Do you feel there is a role for capsulectomy for failed Ahmed implants and what is your preferred surgical approach?

There can be a role for capsulectomy after a failed Ahmed implant. In situations where a needling/5FU is insufficient, a capsulectomy provides a higher chance of success. Typically, I would dissect from the limbus backwards to the plate, excise as much capsule as possible, then close after ensuring adequate dissection/free conjunctiva to reduce tension. I avoid cutting over the plate as the risk of plate exposure is higher and can be devastating.