title: Electron microscopic evaluation of a gold glaucoma micro shunt after explantation.
abstract: We present a case of an explanted gold glaucoma micro shunt (GMS Plus) and the subsequent light and electron microscopic analyses. The shunt was implanted in a patient with medically refractive glaucoma. The intraocular pressure (IOP) was stable at 12 mm Hg 6 months postoperatively but spiked to 26 mm Hg 6 months later; membranous growth was visible on the implant gonioscopically. A second gold micro shunt was placed 2 years after the first. The IOP was 7 mm Hg 1 week postoperatively but increased to 23 mm Hg 3 weeks later; similar membranous growth was visible on this implant. One of the shunts was explanted, and light and scanning electron microscopic analyses revealed encapsulation around the shunt exterior and connective tissue invasion of the microstructure. This represents the first electron microscopic analysis of an explanted gold glaucoma micro shunt and the first unequivocal images of the fibrotic pseudo-capsule traversing its microchannels and fenestrations.
  
  
  BACKGROUND
  Dr. Ahmed is a consultant to and has received research grants from Solx, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
authors: From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
authors: Thomas A
authors: TA
authors: Berk
authors: From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
authors: Diamond Y
authors: DY
authors: Tam
authors: From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
authors: Liliana
authors: L
authors: Werner
authors: From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
authors: Nick
authors: N
authors: Mamalis
authors: From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: ike.ahmed@utoronto.ca.
authors: Iqbal Ike K
authors: II
authors: Ahmed
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D020878:Device Removal; D019544:Equipment Failure Analysis; D005355:Fibrosis / Q000473:pathology; D005549:Foreign-Body Reaction / Q000473:pathology*; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006046:Gold; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008855:Microscopy, Electron, Scanning; D011475:Prosthesis Failure; D012086:Reoperation; D014794:Visual Fields / Q000502:physiology
chemical_list: D001672:Biocompatible Materials; D006046:Gold