Abstract
BackgroundGlaucoma drainage device (GDD) implantation in the anterior chamber are associated with corneal complications. We describe a novel technique to implant GDD tubes in the posterior chamber of pseudophakic eyes.MethodsTen patients with glaucoma who required GDD tube implantation were included.ResultsThe new technique begins with the passage of one of two straight needles existing at each end of a 10–0 Polypropylene suture through the GDD tube. A 23-gauge needle then is inserted at an angle 180° away and passed from the anterior to the posterior chamber and finally through the sclera. The two suture straight needles from the 10–0 Polypropylene suture are positioned in the lumen of the 23-gauge needle. The 23-gauge needle is then extracted from the eye by passing the 2 needles through the lumen. The suture remains inside the posterior chamber, and the tube is inserted into the posterior chamber by pulling on the suture from the other side. No intra-operative complications were found such as bleeding, vitreous tube placement, bent tubes, etc.ConclusionsThis surgical procedure to implant a tube into the posterior chamber of the pseudophakic eyes is uncomplicated and facilitates the insertion of the flexible tube into the posterior chamber. This eliminates the tendency of the tube to enter the vitreous as the tube is always placed in the posterior chamber away from the cornea.Trial registrationCurrent Controlled Trials ISRCTN14276553 (31th May, 2019) Retrospectively registered.
Highlights
Glaucoma drainage device (GDD) implantation in the anterior chamber are associated with corneal complications
Corneal edema can result from multiple factors, but one is mechanical endothelial damage from the tubes in the anterior chamber
We report an uncomplicated and straightforward procedure to implant a silicone tube in the posterior chamber in pseudophakic patients as an alternative to avoid tubal complications in the anterior chamber or vitreous
Summary
A conjunctival peritomy is performed in a quadrant and the GDD plate is sutured 8 to 10 mm from the limbus as in the standard GDD implantation procedure. We recommend injecting hyaluronate into the posterior chamber to enlarge the chamber to facilitate movement of a 23-gauge needle in the posterior chamber. The new surgical technique of GDD tube implantation begins first with shortening the tube to an appropriate length to facilitate visualization through the pupil. The length of the tube is calculated manually and is cut with scissors so that the bevel is - if possible- positioned somewhat laterally. One of the two needles at each end of a 9 or 10 Prolypropylene suture perforates the final part of the tube and is extracted, maintaining the suture through the tube. A clear corneal incision is made on the opposite side from the site of the tubal implantation, and a 23-gauge needle is introduced through
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