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    Glaucoma drainage devices: Location, location, location

    Proper tube placement can reduce major complications


    Hypotony, a flat anterior chamber, and serous choroidal effusions tend to occur together, he commented. “The postoperative hypotonous eye, with a flat anterior chamber and the tube pressing against the cornea, can be due to several reasons: perhaps because the 7-0 suture ligature was not tight enough, the fenestrations were too exuberant, the sclerotomy site was too large, or the creation of an inadvertent cyclodialysis cleft,” he said.

    He offered an example of a patient whose tube opened five weeks after surgery and whose pressure rapidly dropped from 40 mm Hg to single digits, leading to hypotony. “Serous choroidal effusions can develop and, without resolution, hypotony maculopathy may ensue,” Dr. Fechter said.

    In these eyes, he uses a viscoelastic device to raise IOP temporarily and deepen the shallow anterior chamber.

    Dr. Fechter raised the question about whether proper tube position can decrease the risk of complications, to include corneal endothelial compromise and tube erosion.

    He offered ways to improve the tube insertion technique promoted on both the AMO and the New World Medical websites, which demonstrate the tube being routed directly into the anterior chamber through a short scleral tunnel. Dr. Fechter believes that using a long scleral tunnel and directing the tube more superiorly greatly reduces the risk of tube exposure.

    His modified technique is demonstrated in three YouTube videos:

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