Surgery & Procedures

Glaucoma Drainage Implants

Glaucoma Drainage Devices
In some special cases of glaucoma a glaucoma drainage device, or implant, may be preferred to the traditional trabeculectomy. These devices provide greater resistance to scar tissue and therefore can be helpful for patients who have a higher than average tendency of forming scar tissue. This may pertain, for example, to patients with neovascular glaucoma, inflammatory glaucoma, and situations where there have been several prior surgeries in the eye.

About the Implant Surgery
There are a number of different types of glaucoma implants available for patients in need of this procedure. Most of the implants available today are made up of two parts – a tube and a plate. The tube acts in the same manner as the filter site, or window, in the trabeculectomy. It acts to drain the clear fluid out of the eye. It is formed from a soft biocompatible material and is inserted into the front chamber of the eye under the upper eyelid. It is more resistant to closing over from scar tissue than is a conventional trabeculectomy window. The plate acts in the same manner as the bleb does in trabeculectomy. It provides a reservoir for fluid which has drained out of the eye through the tubing. From the reservoir, fluid is absorbed back into the circulation. The plate is situated fairly far back on the eye, underneath the eyebrow area. Neither part, the tube nor the plate, is visible to a casual observer.

The actual steps involved in having the surgery are essentially the same as those described for trabeculectomy. It is performed in an outpatient setting with a local anesthetic. There is an eye patch for the first night and a visit to your doctor’s office the day after the surgery. Activity limitations are similar to those which are needed and are helpful after trabeculectomy. There are postoperative medicines prescribed and adjusted throughout the recovery period.

Complications and Success
Glaucoma implants are relatively new to the surgical arena for management of glaucoma.  The success rate may be slightly lower than standard trabeculectomy and the complication rate is less well defined. This is because long-term studies still need to be done to fully evaluate the role of the implant in the eye. However, in cases where standard trabeculectomy may be less successful, the tube shunt procedure can be helpful and is possibly the best available option. Remember the goal of the surgery is to lower the pressure and preserve vision. You need to work with your doctor to evaluate the different surgeries and make a selection that is best for you.

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