Pilot Outcomes of Cataract Extraction with Modified Ahmed ClearPath 250 Retrobulbar/Intraconal Glaucoma Drainage Device Implantation with Inferior Sclerotomy in Patients with Advanced Glaucoma: A 1-year Retrospective Study

Abstract

Aim: This retrospective study aims to evaluate the real-world safety and efficacy of a modified Ahmed ClearPath 250 retrobulbar/intraconal glaucoma drainage device (GDD) placement in patients with advanced primary open-angle glaucoma (POAG) by assessing intraocular pressure reduction, medication burden, and postoperative complications over a 12-month follow-up period. Methods: This study was conducted at Advanced Eye Care of New York, a private practice located in NY, NY. This was a single-center, retrospective chart review of adult patients with advanced POAG who underwent placement of a modified Ahmed ClearPath 250 retrobulbar/intraconal GDD between 2023 and 2025. De-identified demographic, clinical, and surgical data were extracted from the medical record and organized longitudinally to include baseline and postoperative follow-up at approximately 1, 3, 6, and 12 months. Outcomes assessed included intraocular pressure (IOP), glaucoma medication burden, visual acuity, visual field parameters when available, and postoperative complications at the 6-month and 1-year intervals from baseline measures. Changes in intraocular pressure and medication use over time were analyzed using paired longitudinal comparisons for eyes with available follow-up data. Results: Twelve eyes underwent surgery, of which 9 had complete longitudinal data and were included in repeated-measures analysis of variance. Mean IOP decreased from 17.78 ± 7.69 mmHg at baseline to 13.44 ± 4.30 mmHg at 12 months (28% reduction; p = 0.030), with significant reduction achieved by 6 months (p = 0.008) and maintained through 12 months. Mean medication burden decreased from 2.22 ± 1.56 at baseline to 1.33 ± 0.71 at 12 months (p = 0.004), with significant reductions observed at 1 month (p = 0.035) and 6 months (p = 0.027). Visual acuity remained stable over the follow-up period (p = 0.78). Postoperative complications included transient hypotony in 3 eyes (25%), transient IOP elevation in 2 eyes (17%), hyphema in 1 eye (8%), and fibrin formation in 1 eye (8%). No cases of endophthalmitis, suprachoroidal hemorrhage, choroidal effusions, or retinal detachment were observed. Conclusion: At 1 year, the modified retrobulbar/intraconal placement of the Ahmed ClearPath 250 GDD achieves substantial intraocular pressure lowering, reduces the need for topical medications. These findings support the short-term feasibility of this promising procedure, while longer-term studies are needed to establish its safety, durability, and clinical role.