper R. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma. 2012;21:469-74 pubmed publisher
  24. Gedde S, Schiffman J, Feuer W, Herndon L, Brandt J, Budenz D. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789-803.e2 pubmed publisher
    ..Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 5 years. Additional glaucoma surgery was needed more frequently after trabeculectomy with MMC than tube shunt placement. ..
  25. Tran D, Souza C, Ang M, Loman J, Law S, Coleman A, et al. Comparison of long-term surgical success of Ahmed Valve implant versus trabeculectomy in open-angle glaucoma. Br J Ophthalmol. 2009;93:1504-9 pubmed publisher
    ..024). Trabeculectomy with MMC has a significantly higher 5-year cumulative probability of success compared with AGV implants when greater reduction IOP is necessary. ..
  26. de Jong L. The Ex-PRESS glaucoma shunt versus trabeculectomy in open-angle glaucoma: a prospective randomized study. Adv Ther. 2009;26:336-45 pubmed publisher
    ..The Ex-PRESS is a safe and effective device for treating open-angle glaucoma. ..
  27. Lankaranian D, Reis R, Henderer J, Choe S, Moster M. Comparison of single thickness and double thickness processed pericardium patch graft in glaucoma drainage device surgery: a single surgeon comparison of outcome. J Glaucoma. 2008;17:48-51 pubmed publisher
    ..6 months after repair with no additional conjunctival erosions. DTPP placed over the silicone tube significantly reduced the incidence of conjunctival erosion after MMC augmented GDD surgery. ..
  28. Rouse J, Sarkisian S. Mini-drainage devices: the Ex-PRESS Mini-Glaucoma Device. Dev Ophthalmol. 2012;50:90-5 pubmed publisher
    ..Special attention will also be placed on the authors' own experience using the device. ..
  29. Hinkle D, Zurakowski D, Ayyala R. A comparison of the polypropylene plate Ahmed glaucoma valve to the silicone plate Ahmed glaucoma flexible valve. Eur J Ophthalmol. 2007;17:696-701 pubmed
    ..41). FP-7 model silicone plate AGV resulted in lower IOP compared to the older S-2 polypropylene plate AGV at 1 year. This may suggest that the plate material may influence clinical outcome. ..
  30. T Giorgis A. Initial clinical experience of tube-shunt surgery in Ethiopian patients with refractory glaucoma. Ethiop Med J. 2012;50:159-65 pubmed
    ..The few cases reported are indicators of the importance of the procedure in salvaging vision of patients with refractory glaucoma and the need of large scale prospective study in the country. ..
  31. Mackenzie P, Schertzer R, Isbister C. Comparison of silicone and polypropylene Ahmed glaucoma valves: two-year follow-up. Can J Ophthalmol. 2007;42:227-32 pubmed
    ..Both the silicone and polypropylene Ahmed valves significantly reduced IOP over 2 years. The silicone valve was associated with fewer serious complications. ..
  32. Brasil M, Rockwood E, Smith S. Comparison of silicone and polypropylene Ahmed Glaucoma Valve implants. J Glaucoma. 2007;16:36-41 pubmed
    ..6 and P>0.3, respectively). Silicone and polypropylene AGVs have similar results with respect to both safety and efficacy in the treatment of patients with refractory glaucoma. ..
  33. Sarodia U, Shaarawy T, Barton K. Nonpenetrating glaucoma surgery: a critical evaluation. Curr Opin Ophthalmol. 2007;18:152-8 pubmed
    ..Intraocular pressure-lowering efficacy seems to have improved with recent modifications in technique but the degree and longevity of intraocular pressure-lowering in comparison with trabeculectomy are still uncertain. ..
  34. Freidl K, Moster M. ExPRESS shunt surgery: preferred glaucoma surgery in residency training?. Surv Ophthalmol. 2012;57:372-5 pubmed publisher
    ..Further, needling an ExPRESS is a more technically challenging procedure than needling a trabeculectomy and more limited in its scope...
  35. Good T, Kahook M. Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy. Am J Ophthalmol. 2011;151:507-13.e1 pubmed publisher
    ..Differences in some postoperative outcomes faded with follow-up. There remains a need for long-term prospective studies comparing these 2 procedures. ..
  36. Papadaki T, Zacharopoulos I, Pasquale L, Christen W, Netland P, Foster C. Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol. 2007;144:62-69 pubmed
    ..Long-term success rates are enhanced with the use of glaucoma medications, and corneal complications are the most common of all potential serious complications. ..
  37. Mastropasqua L, Agnifili L, Ciancaglini M, Nubile M, Carpineto P, Fasanella V, et al. In vivo analysis of conjunctiva in gold micro shunt implantation for glaucoma. Br J Ophthalmol. 2010;94:1592-6 pubmed publisher
    ..These findings suggest that the enhancement of the aqueous filtration across the sclera may be one of the possible outflow pathways exploited by the shunt. ..
  38. Faghihi H, Hajizadeh F, Mohammadi S, Kadkhoda A, Peyman G, Riazi Esfahani M. Pars plana Ahmed valve implant and vitrectomy in the management of neovascular glaucoma. Ophthalmic Surg Lasers Imaging. 2007;38:292-300 pubmed
    ..Rancho Cucamonga, CA) implant combined with pars plana vitrectomy and panretinal photocoagulation for the management of neovascular glaucoma in patients with vitreous hemorrhage...
  39. Phillips P, Terry M, Shamie N, Chen E, Hoar K, Dhoot D, et al. Descemet stripping automated endothelial keratoplasty in eyes with previous trabeculectomy and tube shunt procedures: intraoperative and early postoperative complications. Cornea. 2010;29:534-40 pubmed publisher
    ..1%) was higher than the rate for the control group (0.23%), excellent early postoperative outcomes can be achieved when DSAEK is performed in eyes with previous trabeculectomies and GDDs. ..
  40. Law S. A modified technique of Ahmed glaucoma valve implantation with adjunctive use of antifibrotic agents. Am J Ophthalmol. 2008;146:156-8 pubmed publisher
  41. Sharaawy T, Bhartiya S. Surgical management of glaucoma: evolving paradigms. Indian J Ophthalmol. 2011;59 Suppl:S123-30 pubmed publisher
    ..There is insufficient evidence at present to establish the superiority of any of these surgeries over the other. ..
  42. Stahnke T, Löbler M, Kastner C, Stachs O, Wree A, Sternberg K, et al. Different fibroblast subpopulations of the eye: a therapeutic target to prevent postoperative fibrosis in glaucoma therapy. Exp Eye Res. 2012;100:88-97 pubmed publisher
  43. Autrata R, Helmanova I, Oslejskova H, Vondracek P, Rehurek J. Glaucoma drainage implants in the treatment of refractory glaucoma in pediatric patients. Eur J Ophthalmol. 2007;17:928-37 pubmed
    The aim of this study is to report the clinical course, effectiveness, and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments ..
  44. Gedde S, Herndon L, Brandt J, Budenz D, Feuer W, Schiffman J. Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804-814.e1 pubmed publisher
    ..The rates of late postoperative complications, reoperation for complications, and cataract extraction were similar with both surgical procedures after 5 years of follow-up. ..
  45. Ishida K, Ahmed I, Netland P. Ahmed glaucoma valve surgical outcomes in eyes with and without silicone oil endotamponade. J Glaucoma. 2009;18:325-30 pubmed publisher
    ..04). The AGV can control the IOP in the majority of eyes after pars plana vitrectomy and silicone oil injection. However, the presence of silicone oil is associated with increased risk of surgical failure in eyes treated with the AGV. ..
  46. Dohlman C, Grosskreutz C, Chen T, Pasquale L, Rubin P, Kim E, et al. Shunts to divert aqueous humor to distant epithelialized cavities after keratoprosthesis surgery. J Glaucoma. 2010;19:111-5 pubmed publisher
    ..In this retroactive study of such shunts, the risk of postoperative infection (especially endophthalmitis) has been assessed...
  47. Christakis P, Tsai J, Zurakowski D, Kalenak J, Cantor L, Ahmed I. The Ahmed Versus Baerveldt study: design, baseline patient characteristics, and intraoperative complications. Ophthalmology. 2011;118:2172-9 pubmed publisher
    ..To report the design, baseline patient characteristics, and intraoperative complications of the Ahmed Versus Baerveldt (AVB) Study...
  48. Figus M, Lazzeri S, Fogagnolo P, Iester M, Martinelli P, Nardi M. Supraciliary shunt in refractory glaucoma. Br J Ophthalmol. 2011;95:1537-41 pubmed publisher
    ..This study aimed to evaluate the efficacy of Gold Micro Shunt (GMS) for suprachoroidal drainage in patients with refractory glaucoma...
  49. Singh M, Chew P, Tan D. Corneal patch graft repair of exposed glaucoma drainage implants. Cornea. 2008;27:1171-3 pubmed publisher
    The purpose of this study was to describe a novel method of repair for exposed glaucoma drainage implants (GDIs) using corneal patch grafts...
  50. Gedde S, Singh K, Schiffman J, Feuer W. The Tube Versus Trabeculectomy Study: interpretation of results and application to clinical practice. Curr Opin Ophthalmol. 2012;23:118-26 pubmed publisher
    ..Results of the TVT Study support the expanding use of tube shunts beyond refractory glaucomas. ..
  51. Esquenazi S, Rand W. Safety of DSAEK in patients with previous glaucoma filtering surgery. J Glaucoma. 2010;19:219-20 pubmed publisher
    ..No complications were reported in any of the 4 cases. Corneal endothelial failure can be successfully managed with DSAEK in glaucoma patients with previous filtering surgery with good endothelial survival rates and IOP control. ..
  52. Mosaed S, Minckler D. Aqueous shunts in the treatment of glaucoma. Expert Rev Med Devices. 2010;7:661-6 pubmed publisher
    ..The outcomes of these procedures are encouraging, and support their use as first-line surgical options for the treatment of adult and juvenile glaucoma. ..
  53. Wentzloff J, Grosskreutz C, Pasquale L, Walton D, Chen T. Endophthalmitis after glaucoma drainage implant surgery. Int Ophthalmol Clin. 2007;47:109-15 pubmed