# 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

## TL;DR

A new surgical approach combining cataract removal and glaucoma treatment shows early promise in reducing eye pressure and medication use in Black and Afro-Latino patients with advanced glaucoma.

## Contribution

A modified surgical technique combining cataract extraction and glaucoma drainage device placement in the retrobulbar/intraconal space with an inferior sclerotomy is introduced and evaluated.

## Key findings

- Mean intraocular pressure decreased by 18.0% at 6 months.
- Topical medications reduced by 62.5% in patients.
- Five patients achieved IOP ≤12 mmHg on ≤1 medication.

## Abstract

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.

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.

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.

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.