Combined cataract and retrobulbar Ahmed drainage surgery shows preliminary IOP reduction in advanced glaucoma

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Frontiers in Medicine Published April 9, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note preliminary IOP reduction with combined retrobulbar Ahmed drainage in small advanced glaucoma cohort.

This retrospective cohort study evaluated 12 Black and Afro-Latino patients (12 eyes) with advanced glaucoma at a single private practice. All patients underwent combined phacoemulsification cataract surgery and glaucoma surgery using a retrobulbar/intraconal AHMED ClearPath 250mm² glaucoma drainage device with an inferior sclerotomy technique. No comparator group was included in the analysis.

At 6-month follow-up, mean intraocular pressure decreased from 18.08 mmHg to 14.83 mmHg (18.0% reduction). The mean number of topical glaucoma medications decreased from 2.67 to 1.0 (62.5% reduction). Visual field mean deviation remained stable (-18.59 dB to -18.15 dB). Five of 12 patients (41.7%) achieved trabeculectomy-like results (IOP ≤12 mmHg on ≤1 medication).

Safety assessment reported temporary postoperative hypotony and shallow anterior chamber as adverse events. No bleb formation, diplopia, or additional astigmatism was reported. Serious adverse events and discontinuations were not reported.

Key limitations include the small sample size, short 6-month follow-up, retrospective design, single-center setting, and absence of a comparator group. These factors preclude definitive efficacy claims. The study provides preliminary evidence of technical feasibility and short-term safety for this combined surgical approach in a population historically underrepresented in glaucoma surgical trials. Larger prospective studies with longer follow-up are needed to confirm these findings and assess generalizability.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

AimThe 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.MethodsThis 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.ResultsAmong 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.ConclusionCataract 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.