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Surgical Management of Childhood Glaucoma pp 99–127Cite as

Glaucoma Drainage Devices

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Abstract

Glaucoma drainage devices (GDDs) are useful in the management of complex childhood glaucoma. They can be used as a primary procedure in certain circumstances or as a second procedure where more conventional surgery (e.g., angle surgery) has been performed and failed. GDDs can broadly be categorized by whether they are valved or non-valved designs and then further categorized by plate surface area. Non-valved implants must be temporarily occluded to prevent early hypotony until sufficient fibrosis has developed around the plate to prevent hypotony; valved devices allow flow immediately after surgical implantation.

This chapter reviews the current status of GDDs in the management of childhood glaucoma including the general principles of these devices, recommended surgical techniques, and a review of the current pediatric GDD literature. We provide what we hope will be useful guidance to surgeons confronting this clinical challenge, emphasizing the why, when, and how of GDDs in the treatment of childhood glaucoma. Low-cost GDDs are now available for use in resource-constrained settings, and we encourage those caring for children with glaucoma to add the use of GDDs to their surgical portfolio – successful cases make all the hard work of managing these children among the most rewarding long-term aspect of childhood glaucoma care.

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Authors and Affiliations

  1. Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA

    James D. Brandt & Naama Hammel

  2. Manchester Royal Eye Hospital, University of Manchester, Manchester, UK

    Cecilia Fenerty & Tanya Karaconji

Authors
  1. James D. Brandt
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  2. Naama Hammel
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  3. Cecilia Fenerty
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  4. Tanya Karaconji
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Corresponding author

Correspondence to James D. Brandt .

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Editors and Affiliations

  1. Samuel & Ethel Balkan International Pediatric Glaucoma Center, Bascom Palmer Eye Institute University of Miami Miller School of Medicine, Miami, FL, USA

    Alana L. Grajewski

  2. Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA

    Elena Bitrian

  3. Glaucoma Service Moorfields Eye Hospital, London, UK

    Maria Papadopoulos

  4. Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA

    Sharon F. Freedman

Electronic Supplementary Material

Blunt dissection of the correct sub-Tenon’s plane may be started with scissors and completed with two squint hooks inserted back-to-back in this pocket and pulled gently apart. (Courtesy of Cecilia Fenerty, MD, FRCOphth and Tanya Karaconji, MD, FRANZCO) (MP4 210510 kb)

Method of inserting a tube into the anterior chamber using a blunt-tipped cannula. The tip of the cannula is firmly engaged onto the cut bevel of the tube and gently inserted through the scleral tunnel taking the tube with it. (Courtesy of Cecilia Fenerty, MD, FRCOphth and Tanya Karaconji, MD, FRANZCO) (MP4 42304 kb)

A long tunnel in the patient’s native sclera created using a small mini-crescent blade (1.25 mm in width) that can be used to tunnel in the sclera up to about 2 mm posterior to the limbus, then completing the entry into the eye with a 25-gauge needle. (Courtesy of James D. Brandt, MD) (MOV 3040454 kb)

Insertion of the tube of a Baerveldt glaucoma drainage device in an eye with aniridia . The lens is slightly displaced to the nasal side, and insertion of the tube at a tangent avoids contact with the lens. The anterior chamber infusion maintains the anterior chamber and constant intraocular pressure throughout the procedure. (Courtesy of Cecilia Fenerty, MD, FRCOphth and Tanya Karaconji, MD, FRANZCO) (MP4 193935 kb)

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Brandt, J.D., Hammel, N., Fenerty, C., Karaconji, T. (2018). Glaucoma Drainage Devices. In: Grajewski, A., Bitrian, E., Papadopoulos, M., Freedman, S. (eds) Surgical Management of Childhood Glaucoma. Springer, Cham. https://doi.org/10.1007/978-3-319-54003-0_7

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