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    Glaucoma drainage devices: Location, location, location

    Proper tube placement can reduce major complications

    Take-home message: With glaucoma drainage devices gaining in popularity, the implantation technique must be tweaked to achieve the best results with the fewest complications.

     

    Augusta, GA—Glaucoma implants seem to be gaining in popularity among glaucoma surgeons over trabeculectomy because of the incidence of fewer complications, noted one physician. However, as with all medical devices, the implantation of glaucoma shunts—such as the Baerveldt Glaucoma Implant (Abbott Medical Optics Inc. [AMO]) and Ahmed Glaucoma Valve (New World Medical)—may have its fair share of complications and adverse events, explained Herbert P. Fechter III, MD.

    Despite this, however, he noted that the rates of implantations of the drainage devices have increased over the past decade, likely because of the outcomes of two major trials, the Tube vs. Trabeculectomy Study (Gedde et al., Am J Ophthalmol 2012;153:789-803) and the Ahmed versus Baerveldt Study (Christakis et al. Ophthalmology 2013:120: 2232-2240).

    Dr. Fechter, who is in private practice in Augusta, GA, pointed out that with adjustments in Medicare coding, i.e., bundling of aqueous shunt surgery with scleral reinforcement with a graft, glaucoma surgeons will be taking a closer look at their glaucoma surgery techniques and selectively not using patch grafts in the future.

    “I have experienced devastating complications such as phthisis bulbi and endophthalmitis and unfortunate complications such as suprachoroidal hemorrhages and retinal detachments. Uveitis can be particularly challenging for glaucoma surgeons because of excessive inflammation that leads to posterior synechiae, iris bombe, and seriously elevated or decreased IOPs,” he said. “In addition, diplopia can develop in about 5% of patients as the result of exuberant blebs, a thick Tenon’s capsule, or an improper plate position.”

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