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Review
. 2020 Aug 18;13(8):1318-1328.
doi: 10.18240/ijo.2020.08.20. eCollection 2020.

Glaucoma drainage implants

Pavi Agrawal  1 , Palvi Bhardwaj  1
Affiliations
Review

Glaucoma drainage implants

Pavi Agrawal et al. Int J Ophthalmol. .

Abstract

Glaucoma drainage devices have traditionally been reserved for refractory glaucoma. However, there is an increasing body of evidence to suggest the use of these implants at an earlier stage in the surgical management of glaucoma. We describe the mechanics behind their function as well as the various implants available. The implants vary in size, surface area and composition and hence the surgical implantation of these devices are described in detail. The knowledge of such devices and their potential complications is fundamental for the successful management of patients who undergo aqueous-shunt surgery. Careful patient selection and optimal postoperative management is critical to the successful patient outcomes.

Keywords: aqueous shunts; glaucoma; glaucoma drainage devices.

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Figures

Figure 1
Figure 1. Ahmed valve implant (AVI), Model FP7 (left), Baerveldt glaucoma implant, Model 101-350 (right). Note the fenestrations present on both end-plates and the thin curved profile of the Baerveldt implant.
Figure 2
Figure 2. Stages of Baerveldt tube insertion
A: Subtenons pocket is fashioned in the superotemporal quadrant; B: Mitomycin C can be applied using a PVA corneal shield in the subtenons pocket; C: The place is secured to sclera through the eyelets of the plate (note the supramid suture within the tube, and coming out the end plate); D: The tube is inserted into the anterior chamber fixed with two mattress sutures; E: An external ligating suture is secured; F: The patch graft is sutured over the tube and the conjunctiva and subtenons closed.
Figure 3
Figure 3. Encircling band in a patient undergoing Baerveldt tube surgery. The fibrous capsule was dissected and the buckle was locally excised prior to insertion of the plate. Note the retracted conjunctiva making closure challenging.
Figure 4
Figure 4. Shallow diffuse bleb following a Baerveldt tube implant in juvenile uveitic glaucoma. Note the corneal patch graft allows you to see the tube underneath and improves the cosmesis of the patient.
Figure 5
Figure 5. An internal anterior chamber 8-0 prolene suture around a Baerveldt 350-mm2 tube to manage postoperative hypotony.
Figure 6
Figure 6. Hypotony with significant choroidal folds following Baerveldt implant surgery in Sturge-Webber syndrome.
Figure 7
Figure 7. Tube erosion following Baerveldt implant surgery in a young African-Caribbean male with uveitic glaucoma and a decompensated cornea.
See this image and copyright information in PMC

References

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