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    Glaucoma drainage devices: Location, location, location

    Proper tube placement can reduce major complications


    “If vitreous migrates toward the tube tip, a vitrectomy is needed to obtain the best results,” Dr. Fechter explained.

    He uses an anterior bevel when the tube is directed in front of the iris and a posterior bevel when the tube is behind the iris to avoid tube occlusion.

    “I like entering posterior to Schwalbe’s line to reduce corneal complications,” he commented. If the tube is too long or positioned too far anteriorly, the corneal endothelium can be damaged, which leads to bullous keratopathy with endothelial cell failure. When the tube is positioned posterior to Schwalbe’s line, the rate of endothelial cell loss will be less, he advised.

    Dr. Fechter also advised examining the anterior chamber angle for peripheral synechiae preoperatively to determine the best location to direct the tube. If there is a large iridectomy, the tube can be directed through it and placed more posteriorly, away from the endothelial cells. In pseudophakic patients, the tube can be positioned behind the iris.

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