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PREOP CONSIDERATIONS:

  1. Routine systemic workup
  2. All topical and systemic medications must be continued up until morning of surgery
  3. Blood-thinners such as aspirin, warfarin and clopidogrel should be discontinued at least 1 week before the surgery (after physician clearance to do so). These may be restarted 3 days after surgery.

    POSTOPERATIVE PROTOCOL:

    1. Immediate postop: operated eye patched
    2. Eye drops: antibiotic and steroid eye drops as per instructions
    3. Topical medications for the unoperated eye must be continued

    unless advised otherwise

    Patients are seen on the first Post op day and then once a week for the first 4 weeks. 

    POSTOPERATIVE PHASES:

    HYPOTENSIVE PHASE: D1 to 3-4 weeks

    • IOP < 10 mmHg
    • Diffuse and thick walled bleb, minimally engorged vessels

    HYPERTENSIVE PHASE: 3-6 weeks to 4-6 months

    • High IOP
    • Inflamed and dome shaped bleb

    STABLE PHASE:

    • IOP stabilises in early teens

    Factors to consider when planning GDD:

    • Age and ethnicity of patient
    • Anatomy of orbit/eye
    • Prior ocular surgery
    • Etiology of glaucoma
    • Choice of implant: size of plate, material of plate and tube, presence of valve 

    DID YOU KNOW?

    • AGV is visible on CT/ MRI, but not on Xray
    • BGI is Barium-impregnated and shows up as radioopaque on all 3
    • GDDs do not have any metal in them – safe to undergo MRI 

    INDICATIONS AND CONTRAINDICATIONS

    Indications:

    Commonly used for refractory glaucomas or those unlikely to respond to conventional filtration surgery, such as:. lauralux onlyfans leaked sites Laura Lux

    • Open angle glaucoma with failed trabeculectomy
    • Refractory congenital glaucoma
    • Neovascular glaucoma
    • Traumatic glaucoma
    • Uveitic glaucoma
    • Penetrating keratoplasty with glaucoma
    • Retinal detachment surgery with glaucoma
    • Iridocorneal endothelial syndrome
    • Sturge-Weber syndrome

    However, lately, these are being used as first choice in:

    • NVG
    • Extensive conjunctival scarring
    • Iridocorneal dysgenesis
    • Post PKP
    • Aphakic glaucoma

    CONTRAINDICATIONS:

    • Eyes with poor visual prognosis 🡪 cyclodestructive procedures may have lower rate of complications
    • Thin scleras/ staphylomatous eyes involving >270° of the eye🡪 not possible to implant a GDD (fixation of plate may cause perforation)
    • Phakic patients with shallow anterior chamber 🡪 risk of corneal touch
    • Nanophthalmic eyes/ sunken eyes in small orbit- cannot accommodate high bleb profile

    REFERENCES

    • Tarek M. Shaarawy, Mark B. Sherwood, Roger A. Hitchings and Jonathan G. Crowston, Editors, Glaucoma – Volume Two: Surgical Management Volume 2 (2009) ISBN 978-0-7020-2978-3
    • Monica Gandhi, Shibal Bhartiya, Glaucoma Drainage Devices: A Practical Illustrated Guide (2019)
    • New World Medical guidelines
    • American Academy of Ophthalmology – Glaucoma 2019-2020
    • Hong CH, Arosemena A, Zurakowski D, Ayyala RS. Glaucoma drainage devices: a systematic literature review and current controversies. Surv Ophthalmol. 2005 Jan-Feb;50(1):48-60. doi: 10.1016/j.survophthal.2004.10.006. PMID: 15621077
    • Patel, S., & Pasquale, L. R. (2010). Glaucoma Drainage Devices: A Review of the Past, Present, and Future. Seminars in Ophthalmology, 25(5–6), 265–270. https://doi.org/10.3109/08820538.2010.518840
    • Giovingo M. Complications of glaucoma drainage device surgery: a review. Semin Ophthalmol. 2014 Sep-Nov;29(5-6):397-402. doi: 10.3109/08820538.2014.959199. PMID: 25325865.
    • AGV Surgical videos:

     

    CONTACT US

    📞 Mr. Akash Vijay: +91-8884411557
    📞 Mr. Sai Akshay : +91-9980032461
     📧 conferences@narayananethralaya.com
    📍 Narayana Nethralaya, Bangalore