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Glaucoma Implants

Fortunately, there are many different ways to treat glaucoma. There are a variety of eye drops to lower intraocular pressure (IOP) as well as laser surgery. If these methods alone fail, our doctors may suggest a glaucoma filtration and/or glaucoma implant procedure. You may also hear these implant procedures referred to as “aqueous shunts” or “glaucoma drainage devices”.

Filtration surgery

Trabeculectomy FlapA trabeculectomy provides an alternate pathway for the existing aqueous humor fluid within the eye to drain, bypassing the drainage channels of the trabecular meshwork thus lowering the IOP. A partial thickness flap in the sclera is created and a small opening is made called a sclerostomy. The aqueous fluid flows from the anterior chamber through the sclerostomy and under the flap. The flap is then covered by the outer skin layer of the eye, or conjunctiva. The resultant pooling of the fluid under the conjunctiva pushes up the thin, clear reservoir called a bleb. Fluid is collected in the bleb and is eventually absorbed. Medications used to control healing are important during the post-operative period to prevent scarring and to help prevent closure of the drainage site. Sutures are placed to control the amount of fluid that is filtered into the bleb. During the recovery process, your surgeon may elect to remove those sutures with a laser in order to increase the fluid that is filtered.

Ex-PRESS Mini Shunt

There are some situations when your surgeon may recommend using an Ex-PRESS Mini Shunt during your filtration procedure, or trabeculectomy. This tiny stainless steel device is placed in the sclerostomy and allows fluid to escape from the eye. Compared to a standard trabeculectomy procedure, the Ex-PRESS Shunt potentially allows for a more controlled fluid flow rate.

Glaucoma Implants

When Are Implants Used?

It is estimated that several thousand implants are used in the USA each year. Oftentimes implants are used on what eye surgeons consider the more complicated glaucoma cases, when they’ve exhausted the medication and traditional laser treatment options. Because implants have the ability to provide the most drastic decrease in intraocular pressure, these procedures are often recommended when other glaucoma treatments have been unsuccessful.

Types of Implants

Closeup of ShuntsThe Ahmed Glaucoma Shunt is a very common type of implant used during glaucoma surgery. It’s made up of a tiny silicone tube attached to a curved plate. The fluid will exit through the tube and drain to the plate, which is placed under the conjunctiva and behind the eyelid. It’s most often located under the top eyelid, and is not noticed by the naked eye unless the eyelid is flipped up. This unique device utilizes a valve within the shunt to control the amount of fluid released.

Another type of implant is the Baerveldt glaucoma shunt. The Baerveldt shunt offers lowered intraocular pressure when aqueous humor flows from inside the eye through the tube and into the reservoir or plate that rests on the white outer layer of the eye. This is placed out of sight, under the conjunctiva and under the upper eyelid. A suture is placed during surgery and once this dissolves or is removed approximately a month later, the tube will be open and begin to regulate the eye’s aqueous humor outflow.

Complications and Successes

Anytime surgery is performed there are risks involved. Some risks include infection, scarring, pressure becoming too high, pressure to low or vision loss. The decision of surgery is made after careful consideration of all the associated risks, benefits and alternatives.

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