Case reportElectron microscopic evaluation of a gold glaucoma micro shunt after explantationBerk, Thomas A. BSc; Tam, Diamond Y. MD; Werner, Liliana MD, PhD; Mamalis, Nick MD; Ahmed, Iqbal Ike K. MD* Author Information From the University of Toronto Faculty of Medicine (Berk), the Department of Ophthalmology and Vision Sciences (Tam, Ahmed), University of Toronto Faculty of Medicine, Toronto, Trillium Health Partners (Tam, Ahmed) and GoEyecare (Tam, Ahmed), Mississauga, Canada; the Department of Ophthalmology and Visual Sciences (Werner, Mamalis), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA *Corresponding author: Iqbal Ike K. Ahmed, MD, Credit Valley Eye-Care, 3200 Erin Mills Parkway, Unit 1, Mississauga, Ontario L5L 1W8, Canada. E-mail: [email protected] Submitted October 29, 2014; accepted November 6, 2014. Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, USA, to the Department of Ophthalmology and Visual Sciences, University of Utah.Figure: No Caption available.First author: Thomas A. Berk, BSc University of Toronto Faculty of Medicine, Toronto, Canada Journal of Cataract & Refractive Surgery: March 2015 - Volume 41 - Issue 3 - p 674-680 doi: 10.1016/j.jcrs.2014.12.001 Buy Metrics Abstract We present a case of an explanted gold glaucoma micro shunt (GMS Plus) and the subsequent light and electron microscopic analyses. The shunt was implanted in a patient with medically refractive glaucoma. The intraocular pressure (IOP) was stable at 12 mm Hg 6 months postoperatively but spiked to 26 mm Hg 6 months later; membranous growth was visible on the implant gonioscopically. A second gold micro shunt was placed 2 years after the first. The IOP was 7 mm Hg 1 week postoperatively but increased to 23 mm Hg 3 weeks later; similar membranous growth was visible on this implant. One of the shunts was explanted, and light and scanning electron microscopic analyses revealed encapsulation around the shunt exterior and connective tissue invasion of the microstructure. This represents the first electron microscopic analysis of an explanted gold glaucoma micro shunt and the first unequivocal images of the fibrotic pseudo-capsule traversing its microchannels and fenestrations. Financial Disclosure Dr. Ahmed is a consultant to and has received research grants from Solx, Inc. No other author has a financial or proprietary interest in any material or method mentioned. © 2015 by Lippincott Williams & Wilkins, Inc.