title: Oculoplastic technique of connecting a glaucoma valve shunt to extraorbital locations in cases of severe glaucoma.
abstract: OBJECTIVE
  To describe a technique for inserting glaucoma shunts to the sinuses or the lacrimal sac as a means of lowering intraocular pressure in patients with refractory glaucoma associated with severe ocular surface disease.
  
  
  METHODS
  Nineteen patients with severe ocular surface disease necessitating a keratoprosthesis and with intractable glaucoma underwent placement of a modified Ahmed shunt to direct aqueous in the maxillary or ethmoid sinus or lacrimal sac.
  
  
  RESULTS
  Intraocular pressure is presently well controlled without glaucoma medications in two thirds of patients. None of the patients had endophthalmitis.
  
  
  CONCLUSIONS
  Established oculoplastic surgery techniques may be used to redirect aqueous to extraorbital locations and effectively lower intraocular pressure in patients with severe ocular surface disease and refractory glaucoma. This procedure has not been associated with endophthalmitis.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114-3096, USA.
authors.forename: Peter A D
authors.initials: PA
authors.lastname: Rubin
authors.forename: Eli
authors.initials: E
authors.lastname: Chang
authors.forename: Carlo Roberto
authors.initials: CR
authors.lastname: Bernardino
authors.forename: Mark P
authors.initials: MP
authors.lastname: Hatton
authors.forename: Claes H
authors.initials: CH
authors.lastname: Dohlman
mesh_terms: D003315:Cornea / Q000601:surgery; D005005:Ethmoid Sinus / Q000601:surgery*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D007765:Lacrimal Apparatus / Q000601:surgery*; D008443:Maxillary Sinus / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D019919:Prosthesis Implantation / Q000379:methods*