Rahman Anya, Whitney Jordan, Abdeljabbar Nadine, Webel Aaron D
University of Missouri - Columbia School of Medicine, Columbia, MO, USA.
Department of Ophthalmology, University of Missouri - Columbia, Columbia, MO, USA.
Clin Ophthalmol. 2025 Aug 20;19:2871-2877. doi: 10.2147/OPTH.S532710. eCollection 2025.
To evaluate glaucoma surgeons' practice patterns regarding glaucoma drainage device (GDD) tube shunt placement, assess their opinions on sulcus tube placement, and evaluate their receptiveness to technologies designed to improve sulcus tube placement.
A 12-question survey was distributed electronically to American Glaucoma Society (AGS) members between November 6 and December 23, 2024. The survey assessed surgeons' current tube-shunt placement practice patterns, factors influencing tube placement decisions, and receptiveness to proposed technologies designed for sulcus tube placement. Descriptive analysis was performed on 121 completed responses.
Most respondents (55%) reported a preference for placing tubes in the anterior chamber (AC) for the majority of their pseudophakic patients, with efficiency (62%), safety (62%), and familiarity (57%) reported as primary factors for this decision. Barriers to sulcus placement included concern for intraocular bleeding (67%), technical difficulty of sulcus placement (54%), the risk of vitreous loss and tube occlusion (53%), and iris complications (53%). However, if a sulcus tube insertion technology was available and assuming a randomized controlled trial (RCT) demonstrated the superiority of sulcus over AC placement in minimizing endothelial cell loss (ECL), 85% of respondents indicated they would be likely to routinely place tubes in the sulcus. Features deemed very important for such a technology included tube placement accuracy (87%), ease of use (86%), IOP-lowering effectiveness (73%), time-efficiency (71%), and affordability (67%).
Currently, most glaucoma surgeons favor AC tube placement due to its familiarity, efficiency, and perceived safety, despite associated long-term risk of endothelial cell loss (ECL). Survey findings suggest strong interest in adopting sulcus placement, assuming a proven benefit on ECL and the availability of sulcus placement technologies designed to mitigate technical challenges. Development of robust data and reliable sulcus insertion technologies/techniques may change practice patterns.
评估青光眼外科医生在青光眼引流装置（GDD）管分流置入方面的实践模式，评估他们对巩膜沟置管的看法，并评估他们对旨在改善巩膜沟置管的技术的接受程度。
2024年11月6日至12月23日期间，通过电子方式向美国青光眼协会（AGS）成员发放了一份包含12个问题的调查问卷。该调查评估了外科医生当前的管分流置入实践模式、影响置管决策的因素以及对为巩膜沟置管设计的拟议技术的接受程度。对121份完整回复进行了描述性分析。
大多数受访者（55%）报告称，对于大多数人工晶状体植入患者，他们更倾向于在前房（AC）置管，效率（62%）、安全性（62%）和熟悉程度（57%）被报告为做出这一决定的主要因素。巩膜沟置管的障碍包括对眼内出血的担忧（67%）、巩膜沟置管的技术难度（54%）、玻璃体丢失和管阻塞的风险（53%）以及虹膜并发症（53%）。然而，如果有一种巩膜沟置管技术可用，并且假设一项随机对照试验（RCT）证明巩膜沟置管在最小化内皮细胞丢失（ECL）方面优于前房置管，85%的受访者表示他们可能会常规在巩膜沟置管。对于这样一种技术，被认为非常重要的特征包括管置入准确性（87%）、易用性（86%）、降低眼压有效性（73%）、时间效率（71%）和可承受性（67%）。
目前，大多数青光眼外科医生由于对前房置管熟悉、高效且认为安全，因而倾向于前房置管，尽管存在内皮细胞丢失（ECL）的相关长期风险。调查结果表明，如果巩膜沟置管对ECL有已证实的益处且有旨在减轻技术挑战的巩膜沟置管技术可用，那么医生对采用巩膜沟置管有浓厚兴趣。强大数据和可靠的巩膜沟插入技术的开发可能会改变实践模式。
