Early Ripcord Removal and Short-Term Surgical Outcomes After A-stream Shunt Implantation in Primary Open-Angle...

Early ripcord removal (≤4 wk) after A-stream implantation in primary open-angle glaucoma was associated with higher postoperative intraocular pressure, more postoperative interventions, and lower 6-month complete success compared with late or no removal.

To compare postoperative outcomes of early versus late or no intraluminal ripcord removal after A-stream shunt implantation in primary open-angle glaucoma.

This retrospective single-center study included consecutive eyes with primary open-angle glaucoma that underwent A-stream implantation with an intraluminal ripcord (August 2024-April 2025). Eyes were categorized as early removal (≤4 wk) or late/no removal (>4 wk or not removed). Postoperative intraocular pressure, postoperative interventions (bleb needling and subconjunctival 5-fluorouracil), and 6-month surgical outcomes were compared. Univariable and Multivariable logistic regression assessed factors associated with 6-month complete success.

Seventy eyes (70 patients) were included (early, n=20; late/no, n=50) with comparable baseline characteristics. The early removal group showed higher postoperative intraocular pressure and more frequent postoperative interventions (needling 50.0% vs. 10.0%; 5-fluorouracil 55.0% vs. 6.0%). Six-month complete success was lower in the early group (40.0% vs. 72.0%). In univariable analysis, early ripcord removal was associated with lower odds of complete success, and this association remained in multivariable analysis adjusted for early postoperative IOP and clinically relevant covariates (odds ratio, 0.22; 95% confidence interval, 0.05-0.98; P=0.047).

Eyes requiring early intraluminal ripcord removal after A-stream implantation underwent more postoperative interventions and achieved lower short-term complete success. Early ripcord removal may serve as a clinical marker of an unfavorable postoperative course.