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Using shunts to control aqueous flow to suprachoroidal space may be key to lowering IOP
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SAN FRANCISCO — In glaucoma patients, the suprachoroidal space may be the ideal location for an IOP-lowering procedure, according to a presenter here.
“Communicating the anterior chamber with the suprachoroidal space dramatically reduces IOP; however, if a procedure can control the amount of flow to the suprachoroidal space, it could be an ideal approach to lowering IOP,” Celso Tello, MD, said at the American Glaucoma Society annual meeting.
Celso Tello
Currently, there are four suprachoroidal shunts. The Gold Shunt (Solx) and Aquashunt (Opko Health) use an ab externo surgical approach, and the CyPass (Transcend Medical) and iStent (Glaukos) use an ab interno surgical approach.
The Gold Shunt is a non-valve device made of 24 karat gold. The Aquashunt is made of polypropylene and is larger than the Gold shunt.
The CyPass is 6 mm long and can be used as a standalone procedure or in combination with phacoemulsification. The iStent is 4 mm long and is made of polyethersulfone with a titanium sleeve.
“Although the 1-year results of the CyPass and Gold shunts are promising, their long-term success may be limited by excessive fibrosis around the shunts,” Tello said. “Further research is needed to determine if adjunct use of antifibrotic and anti-inflammatory agents, mitomycin C, Ologen (Optous), an injection of steroids, or use of topical nonsteroidal and anti-inflammatory drugs may improve the long-term success of suprachoroidal shunts.”
Disclosure: Tello is an investigator and consultant for Solx.