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    Glaucoma drainage devices: Location, location, location

    Proper tube placement can reduce major complications


    Top complications

    “These top five complications are all related to ideal tube placement. If the patch graft is removed from the equation, I believe these five complications are going to be important,” Dr. Fechter said.

    Modifying the tube position may be advantageous, he said. He likes to make a longer scleral tunnel and route the tube more superiorly than demonstrated on the manufacturer’s web site. The longer scleral tunnel may make the patch grafts unnecessary. He shared that Felix Gill Carrasco, MD, in Mexico City reported 10 years ago that he used this approach in hundreds of cases in which Ahmed devices were implanted without a patch graft and there was no increase in the rate of tube exposure.

    A complication that may occur more frequently when creating the long tunnel is postoperative mild hyphema. In contrast to directing the tube straight into the cornea at the limbus, this recommended approach goes more posteriorly and may nick the blood vessels supplying the iris root and ciliary body inadvertently.

    “More hyphemas can be expected postoperatively, but they tend to resolve spontaneously within several weeks with no extra medications,” he said.

    Another of the top five complications is tube blockage by iris or vitreous.

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