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NR 4-5/2004
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Drainage devices in
glaucoma surgery
Urządzenia do drenażu w
chirurgii jaskry
K. Hille, B. Moustafa, A. Hille, K. W.
Ruprecht
Dept. of Ophthalmology and Eye Hospital
University of Saarland, Homburg (Saar)
Head: prof. dr Klaus Ruprecht |
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| Summary: |
Glaucoma drainage devices,
also termed aqueous shunts (AS), are widely used in the
USA. Indications for AS include excessive conjunctival
scarring diminishing the success of another filtration
surgeries, abnormalities of the iridocorneal angle,
neovascular glaucoma1, presence of corneal
grafts, and inflammatory glaucoma. Qualified success has
been achieved for many years in 50 to 100 % of the
treated eyes, depending on the patient selection. An AS
consists of a silicone tube that is inserted into the
anterior chamber and a plate (explant) made of silicone
or polypropylene. The latter is positioned between the
recti muscles. Within some weeks the surrounding tissue
forms a fibrous bleb around the plate. This serves as a
permanent filtration reservoir. The most serious
complication is postoperative hypotonia, that can lead
to serious choroidal detachment, suprachoroidal
hemorrhage, anterior chamber flattening, and corneal
decompensation. To avoid this complication some devices,
e.g. the Ahmed Glaucoma valve and the Krupin valve, have
integrated mechanisms to sustain a residual intraocular
pressure. With other devices such as the Molteno and the
Baerveldt devices the tube has to be temporarily ligated
until a scar area forms around the explant. On the other
hand, fibrous infiltration of the wall of the bleb often
leads to a reversible rise in intraocular pressure about
one to four months after surgery which can be treated by
massaging the bulb, needling the bleb, or injection of
antimetabolites. There are no obvious differences
between the different AS regarding the success of
pressure control. With appreciation of indications and
therapy of complications, AS are an useful option in the
management of complicated glaucoma, where conventional
filtration surgery is considered to carry a high risk of
failure. |
| Słowa kluczowe: |
jaskra, urządzenia
przetokowe, operacje jaskry. |
| Key words: |
glaucoma, aqueous shunts,
glaucoma surgery. |
1According to our concept AS is here
contraindicated, because the related secondary hypotonia can
induce rubeosis iridis progression [104].
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