Surgical Outcomes of A-stream Shunt Implantation in Neovascular Glaucoma: A Single-Center Retrospective Cohort Study

To evaluate 6-month surgical outcomes of A-stream shunt implantation in eyes with neovascular glaucoma (NVG) and to describe postoperative ripcord management patterns.

This retrospective, single-center cohort study included consecutive NVG eyes that underwent A-stream shunt implantation between August 2024 and April 2025 with available follow-up through 6 months. Intraocular pressure (IOP) and the number of glaucoma medications were assessed at postoperative day 1, week 1, weeks 2-3, and months 1, 2, 3, and 6. Complete success was defined as IOP 6-18 mmHg with ≥20% reduction from preoperative decision IOP, without glaucoma medications or additional glaucoma surgery. Qualified success was defined using the same IOP and reduction criteria with or without medications, and without additional glaucoma surgery. Ripcord removal timing and postoperative interventions were recorded.

Thirty-five eyes were included. Mean preoperative IOP was 37.0 ± 13.2 mmHg on 2.6 ± 1.2 medications. Mean IOP decreased to 10.1 ± 6.9 mmHg on postoperative day 1 and remained in the mid-teens through 6 months (15.7 ± 6.3 mmHg). Medication burden was markedly reduced postoperatively and remained low at 6 months (0.7 ± 0.9). Ripcord removal was performed in 28 eyes (80.0%); mean time to removal was 6.6 ± 4.7 weeks, and 14 eyes (40.0%) underwent removal within 4 weeks. Mean IOP at ripcord removal was 21.2 ± 5.4 mmHg. At 6 months, complete and qualified success rates were 57.1% and 85.7%, respectively. Bleb needling and 5-fluorouracil injections were performed in 14.3% and 25.7% of eyes, respectively; one eye (2.9%) required reoperation.

A-stream implantation provided substantial short-term IOP reduction with low medication requirements and favorable qualified success through 6 months in NVG. Ripcord removal was frequently required and often performed early, supporting stepwise outflow titration as a practical postoperative strategy.