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Editors Selection IGR 12-3
Surgery: Suprachoroidal tube implantation
Comment by Tarek Shaarawy on:
26643 Early results of suprachoroidal drainage tube implantation for the surgical treatment of glaucoma, Unal M; Kocak Altntas AG; Koklu G et al., Journal of Glaucoma, 2010;
Unak et al. (1422) present their shortterm results of implanting a suprachoroidal silicon tube, which presumably aims at augmenting uveoscleral outflow, potentially creating a surgical prostaglandin. Despite using yet other success and failure criteria, their results show some promise. Naturally their results, as they rightfully explain, are not readily comparable with other trials using different criteria, different surgical strategies, and targeting different glaucoma subgroups. Suprachoroidal filtration and shunts have been revisited lately. This is generally because of well-known disadvantages of subconjunctival filtration, and this direction is to be both commended and encouraged. This indeed seems to be the 'promised pathway' or the pathway with promise, whichever you will.
We know very little about tissue responses and scarring ability of the suprachoroidal space, though we may presume that they are somehow distinct from the bulk of known evidence regarding the subconjunctival space
Nevertheless, in the absence of real understanding about what happens in this mysterious area, these trials will continue to be limping on one leg. As often is the case with glaucoma surgical techniques, human clinical trials seem to come first before proper understanding of the mechanisms of function of such techniques. This, for example, is highlighted in this study by the fact that patients who have previously had trabeculectomies did significantly worse than patients who had none. This is interesting because we can speculate that either these patients were failing because of scarring in the subconjuncival space secondary to failed trabeculectomies, and thus we might be tempted to think that there is still some kind of subconjunctival filtration. The second possibility is that scarring in the subconjunctival space secondary to failed trabeculectomy somehow influences scarring in the suprachoridal space. There also might be other possibilities. The fact of the matter is that we know very little about tissue responses and scarring ability of the suprachoroidal space, though we may presume that they are somehow distinct from the bulk of known evidence regarding the subconjunctival space. The authors, though, should be congratulated on thinking outside the box, and attempting to break the monopoly of the subconjunctival space on glaucoma filtration surgery.
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