Early Clinical Experience with the Novel A-Stream Glaucoma Shunt Combined with Mid-Posterior Tenon’s Capsule Advancement Flap

<b>Objectives:</b> The aim of this study was to evaluate the clinical outcomes and surgical techniques of A-stream Glaucoma Shunt (A-stream; MICROT Inc.) implantation. <b>Methods:</b> A retrospective review of 59 eyes from 59 patients who underwent A-stream implantation was conducted. Eyes were divided into two groups: group A (25 eyes), where the distal tip of the ripcord was left exposed and the device was covered with conjunctiva, scleral flap, pericardium patch graft, or mid-posterior Tenon's capsule advancement flap (MPTAF); and group B (34 eyes), where the ripcord was shaped into a loop at the corneal limbus and the device was covered with MPTAF. Intraocular pressure (IOP), number of IOP-lowering medications, visual acuity, and postoperative complications were analyzed. Success was defined as an IOP ≤ 21 mmHg with ≥20% reduction from baseline, without clinically significant hypotony, and no reoperation for glaucoma. <b>Results:</b> At 6 months, the mean IOP decreased significantly in both groups (group A: 27.4 ± 9.8 mmHg to 15.2 ± 5.1 mmHg; group B: 25.1 ± 11.6 mmHg to 14.0 ± 7.0 mmHg, <i>p</i> < 0.001). Success rates were 76.0% in group A and 88.2% in group B (<i>p</i> = 0.207). Early postoperative hypotony occurred in 8.0% of group A and 14.7% of group B, and these cases resolved without further intervention within 1 month. Ripcord complications were observed in 28.0% of group A, but none in group B. <b>Conclusions:</b> A-stream implantation with MPTAF and a limbal ripcord loop is an effective and safe procedure with minimal risk of device exposure and ripcord-related complications.