Background To evaluate the safety and efficacy of a novel approach that combines posterior placement of the plate and intrascleral tunneling of the tube of Ahmed’s glaucoma drainage device regarding intraocular pressure control, frequency, and severity of hypertensive-phase as well as rates of plate exposure and tube erosion. Patients and methods This is a retrospective analysis that included records for 71 patients with refractory glaucoma operated on with the triple-tunnel technique between March 2021 and August 2023. Results The mean age of the patients was 40.52±18.09 years with a mean follow-up duration of 24.54±9.02 months. Intraocular pressure declined from a preoperative value of 32.8±9.85–16.38±3.77 mm Hg ( P ˂0.001). The number of preoperative medications decreased from a preoperative value of 4.18±0.98–1.86±1.01 ( P ˂0.001). The hypertensive phase was encountered in 35.2% of the cases (mean onset of 0.8±1.21 months and peak onset at 2 months in 26.8% of the cases). Early postoperative interventions were needed at day 30 in three cases (needling, YAG iridotomy, and drainage of suprachoroidal hemorrhage), and wipe-out was seen in one case. Four cases required diode cyclophotocoagulation throughout the follow-up period. None of the cases experienced plate exposure or tube erosion throughout the follow-up period. Conclusion The triple-tunnel technique for Ahmed glaucoma drainage device implantation has proven to be a safe and effective method that reduces the risk of tube-related complications and the need for tube coverage. This could be cost-effective by eliminating the need for pericardial grafts and safer by reducing cross-infections associated with scleral-patch grafts.
Abdelrahman et al. (Thu,) studied this question.