Aqueous shunts in the treatment of glaucoma

The main goal of surgical glaucoma treatment is to reduce the intraocular pressure. The standard procedure over the past 40 years has been trabeculectomy, first described in 1968. This procedure comes with a very high risk profile, and results in moderate long-term results at best. Tube shunt devices were introduced as an alternate means to divert fluid out of the glaucomatous eye, attempting to improve upon the poor long-term outcomes of trabeculectomy, particularly in refractory cases that had failed attempts at prior glaucoma surgeries. They are currently available in a handful of different designs and have evolved from representing a second- or third-line treatment in refractory cases, to their current standing of accepted first-line surgical intervention for many surgeons. The designs of the aqueous shunts are simple and installation involves straightforward principles of ophthalmic surgery. Recent additions to the literature, as well as the development of the Ex-PRESS Miniature Shunt, are changing the way shunts are employed in the treatment algorithm for surgical glaucoma. The outcomes of these procedures are encouraging, and support their use as first-line surgical options for the treatment of adult and juvenile glaucoma.