title: Histological findings of failed gold micro shunts in primary open-angle glaucoma.
abstract: BACKGROUND
  To describe the histological features of failed gold micro shunts (GMS) in unsuccessful implantations for refractory primary open-angle glaucoma (POAG).
  
  
  METHODS
  This was an interventional case series study. Five eyes of five glaucomatous patients with unsuccessful GMS implantation underwent shunt removal. Each device was sectioned into three portions: proximal or anterior chamber (AC) portion, middle or scleral portion and distal or suprachoroidal (SC) portion. The histological analysis was performed throughout the whole extent of the shunt, describing both the inner spaces and the outer surface.
  
  
  RESULTS
  At the moment of removal all devices were correctly located into the SC space and in AC, with the exception of a case presenting corneal endothelial contact. The mean intra-ocular pressure before GMS removal was 30.4 ± 5.3 mmHg, and the mean time of GMS removal after implantation was 6.8 ± 2.5 months. No significant histological differences were documented among the five analyzed devices. The main feature was the presence of a thick connective capsule-like reaction surrounding both the proximal and distal ends and invading the posterior and anterior grid holes, whereas a more loosely arranged connective tissue was observed within the inner channels. Signs of surface fibrosis of the middle-scleral portion and inflammatory cell infiltration of the device were not documented in any of the cases.
  
  
  CONCLUSIONS
  Failed GMS implantations presented connective tissue filling all the inner spaces and creating a thick fibrotic capsule surrounding the ends of the device. This modification isolated the GMS from the AC and SC space, impeding aqueous flows throughout the shunt.
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmic Clinic, University of Chieti-Pescara, Via dei Frentani, 114, 66100 Chieti, Italy. l.agnifili@unich.it
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
authors.forename: Michele
authors.initials: M
authors.lastname: Figus
authors.forename: Giovanna
authors.initials: G
authors.lastname: Iezzi
authors.forename: Adriano
authors.initials: A
authors.lastname: Piattelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Carpineto
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.forename: Marco
authors.initials: M
authors.lastname: Nardi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
mesh_terms: D000368:Aged; D003238:Connective Tissue / Q000473:pathology*; D020878:Device Removal; D005260:Female; D005355:Fibrosis; D005549:Foreign-Body Reaction / Q000473:pathology*; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006046:Gold; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D006046:Gold