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Doctors at YNHH use gold shunt method as new gold standard for glaucoma treatment

6/30/2011 — Ophthalmologists at Yale New Haven Hospital and the Yale Eye Center are the first of currently only two university centers in the United States to use a new "gold shunt" drainage device for the treatment of glaucoma. This novel device is designed for patients who have failed prior glaucoma surgery and have a pressure above 24 mmHg.

Glaucoma, which is usually associated with elevated pressure of fluid in the eye, generally leads to damage of the optic nerve result in progressive, irreversible loss of vision that can progress to blindness. Glaucoma, nicknamed the "silent thief of sight," is the second leading cause of blindness in the world.

The new shunt, called the Gold Shunt, is a biocompatible, 24-karat gold flat plate implant that is surgically inserted into the so-called suprachoroidal space of the eye. The shunt uses the eye's natural pressure differential to reduce intraocular pressure (IOP). It is only 3 mm wide, 6 mm long and as thick as a human hair-designed for implantation through a single micro-incision. It contains an internal flow space that allows the fluid to drain to reduce IOP. The shunt is virtually undetectable by the patient and is intended to last indefinitely. It has been found to be a safe and effective means of controlling intraocular pressure in patients with glaucoma.

"This new device works by increasing fluid outflow and reducing IOP by accessing a novel internal drainage space that could not be effectively accessed in the past," said Nils Loewen, MD, PhD, ophthalmologist at Yale New Haven Hospital and the director of the glaucoma section of the Yale Eye Center. "Once inserted, it creates a new fluid pathway that is on the inside of the eye. Classical glaucoma drainage devices are about 200 times larger than the gold shunt and create a buckle on the outside of the eye that can cause double vision or erode."

The eye's natural pressure gradient creates a constant flow of fluid through the gold shunt, lowering the pressure and creating a drainage system that helps to prevent further damage to vision. While the new gold shunt does not cure glaucoma, is designed to reduce pressure to safe levels to sustain the patient's current vision status.

"Glaucoma occurs from a lack of drainage and build-up of fluid," said Dr. Loewen, who is also an assistant professor of ophthalmology at Yale School of Medicine. "Gold is the least reactive of all precious metals. The eye does not seem to view it as a foreign body. As a result, eyes that have received this gold implant are exceptionally quiet and seem to experience minimal scar tissue built up. The gold shunt provides us with an entirely new modality of fluid drainage."

Yale New Haven Hospital (YNHH), part of Yale New Haven Health, is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine (YSM). Founded as the fourth voluntary hospital in the U.S. in 1826, today, YNHH has two New Haven-based campuses, and also includes Yale New Haven Children's Hospital, Yale New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has received Magnet designation from the American Nurses Credentialing Center, the nation’s highest honor of nursing excellence. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties.