A novel retrobulbar/intraconal surgical approach with combined cataract extraction and a modified AHMED ClearPath 250mm2 tube in the ciliary sulcus with an inferior sclerotomy in black and Afro-Latino patients with advanced glaucoma: a 6-month retrospective study.

AIM: The purpose of this early safety and technical feasibility study was to evaluate the real-world performance of cataract extraction combined with a modified Ahmed ClearPath 250 mm² glaucoma drainage device placed in the retrobulbar/intraconal space with inferior sclerotomy in glaucoma patients, focusing on surgical tolerability, device stability, and preliminary safety outcomes while acknowledging limitations in sample size and follow-up that preclude definitive efficacy claims.

METHODS

This study was conducted at Advanced Eye Care of New York, a private practice located in NY, NY. This was a single-center, retrospective study of 12 patients who underwent combined phacoemulsification cataract surgery and glaucoma surgery using a retrobulbar/intraconal AHMED® ClearPath 250mm2 and an inferior sclerotomy technique. We report results at 6 months of follow-up. Investigated parameters were intraocular pressure, number of medications, mean deviation on visual field test, visual acuity, and adverse events.

RESULTS

Among all the 12 eyes undergoing combined cataract extraction and retrobulbar/intraconal AHMED® ClearPath 250mm² placement with inferior sclerotomy, mean IOP decreased from 18.08 to 14.83 mmHg (18.0% reduction) at 6 months. Topical medications decreased from 2.67 to 1.0 (62.5% reduction). Visual field MD remained stable (-18.59 dB to -18.15 dB). Five patients achieved trabeculectomy-like results (IOP ≤12 mmHg on ≤1 medication). Complications were limited to temporary post-op hypotony and shallow anterior chamber, with no bleb, diplopia, or additional astigmatism.

CONCLUSION

Cataract extraction combined with a modified Ahmed ClearPath 250 mm² glaucoma drainage device placed in the retrobulbar/intraconal space via inferior sclerotomy shows preliminary promise in reducing intraocular pressure and medication burden in Black and Afro-Latino patients with advanced glaucoma. These exploratory findings from a small cohort suggest technical feasibility and short-term safety, warranting further research with larger samples and longer follow-up to confirm efficacy and generalizability.