Glaucoma Drainage Devices
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.
KeywordsGlaucoma drainage device Tube shunts Ahmed Baerveldt Molteno AADI, Complications, Outcomes, Surgical techniques, Indications
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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