Glaucoma drainage
devices are useful alternatives to standard filtering surgery or
cyclodestructive procedures in complicated glaucomas. However, postoperative complications are common. Thus creating some challenges for such
procedure especially in Asian setting that outcome of glaucoma surgery is known
to be poorer than the Caucasians.
Valved type device like Ahmed implant has postoperative valved-related
complications and less satisfactory IOP control.
A novel technique of
Sequential Drainage System (SDS) will be presented. The technique minimizes complications of a non-valved
double-plate Molteno device while offers better postoperative IOP control. The basic concept is a sequentially
opening of the drainage device to allow an increase in aqueous outflow at
different. In brief, the anterior
chamber tube is stent internally with Vicryl absorbable suture material, and
temporary ligated externally with black nylon. A preserved corneal graft is
used to cover the anterior tube. Laser suture lysis can be performed to enhance
drainage at postoperative period while Vicryl stent providing some intralumenal
resistance. The interconnecting
tube is ligated with another Vicryl suture that will be dissolved at 4-6 weeks
when some fibrosis has already developed over the second plate. Thus minimize
the risk of hypotony while benefit in further IOP reduction. The technique achieves successful IOP
reduction without hypotony.
Further details and results will be shown.
Another modification
by combining trabeculectomy with Molteno implant and adjunctive Mitomycin-C has
been found to be useful. The
technique and results will be shown and discussed.