The initial ACTSEB procedure described by Schocket and colleagues consisted of shunting aqueous to an encircling band in eyes with NVG [25, 26]. Final IOP in 18 of 19 eyes (95 %) was less than 20 mmHg (average IOP 16.2 mmHg, mean follow up 59 weeks). Of these 18 eyes, only 3 required IOP-lowering medications. The original Schocket faired well when compared to the initial data on the Krupin and Molteno glaucoma drainage devices [25]. The original Schocket was also compared to the double-plate Molteno in a randomized, prospective study in eyes with refractory glaucoma [32]. In this study, the final IOP was similar between groups (14.4 mmHg with Molteno and 15.1 mmHg with Schocket, mean follow up 26 months), although the Schocket group required fewer medications (mean 0.95 vs. 0.43 number of medications for the Molteno and Schocket groups, respectively). Nevertheless, more frequent complications were encountered in the Schocket group. Also, newer glaucoma drainage devices, such as the Baerveldt and Ahmed implants, are similarly effective and do not require placement of a 360° encircling band, making them a more popular choice than the original Schocket procedure for treatment of refractory glaucoma.

The modified Schocket procedure originally described by Sidoti and colleagues—and discussed here—consists of shunting aqueous to the fibrous capsule of a previously existing scleral buckle in eyes with a history of retinal detachment [24]. Successful control of IOP (defined as IOP between 6 and 21 mmHg with or without IOP-lowering medications) after 1 year was achieved in about 85 % of the eyes in 2 independent small case series [27, 24]. Ten out of twenty-one eyes required at least one IOP-lowering medication, and vision improved in nineteen of twenty-one eyes in the two series combined. Thus, shunting aqueous to an encircling band placed at the time of surgery (original Schocket) or into the capsule surrounding a preexisting scleral buckle (modified Schocket) is similarly effective in lowering IOP.

Using glaucoma drainage devices in eyes with preexisting scleral buckle is also a good surgical option. Small retrospective case series have looked at outcomes of Baerveldt drainage implants in eyes with preexisting scleral buckle and found similar results compared to the modified Schocket procedure [30, 31]. Twenty-eight of thirty-three eyes (85 %) achieved successful control of IOP (defined as IOP between 6 and 21 mmHg with or without IOP-lowering medications) at last follow up in both studies combined. In one of the series, 7 of 16 eyes required at least one IOP-lowering medication. Of the 9 eyes that did not need postoperative IOP-lowering medications, 2 had a Baerveldt 250 mm and 7 had a Baerveldt 350 mm device [30]. In general, vision remained stable in both these studies at last follow up.

There is no prospective, randomized clinical trial to date to compare the safety and efficacy between the modified Schocket procedure and glaucoma drainage implants in eyes with preexisting scleral buckles. Nevertheless, the outcomes reported for both procedures are comparable, and both are effective options in the treatment of refractory glaucoma in eyes with preexisting scleral buckles.

In the original series by Sidoti and colleagues, all complications related to the modified Schocket procedure were observed within 4 months postoperatively [24]. Complications included serous choroidal detachment, conjunctival dehiscence and wound leak, hyphema, and tube obstruction by lens, vitreous, or episcleral fibrous tissue. Interestingly, a more recent series by Lee et al. reports significantly fewer complications [27]. Lee et al. report tube exposure in one patient, and self-limited choroidal effusions in three eyes during the immediate postoperative period. They attribute the decreased rate of complications to securing the tube to the sclera, and creating side ports on the intracapsular end of the tube (Fig. 12.2). Indeed, intracapsular obstruction was the most common complication, and obstruction inside the eye could be attributed to tube migration. Thus, albeit limited evidence, these simple modifications appear to be beneficial in decreasing complications.

Placement of Baerveldt drainage implants in eyes with preexisting scleral buckle is associated with similar postoperative complications, including limited choroidal effusion, limited choroidal hemorrhage, hyphema, and conjunctival dehiscence and wound leak [30, 31]. Of note, there were more serious complications observed in these series, including retinal detachment recurrence, limited vitreous hemorrhage, and significant choroidal hemorrhage with subsequent phthisis.