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Investigations of the reasons for success and failure in the anterior shunt-to-the-encircling-band procedure in the treatment of refractory glaucoma.

THE ANTERIOR-CHAMBER SHUNT-TO-THE-ENCIRCLING-BAND (ACTSEB) PROCEDURE offers a high degree of success (65% to 96%) even in refractory glaucomas. The aqueous humor is shunted from the anterior chamber through a Silastic tube to a reservoir between the encircling band and the sclera. When the procedure is successful, there is no postoperative conjunctival bleb such as one sees in the standard anterior filtering procedure. If one has the opportunity to examine the Silastic tube, it is seen to be located in the gutter of the encircling No 20 silicone band. The lumen of the tube remains patent despite a well-formed capsule surrounding the silicone band. It is the purpose of this thesis: (1) To review the history of setons in glaucoma surgery. (2) To demonstrate the fate of the aqueous in the reservoir, using horseradish peroxidase (HRP). (3) To review the chemistry of silicone. (4) To review the role of silicone in the formation of the enveloping fibrous capsule. (5) To present in vitro studies that explore the development of the capsule around silicone implants. (6) To discuss the ACTSEB failures and techniques in order to avoid them. (7) To present a revised ACTSEB device that incorporates the findings of the above studies.